‘It’s Kitchen Sink Time’: Fast, Less-Accurate Coronavirus Tests May Be Good Enough
For months, the call for coronavirus testing has been led by one resounding refrain: To keep outbreaks under control, doctors and researchers need to deploy the most accurate tests available — ones reliable enough to root out as many infections as possible, even in the absence of symptoms.
That’s long been the dogma of infectious disease diagnostics, experts say, since it helps ensure that cases won’t be missed. During this pandemic, that has meant relying heavily on PCR testing, an extremely accurate but time- and labor-intensive method that requires samples to be processed at laboratories.
But as the virus continues its rampage across the country and tests remain in short supply in many regions, researchers and public health experts have grown increasingly vocal about revising this long-held credo. The best chance to rein in the sprawling outbreaks in the United States now, experts say, requires widespread adoption of less accurate tests, as long as they’re administered quickly and often enough.
“Even if you miss somebody on Day 1,” said Omai Garner, director of clinical microbiology in the U.C.L.A. Health System. “If you test them repeatedly, the argument is, you’ll catch them the next time around.”
This quantity-over-quality strategy has its downsides, and is contingent on an enormous supply of testing kits. But many experts believe more rapid, frequent testing would identify those who need immediate medical care — and perhaps even pinpoint those at greatest risk of spreading the disease.
Such a considerable shift would likely be a welcome change for a country where the status quo of testing was just described as “unacceptable, period” by Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, in an interview Wednesday on CNN.
“If you had asked me this a couple months ago, I would have said we just need to be doing the PCR tests,” said Susan Butler-Wu, a clinical microbiologist at the University of Southern California. “But we are so far gone in this country. It is a catastrophe. It’s kitchen sink time, even if the tests are imperfect.”
Of the dozens of coronavirus tests that have been granted emergency use authorization by the Food and Drug Administration, most rely on complex laboratory procedures, like PCR, to detect the coronavirus’s genetic material.
Only a handful are quick and simple enough to be run in what is called a point-of-care setting, like a doctor’s office or urgent care clinic, without the need for lab equipment. And these tests are still relatively scarce nationwide. Government officials have pledged to astronomically scale up the number of point-of-care tests by fall, increasing by millions the weekly tally of tests conducted.
But many of the rapid tests at the center of this buzz still rely on specialized machines that are neither cheap nor easy to produce in bulk. And while some rapid tests, like the Abbott ID Now, were quickly adopted into the White House, most are unlikely to get much play in the larger community.
“We can’t have these in every household,” said Michael Mina, an epidemiologist at Harvard University’s School of Public Health and a
Frequently Asked Questions
Updated August 6, 2020
Why are bars linked to outbreaks?
- Think about a bar. Alcohol is flowing. It can be loud, but it’s definitely intimate, and you often need to lean in close to hear your friend. And strangers have way, way fewer reservations about coming up to people in a bar. That’s sort of the point of a bar. Feeling good and close to strangers. It’s no surprise, then, that bars have been linked to outbreaks in several states. Louisiana health officials have tied at least 100 coronavirus cases to bars in the Tigerland nightlife district in Baton Rouge. Minnesota has traced 328 recent cases to bars across the state. In Idaho, health officials shut down bars in Ada County after reporting clusters of infections among young adults who had visited several bars in downtown Boise. Governors in California, Texas and Arizona, where coronavirus cases are soaring, have ordered hundreds of newly reopened bars to shut down. Less than two weeks after Colorado’s bars reopened at limited capacity, Gov. Jared Polis ordered them to close.
I have antibodies. Am I now immune?
- As of right now, that seems likely, for at least several months. There have been frightening accounts of people suffering what seems to be a second bout of Covid-19. But experts say these patients may have a drawn-out course of infection, with the virus taking a slow toll weeks to months after initial exposure. People infected with the coronavirus typically produce immune molecules called antibodies, which are protective proteins made in response to an infection. These antibodies may last in the body only two to three months, which may seem worrisome, but that’s perfectly normal after an acute infection subsides, said Dr. Michael Mina, an immunologist at Harvard University. It may be possible to get the coronavirus again, but it’s highly unlikely that it would be possible in a short window of time from initial infection or make people sicker the second time.
I’m a small-business owner. Can I get relief?
- The stimulus bills enacted in March offer help for the millions of American small businesses. Those eligible for aid are businesses and nonprofit organizations with fewer than 500 workers, including sole proprietorships, independent contractors and freelancers. Some larger companies in some industries are also eligible. The help being offered, which is being managed by the Small Business Administration, includes the Paycheck Protection Program and the Economic Injury Disaster Loan program. But lots of folks have not yet seen payouts. Even those who have received help are confused: The rules are draconian, and some are stuck sitting on money they don’t know how to use. Many small-business owners are getting less than they expected or not hearing anything at all.
What are my rights if I am worried about going back to work?
- Employers have to provide a safe workplace with policies that protect everyone equally. And if one of your co-workers tests positive for the coronavirus, the C.D.C. has said that employers should tell their employees — without giving you the sick employee’s name — that they may have been exposed to the virus.
What is school going to look like in September?
- It is unlikely that many schools will return to a normal schedule this fall, requiring the grind of online learning, makeshift child care and stunted workdays to continue. California’s two largest public school districts — Los Angeles and San Diego — said on July 13, that instruction will be remote-only in the fall, citing concerns that surging coronavirus infections in their areas pose too dire a risk for students and teachers. Together, the two districts enroll some 825,000 students. They are the largest in the country so far to abandon plans for even a partial physical return to classrooms when they reopen in August. For other districts, the solution won’t be an all-or-nothing approach. Many systems, including the nation’s largest, New York City, are devising hybrid plans that involve spending some days in classrooms and other days online. There’s no national policy on this yet, so check with your municipal school system regularly to see what is happening in your community.