What we have now is often not testing — it’s testing theater.
Desperate to continue
the tradition of a family beach week, I hatched a plan that would allow some
mask- and sanitizer-enhanced semblance of normality.
We hadn’t seen my two
20-something children in months. They’d spent the lockdown in Brooklyn; one of
them most likely had the disease in late March, before testing was widely
available. My mother had died of COVID-19 in
May.
So a few weeks ago, I
rented a cute house on the Delaware shore. It had a screened-in front porch and
a little cottage out back, in case someone needed to quarantine.
I asked my son, who
had participated in several protests and had been at a small outdoor July
Fourth gathering, to get tested before he came. Testing had been recommended by
the governor and the mayor, and many centers were offering an anticipated
48-hour turnaround.
Coronavirus testing in the United States has been bungled in
every way imaginable.
He got one and
downloaded the app for results. And waited. And waited. And waited. For 12
days.
Coronavirus testing
in the United States has been bungled in every way imaginable. The latest
fiasco is perhaps the most Kafkaesque: Tests are now widely available in many
places, but results are often taking so long to come back that it is more or
less pointless to get tested.
If it takes up to two
weeks to get results, we can’t detect brewing outbreaks and respond with
targeted shutdowns. We can’t do meaningful contact tracing. We can’t expect
people to stay home from work or school for two weeks while they wait for the
result of a screen. We have no way to render early treatment and attention to
those who test positive, to try to prevent serious illness. It’s a disaster.
Many doctors can do a
rapid strep test in half an hour, and the “slow” test takes a day. Imagine if
it took 12 days before doctors knew whether to prescribe an antibiotic. You’d
end up with more cases of meningitis, pneumonia and rheumatic fever. Strep
could spread through families and schools like wildfire.
One canon of medical
practice is that you order a test only if you can act on the result. And with a
turnaround time of a week or two, you cannot. What we have now is often not
testing — it’s testing theater.
For months the hue
and cry was about testing not being more widely available. Even many sick
people couldn’t get one. The first tests proved faulty. Then good ones were not
distributed to the hot spots. Then there were not enough swabs, personal
protective equipment or ingredients like reagents needed to administer the
tests.
After all these
missteps, the political pressure to provide widespread free testing was
enormous. And with little help from the White House, many states turned
somersaults and delivered. Voilà!
But there was far
less pressure to make sure that labs receiving the swabs had the capacity to
process all those collected specimens.
Now, in cities like
New York and Washington and Los Angeles, there are dozens if not hundreds of
clinics where anyone who wants a test can walk in and get the famous stick up
your nose or some variant. Though the simple tests are by law “free” to
patients, the clinics bill insurers (or the government) hefty fees — sometimes
hundreds of dollars — for administering them. This gives clinics the incentive
to throw open the doors and do as many tests as possible.
Some hospitals,
clinics and cities that run the specimens themselves or outsource to an array
of different labs can deliver results in a timely fashion. State labs in Texas,
which is experiencing a major outbreak, say their
turnaround time is two to three days. But many results take far
longer.
LabCorp and Quest,
the two biggest commercial labs, have both acknowledged sometimes
long delays in processing the vastly increased volume of tests. Governors are
furious. Gov. Jared Polis of Colorado said that the nine days it sometimes took
to get a result from these companies rendered them “almost
useless.”
A coronavirus test is
not really a test if the result is too late to act on. So labs need to ramp up
capacity, as they’ve vowed to do. More important, all those centers offering
free testing need to take responsibility for delivering results within 48 or,
maybe, 72 hours. That means contracting with labs that can guarantee
turnaround.
“Anyone who wants a
test can get one” is a nice-sounding political promise, but it’s not helping
anyone. Sick people need to know if they’re sick with the coronavirus. Those
who have been seriously exposed need to know if they got it. And others will
need tests to be cleared for work, school or a family visit with vulnerable
relatives.
This is how the
coronavirus played out in my family’s vacation: While my son arrived on
schedule, his test results did not. So he was consigned to the quarantine
cottage. He wore a mask in the house and the car. We ate outdoors and he sat at
the far end of a picnic table. We even squirted the ketchup on his burger for
him, so that he wouldn’t have to touch the bottle. Each morning we checked the
app, hoping for deliverance. It never came.
Finally, 12 days
after my son’s last potential exposure at the Independence Day picnic, I agreed
he could take off the mask. He had no symptoms and at that point he was most
likely no longer contagious, either way. We hugged and enjoyed our last two
days of vacation. Then he returned to New York.
The next morning, I
got his text: “Test came back negative!”
Kaiser Health News (KHN)
is a national health policy news service. It is an editorially independent
program of the Henry J. Kaiser
Family Foundation which is not affiliated with Kaiser
Permanente.
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