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Why COVID-19 testing probably won’t improve your health

Why COVID-19 testing probably won’t improve your health

(Photo by Josh Edelson/AFP)
(Photo by Josh Edelson/AFP)

In the midst of this unprecedented public health crisis, many people may be wondering whether they should be tested for COVID-19. Hospitals and doctors’ offices around the nation — including ours — are already being inundated with calls from patients requesting tests. One of us has left his primary care practice to work full time evaluating high-risk patients for COVID-19. Some patients who want tests have typical cold or flu symptoms, others fear they were exposed to someone with the virus, while many don’t have any symptoms or exposure but are simply worried. 

Public health experts, politicians, and journalists alike have called for more widespread COVID-19 testing, pointing to countries like South Korea where tests are almost universally available. The U.S. government recently announced sweeping expansions of coronavirus testing, including the approval of new commercial test kits and opening of drive-through testing facilities. With tests becoming increasingly available each day, should we all seek to get tested?

Making sure we have enough capacity to test for COVID-19 certainly has an important role in tracking the disease and ensuring that we provide the best possible treatment to hospitalized patients. Those with mild symptoms who do test positive can take the necessary steps of self-quarantine to prevent spreading the disease. Eventually, newly approved rapid antibody tests could help identify recovered health workers who can safely treat patients again, along with newly immune individuals who can go back to work. 

But for most of us, testing doesn’t actually offer any benefits for treatment. In fact, getting COVID-19 testing if you only have mild symptoms or are simply worried could actually be more harmful than helpful. 

In the nation’s most heavily affected areas, public health officials are shifting their approach towards COVID-19 testing. Doctors in New York City and Los Angeles have restricted testing to only the severely ill who need hospitalization and health care workers. Dr. Anthony S. Fauci, the government’s top infectious disease physician, urged Americans: “Not every single person in the U.S. needs to get tested.” Here’s why this shift in approach makes sense:

1. Unless you are severely ill, testing for COVID-19 does not change your treatment. Healthy people with mild symptoms will get the same advice as those who get the flu: stay home, stay hydrated, and take Tylenol. If you feel sick, prevent spreading your infection to others through self-quarantine for 14 days. Regardless of whether or not you may have a positive diagnosis of COVID-19, we can all do our part by practicing responsible social distancing.

2. Going to get tested could put you at risk for catching or spreading COVID-19. Patients are crowding waiting rooms to request testing, leading to a breakdown in social distancing that exposes more people to the spread of COVID-19. Even the test itself can spread infectious particles, as patients undergo the unpleasant process of having a nasopharyngeal swab stuck up their nose and often end up coughing or gagging.

3. Current tests can still miss infections. A recent study found that nasal swab testing in China missed 37% of COVID-19 cases, while throat swabs missed up to 68%. In the U.S., there are multiple different tests with varying degrees of accuracy, and the number of patients who test negative but actually have COVID-19 remains unknown. In the early stages of infection, it’s possible for your test to be falsely negative, which could lead to a false sense of confidence. A negative test does not change your risk of becoming infected, and everyone must continue to practice responsible health precautions.

4. In most regions of the U.S., COVID-19 is so widespread that testing is no longer helpful for containment. During the initial “containment” phase of an outbreak, testing is critical for finding isolated cases and tracking down contacts who may have been exposed. Done properly, like in South Korea and Singapore, early testing prevents an outbreak like COVID-19 from spiraling out of control. Unfortunately, our own efforts to ramp up testing have come far too late – we missed the opportunity to trace and contain COVID-19. Now that the coronavirus has become so widespread, social distancing, rather than testing, is the most effective strategy for fighting this pandemic. 

5. Unnecessary testing could overwhelm our health care system and deprive resources from critically ill patients. As we face one of the most severe flu seasons of this decade, hospitals are already operating at close to maximum capacity. With impending shortages of beds, masks, and ventilators, it may only be a matter of time before American doctors are forced to make the same extraordinary rationing decisions being made by their Italian colleagues.

