Sorting Out the COVID-19 “Testing Mess”

COMMENTARY Public Health

Sorting Out the COVID-19 “Testing Mess”

Aug 28th, 2020 6 min read

Commentary By

Amy Anderson, DNP, RN

Visiting Fellow

Doug Badger

Visiting Fellow, Domestic Policy Studies

A medical assistant takes a swab sample from from a patient at the NEW Health COVID-19 testing site at the Bunker Hill Housing Development on August 11, 2020 in Charlestown, MA. MediaNews Group/Boston Herald via Getty Images

Key Takeaways

Reduced testing demand—not government policy or insufficient supply—is driving the decrease in testing (where that decrease is occurring).

The current rate of positive tests is the lowest since June and is moving in the right direction.

The U.S. needs a national consensus on testing metrics, defined criteria and accuracy and continuity in data reporting. Without it, the public can easily be misled.

The media has hit a drought of COVID-19 bad news.

The surge in cases that struck much of the South and Southwest has begun to subside. The seven-day moving average of new cases, while still around 50,000 on August 20, is down 30% from its late-July peak. Daily deaths are running about half the rate compiled in New York and other Northeastern states during April. Despite dire predictions, hospitals in Texas and Florida were not overrun with COVID-19 patients and there was no shortage of intensive care beds or ventilators.

Professional sports are back, and some conferences are gearing up for college football. People are enjoying the beaches, frequenting restaurants and otherwise going about their lives.

While the pandemic is by no means over, Americans seem to be finding ways to coexist with it. Most are careful to practice good hygiene, maintain social distancing, avoid indoor gatherings and wear masks—reducing (but not eliminating) the risk of another resurgence.

What’s a pessimist to do?

If you’re a reporter for Axios or for a niche publication called “Politico Pulse,” you announce that there’s a crisis in COVID-19 testing. “The U.S. is cutting back on testing,” Axios recently reported, while Politico Pulse proclaimed that a “testing mess” had hit Texas.

Neither claim is accurate. The chart that appears in the Axios article shows that more Americans were being tested in mid-August than in mid-July. The number of tests fell in several states over that time period, although that reduction did not result from a decision by  U.S. or state officials to “cut back on testing.”

People choose whether to access testing. Reduced testing demand—not government policy or insufficient supply—is driving the decrease in testing (where that decrease is occurring). In most places, testing is readily available.

Testing saturation may explain the reduction in some populations. Many who were concerned with illness early in the spring needed testing after summer travel, and those interested in determining whether they were asymptomatic have likely been tested. The initial influx of results from robust state testing programs for nursing homes, assisted living, prisons and mobile testing sites have—for the most part—been reported.

The public may be experiencing testing fatigue. The testing process in the initial wave was difficult, and reports of wait times during July may be deterring people from getting tested. It’s also possible the initial testing group won’t return unless they become symptomatic.

Ironically, the Axios post was occasioned by a bit of good news about testing—an announcement by the U.S. Department of Health and Human Services that 90 percent of test results are coming back within three days. The post rightly termed that “a big improvement from turnaround times that had been stretching well over a week.”

A test result that tells you that you didn’t have the coronavirus a week ago isn’t terribly helpful. A negative test result that comes back within 3 days is not only meaningful to you, but to your family and others with whom you may have had close contact.

Since the Axios post, there’s been more good news about testing. According to data collected by Johns Hopkins University, the seven-day moving average of positive test results had declined to 6.3% by August 20, down from an 8.5% rate that had persisted from mid-July through early August. While not ideal, the current rate of positive tests is the lowest since June and is moving in the right direction.

So—what about that “testing mess” in Texas?

A recent backlog in reporting resulted from a coding error in the state laboratory reporting system. Much of that backlog may already have been cleared out, as the state reported a total of more than 240,000 results on two recent days.

The backlog was attributable to the inherent challenges of real-time reporting. Despite these challenges, reporting data on the day the test was performed versus the day the results arrive will provide a clearer picture of the present situation.

So how should we think about data from testing, and what can public health officials do to present a more accurate understanding of the pandemic?

Data from testing alone—the number performed, the percent positive and the number of cases confirmed by positive tests—presents an incomplete picture of the state of the pandemic in a community. The public should also be kept updated on other metrics, such as the percentage of COVID-19-Like-Illness in the emergency room, the number of hospitalizations with COVID-19, percentage of in-patient beds occupied by COVID-19 patientsactive versus recovered cases, symptomatic versus asymptomatic cases, average age of active cases, death rates by age and underlying health conditions, and concentration of active infections based upon zip code, town or city.

Public health authorities have done an especially poor job of collecting and disseminating this data, distorting the public’s perception of the pandemic. The lack of continuity and challenges with real-time data reporting have been uneven and, in some cases, led to unwarranted and detrimental policy decisions.

The U.S. needs a national consensus on testing metrics, defined criteria and accuracy and continuity in data reporting.

Without it, the public can easily be misled—and the media’s “the sky is falling” message will prevail.

This piece originally appeared in the Daily Caller