More Vaccines, Fewer Tests: Why COVID-19 Testing Remains Important
As COVID-19 vaccination programs are expanding in scale across the United States, it is easy to neglect the fact that effective containment of the pandemic requires not only mass vaccination to establish herd immunity, but also timely testing to prevent the virus from being transmitted from person to person unchecked. However, the number of COVID-19 tests being conducted in the United States is plummeting at an alarming rate, towards which medical professionals and public health experts are expressing concern. In this update, we will walk you through why fewer Americans are getting tested, the importance of expanding the scale of testing despite mass vaccination, and how you can stay vigilant about getting tested when necessary, per the guidance below.
Introduction
According to data from the Covid Tracking Project, the average number of tests being delivered per day has dropped by around 33.6% percent since January. Despite the drastic decline in testing, the average of daily reported cases per 100,000 residents in the United States in the past week has increased by 13%, with many states seeing an increase of over 50%1. The 7-day average of percent positivity also saw an increase of 9.4%, meaning that a greater proportion of individuals who got tested for COVID-19 received positive results2. Since the turn of the new year, January was the deadliest month with an average of 3,100 patients dying from COVID-19 every day, and the United States death toll surpassed half a million on February 22, 20213. While the statistics show a general decline in confirmed cases and hospitalizations of COVID-19, they might be obscured by the fact that fewer tests were administered and therefore fewer infected individuals were identified. In addition, an increasing number of states are lifting their statewide mask mandates, which usually require mask-wearing in indoor public spaces and outdoors whenever 6-feet social distancing is not possible4. Such changes at the policy level can potentially increase the risk of interpersonal transmission in public spaces and result in the need for more testing.
Why are there fewer Americans getting tested?
There are several reasons why fewer Americans are getting tested for COVID-19. Firstly, in the United States, the pandemic appears to be improving overall with the total number of COVID-19 cases decreasing for the past 10 weeks5. In essence, fewer people have been experiencing COVID-19 symptoms which is usually the primary motivation for getting a test. Secondly, COVID-19 complacency rose as the infection death rates saw a slight decline, and several states’ decisions to ease the stringent COVID-19 restrictions contributed to the complacency. However, as warned by Dr. Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization (WHO), now is “not the time for any country to relax measures, or for any individual to let down their guard” as complacency is “as dangerous as the virus itself”6. Similarly, Dr. Anthony Fauci, Director of the U.S. National Institute of Allergy and Infectious Diseases, says that while vaccination rollouts are moving in the right direction, the nation might risk another surge of infections if premature victory is declared7. Thirdly, getting tested is time-consuming, especially for marginalized communities with limited testing centers and services. Fourthly, a positive test might have implications like quarantine and absence from school or work, which contributes to testing hesitation8.
Why should people continue to get tested?
As shown by statistics from public health surveillance, the pandemic is far from over. Despite gradual vaccine rollout and a slight decline in the number of cases in the past few weeks, the infection and mortality rates remain “unacceptably high”, according to Dr. Fauci9. To effectively lower these numbers, as pointed out by Dr. Ghebreyesus, testing combined with isolation is necessary to break the chains of transmission10. The emergence of SARS-CoV-2 variants in the United States, some of which are shown to have higher transmission rates and lower vaccine efficacy, has brought with it a new set of challenges to public health11. So far, over 5,500 variant cases have been identified in 51 jurisdictions in the United States12. Besides, schools and universities are gradually reopening throughout the country, while safety measures such as mask mandates are being lifted in more and more states. Many health experts have warned that letting our guards down too soon will give rise to new variants and resurgence of infections both in the United States and internationally. Further, if people do not maintain their vigilance during the spring, it is very likely that new waves of infection will compromise the containment efforts in the winter, as put by Dr. Fauci13. Testing remains the key tool to slow down the transmission and prevent COVID-19 from spreading unchecked.
What type of test should I get?
