In late August, the Centers for Disease Control and Prevention (CDC) released new coronavirus testing guidance that sparked a wave of criticism from many public health experts. The updated guidance says you “do not necessarily need a test” if you don’t develop COVID-19 symptoms after spending at least 15 minutes in close contact with a person who has the virus. (Close contact means being within six feet of that person.) Instead, the CDC puts asymptomatic people who have had this kind of contact into a category it calls “considerations for who should get tested” while also saying that “not everybody needs to be tested.” The CDC notes that there are a couple of exceptions to this new guidance. People who are asymptomatic after this kind of extended close contact should still get tests if they are “vulnerable” (like older individuals) or their doctors recommend getting tested. Otherwise, the CDC says, it’s not necessary to get tested when you’re asymptomatic but have spent more than 15 minutes in close contact with someone who has COVID-19. This is a clear departure from the CDC’s past testing guidance, which has recommended testing for all close contacts of someone who has COVID-19, the New York Times reports.
After learning of this new guidance, “Many of us in the public health community were stumped and concerned,” Carolyn Cannuscio, Sc.D., an epidemiologist at the University of Pennsylvania, tells SELF. The CDC’s recommendation “goes against what we’ve thought to be the best in public health practice since the beginning,” Stephen Kissler, Ph.D., a researcher who studies infectious diseases at Harvard T.H. Chan School of Public Health, tells SELF.
The CDC later “clarified” its position to say “testing may be considered” in these cases. But many public health experts say this still isn’t a strong enough stance on the need for a robust testing plan in this country. It’s especially key for U.S. public health agencies to be clear about the importance of expansive testing in light of President Trump’s inaccurate claims that “if we didn’t do testing, we would have no cases,” a strategy experts say would backfire with disastrous consequences.
As we open back up while living with this virus, we actually need more testing than ever—of both asymptomatic and symptomatic people—not less. We need cheap, fast, and reliable tests “that can transition us from very strict diagnostic testing to solutions that we can use for screening and surveillance going forward,” Anne Wyllie, Ph.D., an epidemiologist at Yale, tells SELF. Without this level of testing, the hope of getting a real handle on COVID-19 in the United States may be a pipe dream.
We can’t control this pandemic without extensive testing, including of asymptomatic people.
The point of testing is to identify people who have COVID-19, even without symptoms, so they can isolate themselves from others as quickly as possible to avoid spreading the disease, says Cannuscio.
People who develop COVID-19 symptoms typically first start feeling sick within five to six days after catching the virus, the World Health Organization says, although it can take up to 14 days for symptoms to appear. But, crucially, it’s possible to spread the disease before symptoms show up (this is known as presymptomatic spread), and some people with the infection never develop symptoms at all (also called asymptomatic spread).
Estimates vary for just how common it is to spread COVID-19 without symptoms, but some reports have found that around half of people who test positive don’t have signs of the illness, as SELF previously reported. Quick, reliable, accessible testing increases the odds of identifying people with asymptomatic cases before they can spread COVID-19 to others. “In order to control this particular disease, we absolutely need to do asymptomatic testing,” says Cannuscio.
Frequent and extensive testing also makes it easier to do contact tracing to reduce transmission. South Korea, for example, initially halted its COVID-19 outbreak without lockdowns thanks in part to a streamlined, accessible testing and contact tracing system. “That’s the model we need here in the U.S.,” says Cannuscio. Quick, ubiquitous testing is “key to opening things back up because then we don’t have to rely on widespread lockdowns,” says Kissler.
There’s plenty of evidence that more vigorous testing leads to better control over the coronavirus’s spread. As proof, look at U.S. testing and case numbers in relation to a few other countries. Doing a high number of tests per confirmed case indicates that a country has adequate testing, says Wyllie. At press time, the seven-day average of tests done per confirmed case in the U.S. was 17.2, compared to 128.0 in Germany, 120.7 in South Korea, and 1,607.5 in New Zealand, according to data pulled from Our World in Data. Unsurprisingly, these are all countries with a much better grasp on the coronavirus than the U.S., even as they grapple with resurgences. Here’s proof of that: A good metric of COVID-19’s overall impact is deaths per 100,000 people in any given country, says Kissler. As of September 14, the U.S. rate was 59.32 deaths per 100,000 people, according to Johns Hopkins, compared to 11.28 in Germany, 0.70 in South Korea, and 0.49 in New Zealand.
Testing volume varies a lot based on where you live, but only 23 U.S. states are meeting “recommended positivity levels” of 5% or fewer of all tests coming back positive, according to Johns Hopkins. “[With high positivity rates], you can be pretty sure that you’re missing a lot of cases and that you’re not catching them quickly enough to control the outbreak,” says Kissler.
This new guidance is only the latest example of how the U.S. has screwed up COVID-19 testing.
Coronavirus testing in the U.S. has been a mess from the start. Complex and changing test policies “led to confusion, not only among consumers but also professionals,” says Cannuscio. At one point, the CDC inflated testing numbers by combining viral and antibody COVID-19 tests in official counts. We’ve also had an ongoing lack of sufficient supplies and labs, which has led to continuing delays in test results, says Kissler. (In some cases, contaminated test kits contributed to delays.) “With some delay, we’ll continue to see a subset of people who will appear in our E.R.s…and who will die,” says Cannuscio.
Many other countries routinely return COVID-19 test results within a day or two. Some Americans reportedly wait weeks for their results, meanwhile potentially unwittingly infecting coworkers, family, and other people they encounter. “A negative person could get tested and then get exposed [and] become sick…in the time it takes to get the first negative test back,” Michael Mina, M.D., Ph.D., an assistant professor of epidemiology at Harvard T.H. Chan School of Public Health.
Some wealthy colleges and corporations have tried to fill testing gaps by offering students and employees regular tests, but “that’s likely to reinforce disparities in COVID-19,” says Cannuscio.
Luckily, the future of COVID-19 testing has some bright spots.
Imagine that for a couple of dollars you could test yourself at home before heading to the office or hopping on a plane. That’s where experts hope we’re headed. Current tests require trained personnel and expensive instruments. “We need a new paradigm in testing: cheap, daily, rapid tests used by most people in areas where outbreaks are occurring,” says Dr. Mina. “If 50% of people choose to use this test every three days…we estimate it could contain and suppress outbreaks in weeks.”
In August, the U.S. Food and Drug Administration granted the pharmaceutical company Abbott emergency use authorization for a $5 coronavirus antigen test that delivers results in 15 minutes without specialized equipment. The authorization only allows for testing in symptomatic people and requires going to a doctor’s office, so it doesn’t provide the frequent surveillance screening experts ultimately want. Still, it’s “a big step in the right direction,” says Kissler.
In the meantime, outbreaks continue even in countries like South Korea that initially controlled the virus. “The virus is elusive, and we’ll see continued flare-ups across the world,” says Cannuscio. Even if a vaccine is approved soon, it may not be as effective as hoped, it will take time to distribute, and some Americans won’t get it. With that in mind, Wyllie predicts we’ll have to heavily rely on testing to stop the spread of COVID-19 for at least another year. “We need to behave like there is a war going on, and congregating without masks and without tests puts a target on your back,” says Dr. Mina.
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