The Rapid Test Epiphany
Public health has finally got the message
Welcome to Plugging the Gap (my email newsletter about Covid-19 and its economics). In case you don’t know me, I’m an economist and professor at the University of Toronto. I have written lots of books including, most recently, on Covid-19. You can follow me on Twitter (@joshgans) or subscribe to this email newsletter here. (I am also part of the CDL Rapid Screening Consortium. The views expressed here are my own and should not be taken as representing organisations I work for.)
Right now, to many, our Covid-19 experience seems surreal. It can feel like we are back at square one in March 2020 and facing a massive outbreak and over-run health systems. But it is not the same. In fact, to me, it feels surreal because at long last, after over 20 months of frustration as public health officials resisted rapid tests, it all seems to have flipped. Rapid test advocates such as myself have suddenly moved from fringe crazies who were told they didn’t understand the science to we need them and we need them now.
Several cases in point:
The CDC now says that unvaccinated students exposed to Covid can “test to stay.” That is, rather than sending all the students in a class (or a school!) home when one tests positive for Covid, they test the students instead and so long as they are negative, they stay.
The US Government is going to order 500 million rapid tests and distribute them free to the public … by mail!
It is hard to appreciate what a sea change this is in terms of attitude. A year ago, when we tried to roll out rapid tests — that had already been purchased and were sitting in their millions in warehouses in Canada — to Canadian workplaces, we were told that those tests had to be administered by health care professionals in PPE in secure and sanitised environments with all manner of precautions taken that really took the “rapid” out of rapid testing let alone exploding the costs to businesses who wanted to keep their workers safe. This was because they required those long-swabs etc. Eventually, short swabs were permitted. Then self-swabbing supervised in the workplace. Then swabbing at home while on a virtual call with a professional for that supervision with the swabs being picked up and then taken for safe disposal. Finally, we got to self-administered, at-home screening without supervision and you could pop your negative swan in the bin. A year after we had been told that you needed a full-court medical professional press to do this, our kids in Ontario were sent home with 5 rapid tests to use over the holidays. Only a couple of weeks ago, the Ontario government’s advisory board, the Ontario Science Table, finally endorsed the use of rapid tests in this way.
Given the resistance from the mainstream medical community that led Abbott to actually dispose of tests and reduce production capacity this summer, everything seems to have flipped.
Living with the Virus through Testing
Regular readers know that this newsletter is usually a downer bringing in bad news which makes the above discussion somewhat off-brand. Never fear. I can take the shine off of any positive development.
The new plans allow people to better know their Covid status and risk of passing on infections to others. This is great if you are about to meet in a large group or with vulnerable people. This is great if you have symptoms that may be Covid but may also be a cold or flu. The philosophy is that people need to manage their own risk and their own riskiness and for that, more information is better than less.
Here is what it is not: a way of really breaking transmission chains to prevent outbreaks nor a means of being able to wipe the virus out or at least make it safe to act normally. Both of those things are possible with testing. South Korea has long shown the way on this. But to do that requires a system. People need to be tested regularly or, in the alternative, the government has to have great surveillance and then ramp up regular testing in localities where outbreaks look like they are emerging. Those systems are largely absent in the West and it is tough to create them overnight.
But there is a way to do that at least for places you have control over — workplaces, facilities and schools. The CDL Rapid Screening Consortium developed that system. In Canada, anyone can sign up and get all of the tools they need to put it in place right now. It takes a little but not an impossible amount of upfront work and then you can get the information you need to monitor workplace risk and act accordingly. Our experience tells us that your people will thank you for it.
Even if you aren’t in Canada, the entire playbook of how to set up a system is online and available to all. It is based on months of experimentation and validation.
The point is, public health has come around but real pandemic management comes with a system. The good news is that system is available; all you need to supply are the tests.
The Omicron Issue
Regular readers may be thinking “well that isn’t the usual doom and gloom I’ve come to expect from Gans.” You are right. It has a little too much hope. Let me pull it down another notch.
Pandemic management is all about getting information so you can identify who is a risk and isolate them rather than just treat everyone as equally risky with all of the costs that involve. The problem we face with Omicron is that its spread is wickedly fast. This means that the cadence of rapid tests really matters. By the time someone tests positive with a rapid test, they may have already interacted with many others and spread the virus. It helps but timing is everything.
That means that testing will be more effective at stopping transmission when paired with other measures such as social distancing and masking. It is not the substitute for those things that we have previously hoped for but they are all complementary measures. In other words, testing doesn’t get us back to normal with Omicron. For the next few months, testing helps but cannot be relied on exclusively. Omicron is a variant that evolved to get around information issues as well as everything else.
So the message is, get your tests, use them wisely but still take care for the moment. I want tests to be the thing that helps us relax. Right now, they aren’t that. Perhaps with more vaccinated with boosters and then getting on the other end of Bad January, we can get there. The good news is that mainstream science is now on board with it all as a tool in our ongoing pandemic management. I’ll take that win.