In March 2020, the World Health Organization gave the solution to reducing the impacts of the pandemic in the short term: tests, tests — and more tests.
Universities have taken this to heart. Many large state universities have set up testing labs to be able to conduct surveillance testing on campus. N.C. State has joined other institutions in this including Georgia Tech, Penn State, Purdue University, and many more. Recent “gateway” testing on the campuses of Georgia Tech and N.C. State identified about 400 cases on each campus, many of whom were asymptomatic at the time of the test. The individuals testing positive were quarantined from others, and next week surveillance testing will be done again. In Fall 2020, Duke University showed that the risk of spread on campus could be much less than in the surrounding community with extensive testing.
What has happened to being tested in America? We seem to have forgotten that it is one of the best tools that we have to get the pandemic back under control. Nationwide, the number of tests performed have had a declining trend over the past two months. This is troubling, especially given that the percentage of tests with positive results has been more than 10 percent. This is well over the 5 percent threshold that is sometimes mentioned as a guideline by the WHO and others mention for countries to reopen. When the positivity is high, it means that there is a lot of virus circulating in the community, or that the number of tests is low, or both. When surveillance testing is performed on asymptomatic individuals, the value should be even lower: For example, a college campus may be under control if positive tests are less than 0.5 percent of the tests completed.
We have spent months building our testing capacity, in both commercial labs and in college campuses like my own. In the chaos of vaccine distribution, we seem to have lost focus on this trusted strategy. It is more important now than ever before, as we are still reeling from the effects of social gatherings over the holidays. Further, the risk of viral mutations is greater with more virus circulating, so widespread testing could help get transmission under control to reduce the number and speed of mutations.
Who should get tested? Everyone. Let’s start with employers, who should ask employees to get tested and make sure they have the flexibility to quarantine at home if they test positive. This is especially true for employees who have contact with the public, are at risk of exposure due to their work environment or have health conditions that put them at higher risk. Households should get tested if they have social interactions with individuals outside of their immediate household. Many K-12 schools (especially the private ones) have realized that frequent testing allows them to gather in person. Basically, anyone who is at risk of acquiring the Sars-CoV-2 virus that causes COVID-19 should get tested.
How often should someone get tested? It depends on the acceptable risk level. Computational models that we ran of college campuses showed that weekly testing of 50-80 percent of the population with RT-PCR tests (or 75 percent or more with antigen tests) would be the minimum needed to keep the virus from exploding on campus. More frequent testing (or more people) would be needed if there are super spreading events or if some people consistently avoided testing. This is consistent with what others have determined as well, even when there may be some other measures in place like distancing or mask-wearing. Our surveillance program settled on requiring students to be tested weekly. It is also consistent with policies that are being applied now at many nursing homes and prisons. Much depends on the risk, of the environment, of the individuals, and of the community.
Other countries have had great success using tests to identify asymptomatic infections. China tested almost 10 million people in one city over a 19-day time period. The testing identified 300 people, all of whom were asymptomatic at the time. Can you imagine what would happen to disease spread in New York City or Los Angeles if the United States tested every individual over a short period of time? I can tell you what wouldn’t happen — the hospitals would not be overrun with COVID-19 patients, and families would not lose as many loved ones.
Testing is much more widely available now than it was in the spring and summer. When we had our household tested, I found locations provided by my county’s health department. It took less than 10 minutes for us to go through the entire process, and we received our results within 12 hours. Nationwide, there are resources that have made sure that testing can be free, with searchable locations online.
Biden’s administration is working on a national testing plan, but it cannot come fast enough. State and local health departments have an obligation to promote testing of a large number of asymptomatic people as soon as possible. Employers, schools, community organizations and households should also take it upon themselves to encourage and support an increase in testing. If we test, test, test, we can buy us some more time to get our vaccine distribution process working more smoothly and make sure that the vaccines get distributed before the worst mutations take hold.
Julie L. Swann, Ph.D., a prominent member of INFORMS, is the A. Doug Allison Distinguished Professor and Department Head of the Fitts Department of Industrial and Systems Engineering at NC State and served as a Senior Science Advisor at the CDC during the H1N1 pandemic.
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