Before you choose to get tested, be mindful of the huge amount of resources needed to test each patient: workers wear at least one set of personal protective equipment (PPE) that can take several minutes to safely put on and take off. Laboratory workers must also wear PPE to protect themselves when processing samples, while the tests require chemical reagents already short in supply. Furthermore, drive-through testing has been met with overwhelming demand, with reports of four-hour wait times and early closures across the nation. Some have even called drive-through tests “irresponsible and dangerous,” by encouraging unnecessary testing when PPE supplies continue to dwindle. Ultimately, every mildly symptomatic patient who foregoes testing can help preserve valuable resources for the growing number of critically ill patients.

As the United States ramps up its capacity to test for COVID-19, the increased availability of tests will be critical for epidemiologists in relatively unaffected communities and hospitals caring for vulnerable patients. For the majority of us who might feel mild symptoms, we can do our part by self-isolating, calling the doctor instead of rushing to the nearest testing center, and preserving our health system for those who need it the most.

The bottom line is this: There is no urgent need to ask your doctor for COVID-19 testing. Consider letting your doctor tell you if you truly need testing.

Kevin Tyan is a student at Harvard Medical School and the co-founder and chief scientific officer of Kinnos. Dr. Michael Hochman is an associate professor of clinical medicine and the director of the Gehr Center for Health Systems Science at the University of Southern California. Dr. Pieter Cohen is a practicing internist in Cambridge Health Alliance, Massachusetts and an associate professor of medicine at Harvard Medical School.

Comments

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You may be right: if you currently have flu-like symptoms or are worried about catching Covid, testing should not be your personal priority. But as Dr. Hochberg has pointed out, we urgently need a more targeted strategy for moving forward to contain this virus without dismantling the fabric of our entire society.

Another month of lockdown may be do-able, although at great social cost. But lockdowns can't last forever. Being able to quarantine people who test positive -- especially health-care, retail and personal service workers -- will be key to allowing the rest of the workforce to return to work (with reasonable precautions).

So will being able to distinguish between those who need close medical monitoring, and those who really can "ride it out at home." Our current strategy guarantees that we will not begin to treat Covid-19 patients until they are sick enough to need intensive care -- and that they will infect their families in the meantime.

The line that it is now "too late" to start widespread testing in the USA is ill-founded and dangerous for this reason. Its only use is to apologize for the catastrophic failures of our privatized, fragmented, profit-driven health care system. Please, do not join in the apologetics. We need widespread testing now. Without it -- as the WHO and all those pesky foreigners keep trying to tell us -- we are truly flying blind.

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With respect to Drs. Cohen and Hochman, your article focuses on the impact of testing at hospitals and medical facilities and not enough on the need for testing to understand more about the transmission vectors of this virus and how to keep it from infecting communities.

1) The testing scenario you point out in your second point is extreme and ignorant. Today, there should be NO ONE crowding a waiting room looking for tests. Everyone wanting or needing tests should be tested at a drive through or outdoor walk up scenario where testers have proper PPE and the tested person is also socially distanced and protected. The chance of coughing or gagging due to the test should be anticipated and mitigated. And these type of facilities can be easily set up in a community setting, especially to reach those at the most risk. You are fueling greater fear and concern by making this ridiculous scenario sound like it is the norm.

2) People crowding the waiting rooms need education and outreach to their communities - not to be spending time in waiting rooms.. If they don't have the digital/online/social media tools to follow what is going on with the pandemic, understand their local conditions, and (most importantly!) understand what they should be and should not be doing -- then it's time for our local officials to fix those problems. Your scenario probably applies more so to immigrant communities who may be more isolated due to language, cultural and economic barriers. Consequently they need more testing, not less -- and AGAIN more education and follow up by elected officials and public health outreach.

3) You are being held prisoner to two competing ideas that must coexist for our society to move forward, contain the virus and recover. We need to strengthen our practices around social distancing and cleanliness AND we need testing to find hot spots, see how the virus is spreading, and to help people quarantine/self isolate sooner and more effectively. If your hospitals are being overrun by test requests in Los Angeles and Cambridge (highly Democratic areas, I should add), you need to shut your doors to people wanting tests and direct them to the proper county run facilities. You don't need physicians and trained nurses conducting these tests, trained social workers are more than able to complete the process. Put the task of solving the testing problem back where it belongs - on the backs of elected politicians and community health policy makers.

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I have a question is having a covid test weekly harmful to you? And is really necessary?
Im a CNA and I'm dont think weekly is necessary.

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