Ask the Expert: COVID-19 testing
Debra Furr-Holden, associate dean for public health integration and C.S. Mott Endowed Professor of Public Health in the College of Human Medicine, answers questions about the different COVID-19 tests.
Q: We continue to hear that widespread testing is key to safely reopening states/communities. Why are states reopening without requiring mass public testing?
A: We do need community wide testing of asymptomatic people before we can effectively get a handle on exposure and do appropriate contact tracing. States are re-opening without this widespread testing because the governors are responding to people’s demand to reopen and states don’t have sufficient testing strategies and capacity to do regular, community-wide testing. In addition, testing sites are coming on and offline and the best sources of testing are at the local level and change at least weekly.
Q: Which test should I be getting?
A: There are two kinds of tests being used: the RNA versus antibody tests, and they have different uses. RNA testing, which tests to see if you have the actual virus, will help slow the spread and improve contact tracing. The antibody testing will tell us who has ever been exposed and is only useful once people start to show symptoms and then recover, which is when our bodies make antibodies. While states understand the difference, the community at large does not. Much more communication is needed.
Q: Even if mandatory widespread testing was required, do we have enough tests to accomplish it?
A: Right now the answer is "no." We do not have sufficient tests for the type of community-wide testing that would really help to slow the spread, but more testing sites, test kits and so on are becoming available.
Q: Are there enough tests for those who want to be tested?
A: Sadly, testing is being underutilized in many places and availability exceeds demand. This is largely due to mistrust, misinformation, poor communication on testing availability and restrictions on who is eligible for testing. These restrictions vary across and within states and include insurance barriers and transportation barriers. For example, you cannot walk to a drive-thru testing site. Further complicating the issue is that there were many “fake” tests which flooded the market and were circulated for use.
Q: Can I get tested if I don’t have the more common signs of coughing, fever, shortness of breath?
A: Who is eligible varies by testing site. Exclusion criteria are a big problem and people have been turned away for a variety of reasons, including some noted above. Those people tell others, so people are not going for testing who need to be tested and, when they do go, they are sometimes being turned away. When the virus first emerged, the main reported known symptoms were shortness of breath, cough and fever.
Since that time many more prevalent symptoms, like loss of taste and smell, body/muscle aches, diarrhea, confusion and COVID toes have emerged. Testing criteria has not caught up to the symptoms being experienced.
Q: Is there any way that tests could have been available more quickly?
A: The FDA approval requires a certain amount of vetting as it should. They have moved faster with COVID-19 than they would in a non-crisis situation. If they move too fast, and tests that don’t work or vaccines that make people sicker, for example, hit the market — they are liable. If they move too slow, more people get sick and or die. This is truly a tough situation, but it is best to not move too fast and cause unintended and avoidable harm.