To detect current infection with SARS-CoV-2, the virus that causes COVID-19, you will need to get a viral test. Viral tests include, but are not limited to, antigen tests and nucleic acid amplification tests (NAATs)14. NAATs are known for their high sensitivity and high specificity. While most NAATs need to be processed in a laboratory-based setting and generate results in 1-3 days, some NAATs can deliver results in approximately 15-45 minutes. On the other hand, antigen tests are generally as specific as most NAATs but less sensitive, meaning that they might leave some current infections undetected. They can deliver point-of-care results in as quick as a few minutes and are usually used for screening a large number of potentially contagious patients15.
Another type of test is the antibody (or serology) test, which is used to detect past infection or examine antibody response after vaccination16. It is not recommended to diagnose current infection with antibody testing, since there might be a time lapse between initial infection and antibody response. Also, a positive antibody test does not indicate an individual’s immunity against COVID-19 reinfection.
When should I get tested?
The Centers for Disease Control (CDC) has issued official guidance on when to get tested, as illustrated below. If you test positive, it is important that you take the protective steps as advised by CDC. It should also be noted that a negative test result only indicates that you were probably not infected at the time of sample collection, and it is necessary to continue taking precautionary measures as outlined by the CDC.
Testing is necessary for people who have:
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Developed symptoms of COVID-19, regardless of past infection and vaccination status
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Had close contact (<6 feet for >15 min over 24 hours) with someone with confirmed COVID-19
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Taken part in high-risk activities where social distancing is not observed (e.g., travel, large gatherings, crowded or poorly-ventilated indoor settings)
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Been asked or referred to get tested by their healthcare provider, or state, tribal, local, or territorial health department
Testing is not necessary for people who have:
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Been fully vaccinated or tested positive for COVID-19 within the past 3 months and recovered, as long as they do not develop symptoms of COVID-19
It should be noted that immunocompromised individuals, including solid organ transplant recipients, might develop insufficient immunity against COVID-19 post-vaccination or post-infection. As mentioned in our previous COVID-19 update, while new study results indicate that transplant recipients can develop immunity after contracting COVID-1917, research has also shown that antibody responses in those individuals after the first dose of mRNA vaccines were poor compared to their immunocompetent counterparts18. Therefore, consultation with healthcare providers is recommended for immunocompromised individuals who might be at risk of COVID-19 infection even if they have been fully vaccinated or recovered from an infection in the past.
Back-to-work Testing Guideline
For employers
According to the latest guidance, the CDC advises that individuals without critical illnesses who meet ALL of the following three criteria can return to work19:
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At least 10 days have passed since the onset of COVID-19 symptoms or the initial positive test date.
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They have been fever-free for at least 24 hours without the use of fever-reducing medications (e.g., acetaminophen, ibuprofen).
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All other symptoms continue to improve.
With that being said, the CDC no longer recommends requiring negative test results before returning to work if the employee has completed the isolation period. This updated advisory is based on several considerations, including allowing workers to get back to work sooner and the fact that individuals may continue to test positive for COVID-19 after the isolation period despite not being infectious. However, business owners are advised to closely follow changes in CDC and state guidelines.
More situational workplace and business-specific Frequently Asked Questions about suspected or confirmed COVID-19 cases and risk reduction in the workplace can be found here.
For employees
Employees should be aware that employers may have different testing requirements and some might require asymptomatic testing for all employees. If they have been facing challenges returning to work, they may wish to consult their human resources offices or unions about testing policies.
How can I get tested?
To find information about getting tested, you need to reach out to your healthcare provider or visit your state, tribal, local, and territorial health department’s website20. You might be able to get tested at home with an at-home collection kit or an at-home test by prescription or over the counter in a local pharmacy or retail store without a prescription21. Online food ordering service Doordash has started offering polymerase chain reaction (PCR) test kits, which can yield results within 24 to 48 hours with a nasal swab or a saliva sample22.
Should I still get tested if I have been vaccinated?
Based on the current guidance issued by the CDC, unvaccinated individuals who have tested negative are required to continue to quarantine for two weeks or for the period advised by local authorities after exposure to someone with suspected or confirmed COVID-19. Fully vaccinated individuals who have been exposed but do not show COVID-like symptoms are exempt from quarantine and testing due to their low risk for infection23, as suggested in the Interim Public Health Recommendations for Fully Vaccinated People. However, as discussed above and in our previous update, a recent study conducted by the Johns Hopkins University has shown that transplant recipients develop poor antibody responses after their first dose of mRNA vaccines and may need post-vaccination antibody tests as a precautionary measure24. Therefore, fully vaccinated transplant recipients should continue to carefully follow the self-protection measures recommended by the CDC and receive further testing as advised by healthcare professionals.
