Question: Doesn’t it seem like cheap, rapid testing is the best approach to getting kids back to school, and people back to offices and public events? It doesn’t have to be perfect, just good enough to identify most positive cases.
Answer: I agree that cheap, rapid testing is a key component of pandemic response, including for helping us return to work and school. As an intervention, however, it’s not sufficient. Rapid testing must be used alongside other public health measures, including masking and distancing, and in the case of school, podding. Last week, JAMA published an overview of the benefits and limitations of rapid testing, The Challenges of Expanding Rapid Tests to Curb COVID-19, which nicely lays out the pros and cons.
Pros include:
-Quick turn-around;
-Inexpensive (the aim is to have DIY tests for ~$1/test); and
-Identification of far more cases, especially those who are pre-symptomatic and asymptomatic.
Cons include:
-No DIY option yet (still need a health provider to give you the nasal swab and read results);
-Risk of false negative (discussed most recently in Q&A of 10/22 #Testing; additionally, most currently available rapid tests have not been evaluated specifically for performance in children or people who do not have symptoms);
-Potential for over-reliance on testing (for example, see CDC’s latest MMWR, “Outbreak at an Overnight Summer School Retreat” where testing was used to admit summer campers, no other public health measures were followed, and a huge outbreak occurred); and
-Human behavior is difficult to change (will people regularly self-test? correctly self-report?).
Johns Hopkins Center for Health Security and Duke-Margolis Center for Health Policy issued a report earlier this month, “Risk assessment and testing protocols for reducing SARS-Cov-2 transmission in schools,” which offers helpful guidance to schools based on different levels of community transmission and risk. As stated in the JAMA overview, “To assess the approach described in the report, The Rockefeller Foundation signed a memorandum of understanding with HHS, which is sending at least 120 000 Abbott BinaxNOW tests to 5 pilot areas: Louisville, Kentucky; Los Angeles; New Orleans; Tulsa, Oklahoma; and Rhode Island.” It will be fascinating to learn the results of these pilot tests to understand how rapid testing can help schools open and remain open.