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I hear many people expressing frustration with COVID testing requirements and timing. Given that one could contact COVID right after a test is done (which lets say comes back negative 2-3 days later) they feel as though testing is not a reliable indicator of risk unless it comes back positive. Many people feel as though symptom monitoring is more accurate. Can you speak to why officials still value negative test results as indicators of clearance for travel and return to campus, work, etc. given these understandings?
COVID-19 testing, just as for any test, can be a useful test based on a number of characteristics, such as accuracy (i.e., sensitivity and specificity), timeliness (both for the time for the test result to be made known and for the duration of time that the disease must be present for the test to be positive), availability (the lack of ease of availability is one of the major criticisms across the globe), and simplicity (i.e., simple point-of-care test which can be deployed with low technological requirements vs. a high-complexity test which can only be performed by specially-trained centralized laboratories). Yes, it is true that a COVID-19 test on one day, which comes back as negative, does not guarantee that risk is “low”; especially if the individual is continually engaging in high-risk activities (e.g., healthcare workers and first responders by occupation are continually at risk, especially if they fail to properly protect themselves with PPE). Unfortunately there is a lot of non-symptomatic and pre-symptomatic COVID-19 infection—the estimates range between 30-70% of infections have no symptoms--so symptom monitoring will miss a lot of infections and therefore there can be continued infections in the community which are not recognized. Therefore, COVID-19 testing for travel or return to campus/work is designed to detect both symptomatic and asymptomatic infections. The integrity of testing and allowing people with negative test results to travel or return to campus/work, which is performed at a snap-shot in time, relies on each individual not putting themselves at risk. Therefore, there must be universal masking, physical distancing, and personally responsible behaviors practices both on-campus and at-home for there to continue to be a “safe” environment for the campus, work-place, travel conditions, etc.
This question about testing and “reliable indicator of risk” is illustrated by many of the outbreaks which have been observed in professional sports teams. Across professional sports teams which have attempted to continue playing their competitive schedules, there has been the attempt to test all players frequently and to place them into protective “bubbles” where they were instructed not to venture beyond their assigned living and work conditions (hotels and sports arena). However a number of outbreaks have occurred despite these herculean efforts. Why? Players did not remain within the protected environment and covertly visited with each other and ventured out to bars and restaurants, had “guests”, etc. Each of these breaches in the “secure environment” presented opportunities for virus transmission and infection.
