Careful testing to detect community transmission will be crucial if we are to identify exactly when and where cases start to build up again, and determine in a timely fashion if action is needed to avoid straining our health systems. This is the only way we can move forward. It’s Business 101 – you can’t manage what you don’t measure. We also need to think carefully about the logistics of testing. There have been avoidable shortages of the kits needed to purify viral RNA, for example, and even the swabs used to collect samples. While developing new supply chains for these items, we need to aggressively pursue ways to test without these supplies – using different technologies that don’t depend on extracting RNA, or testing saliva that can be collected without tubes.
Second, we don’t just need to know who is currently infected, we need to know who was previously infected. This may help us determine who can go on working freely without fear of infecting others. However, we do not yet know how much protection a person receives from previous infection, and we do yet know for how long the protection might last. Studies are beginning that will allow this to become clearer in the coming months. If, as anticipated, recovery from COVID-19 confers some measure of protection, then those who have been sick and recovered might be pivotal to jump-start the economy and in keeping the economy going should additional waves of the epidemic necessitate future rounds of more intense physical distancing.
This type of testing is also key to refining epidemiological models, and leveraging herd immunity, because it will allow us to calculate how many people had mild or no symptoms, and to measure the true epidemic curve to date. There is currently great variability in the hundreds of serological antibody tests available, and it is essential that the tests be validated and standardized by the Food and Drug Administration (FDA) or Centers for Disease Control (CDC) before it can be clear whether positive tests indicate that the individual is likely to be resistant to the virus and a decision can be made to allow them to safely return to work.
