March 5, 2021 – A recent decrease in the number of Americans seeking to test for COVID-19 has experts on alert. Accurate and timely testing remains essential to treat and isolate people infected with COVID-19, they stress. Widespread testing also helps track the spread of the virus and any variants of concern as they arise.
“Even though it looks like things may be slowing down a bit with this pandemic, it is still very important to get tested,” especially for people who have symptoms compatible with COVID-19, said Romney M. Humphries, PhD. at a press conference hosted by the Infectious Diseases Society of America (IDSA) on Thursday.
“If we don’t test, we don’t know how much infection there is,” Humphries added.
Although the infection rates are much lower than a few months ago, “they’re still high,” Mary K Hayden, MD, told the briefing.
Rates remain higher in some areas than they were in the summer of 2020, said Hayden, an IDSA scholar, head of the infectious disease division and director of the clinical microbiology division at Rush. University Medical Center of Chicago.
“So we’re still seeing a fair amount of infection,” Hayden said. “I don’t think we’re yet in a place where we can really relax our overall strategies and cut back on testing.”
Testing a back seat for vaccination?
While getting more Americans vaccinated is good news, COVID-19 vaccinations could distract attention and limit resources from COVID-19 testing. “While the public may view vaccination as a priority right now, and it is a priority, widespread testing is still essential for infection control,” said Humphries, IDSA member and laboratory medical director. of Clinical Microbiology at Vanderbilt University Medical Center in Nashville.
Vaccination is replacing testing in some public health jurisdictions and is partly responsible for the recent decline in the number of tests. “Public health authorities may not have the bandwidth to do large-scale testing and to do vaccinations, so they are currently focusing on vaccination,” said Hayden.
In addition, fatigue among Americans who have faced a pandemic for more than a year could deter some people from getting tested. “I think a lot of people are just done with the pandemic,” Hayden said.
Initially, many people who were asymptomatic or with mild symptoms sought screening for their peace of mind. While it’s anecdotal, “it seems like now we’re seeing less of this,” Hayden said.
Why testing remains essential
With the number of tests going down, “are we really seeing a reduction in cases?” Humphries asked.
The tests will help public health officials track variants of interest and variants of concern, as well as assess vaccination success and protection against previous infection, she added.
The message remains that people with symptoms compatible with COVID-19 should get tested. At the individual level, accurate and timely diagnosis can promote appropriate treatment and help protect close contacts.
At a societal level, testing is the most accurate way to determine how much coronavirus is circulating in a given community, adjust quarantine requirements, and allocate resources to areas with an outbreak.
Also, said Hayden, someone who tests positive could be part of an important chain of transmission. In this case, officials in the public health department can initiate contact tracing to curb transmission.
“Beyond diagnosis, testing is an important tool in helping us recruit people into therapeutic clinical trials,” Humphries said.
A continued focus on COVID-19 could also help answer the remaining questions: How many people previously infected with COVID-19 subsequently test positive? And if so, is the new infection the same or a variant?
Home testing: convenience with caveats
A number of home tests for coronavirus infection available under the FDA’s emergency use authorization could help increase the number of tests. A variety of testing methods available will help “really do a lot of testing,” Hayden said.
Although some data suggests that point-of-care testing is “not as sensitive as some of the lab tests we can do, but again there may be other benefits that outweigh these “, she added. Greater convenience and testing from people who otherwise might not be able to make it to a public testing site are examples of this.
Unlike federal and state testing sites that regularly report positive test numbers, some home tests report results through a smartphone app, while others do not. As a result, some positive cases detected at home may not be counted, a concern that may increase with the increasing use of home testing.
“We want to be able to process the results of this test,” said Hayden. Linking home test results to a health care provider could aid counseling people based on their results.
Home testing could also prevent genomic sequencing of samples to detect and track virus variants. Commercial and state labs often have enough sample after testing to further test the variants of interest.
“The reality is that it’s pretty unlikely to get these samples from people who have tested positive at home,” Humphries said.
On the bright side, Hayden pointed out that while sample sequencing for the variants remains important, each sample does not need to be sequenced to keep up with the spread of the new variants.
The cost of convenience?
Reimbursable fees of $ 25 or more for home tests could be a barrier for some people, experts agreed. “I think the price point is a challenge. In reality, getting that price point down to a very low level will be a tough challenge,” Humphries said.
“The populations most affected by COVID-19 are those who would be least able to afford this type of price from the point of view of home testing,” she added.
Even though the COVID-19 test was more widespread and accessible, Humphries said other concerns remained. “One of the challenges we face is that there has been a lot of movement away from some of the really important control strategies that have been used to mitigate this pandemic.” Areas that open up public spaces to their full capacity or eliminate mask mandates, for example, “create a feeling, I think, for the public that the pandemic is over.
“And that is by no means true,” she added.