Final Words
It has been one year since the WHO described COVID-19 as a pandemic in March 2020. However, with vaccine inequity issues and recent supply chain disruptions, the end of the pandemic is not yet in sight. While it is natural to feel tired of living with the “new normal”, pandemic fatigue and complacency remain the biggest threats to our ongoing battle against COVID-19. Building a robust testing system is still essential to tracking transmissions in communities and informing individuals’ actions25. Seeing vaccination underway and trends in statistics showing hope, it is the exact time for us to remain vigilant and get tested whenever necessary.
Sources
(1) Joe Fox, B. (2020, June 26). U.S. coronavirus cases: Tracking deaths, confirmed cases by state. Retrieved March 31, 2021, from https://www.washingtonpost.com/graphics/2020/national/coronavirus-us-cases-deaths/
(2) “COVID Data Tracker Weekly Review.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html
(3) America's half a million Covid deaths a stark reminder of challenges for Biden. (2021, February 22). Retrieved March 19, 2021, from https://www.theguardian.com/us-news/2021/feb/22/coronavirus-america-half-a-million-deaths-biden
(4) Markowitz, A. (n.d.). Does Your State Have a Mask Mandate Due to Coronavirus? Retrieved from https://www.aarp.org/health/healthy-living/info-2020/states-mask-mandates-coronavirus.html#:~:text=To%20date%2C%20six%20states%20that,for%20her%20state's%20mask%20order
(5) COVID data Tracker Weekly review. (n.d.). Retrieved March 31, 2021, from https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html
(6) Lisa Schnirring | News Editor | CIDRAP News | Feb 12, 2. (2021, February 12). As global COVID-19 cases fall, WHO warns of complacency. Retrieved March 22, 2021, from https://www.cidrap.umn.edu/news-perspective/2021/02/global-covid-19-cases-fall-who-warns-complacency
(7) Dr. FAUCI: If we declare victory too soon, we can risk a surge. (2021, March 16). Retrieved March 25, 2021, from https://www.msnbc.com/morning-joe/watch/dr-fauci-if-we-declare-victory-too-soon-we-can-risk-a-surge-107861573815
(8) Wan, W. (2021, March 05). Americans are getting fewer coronavirus tests. Here's why that's bad. Retrieved March 22, 2021, from https://www.washingtonpost.com/health/2021/03/04/covid-testing/
(9) Dr. FAUCI: If we declare victory too soon, we can risk a surge. (2021, March 16). Retrieved March 25, 2021, from https://www.msnbc.com/morning-joe/watch/dr-fauci-if-we-declare-victory-too-soon-we-can-risk-a-surge-107861573815
(10) Who director-general's opening remarks at the media briefing on covid-19 - 16 march 2020. (n.d.). Retrieved March 24, 2021, from https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---16-march-2020
(11) Mahase, E. (2021). Covid-19: Where are we on vaccines and variants? BMJ. doi:10.1136/bmj.n597
(12) COVID Data Tracker Weekly Review. (n.d.). Retrieved March 22, 2021, from https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html
(13) Dr. FAUCI: If we declare victory too soon, we can risk a surge. (2021, March 16). Retrieved March 25, 2021, from https://www.msnbc.com/morning-joe/watch/dr-fauci-if-we-declare-victory-too-soon-we-can-risk-a-surge-107861573815
(14) Overview of Testing for SARS-CoV-2 (COVID-19). (n.d.). Retrieved March 22, 2021, from https://www.cdc.gov/coronavirus/2019-ncov/hcp/testing-overview.html
(15) Overview of Testing for SARS-CoV-2 (COVID-19). (n.d.). Retrieved March 22, 2021, from https://www.cdc.gov/coronavirus/2019-ncov/hcp/testing-overview.html
(16) Overview of Testing for SARS-CoV-2 (COVID-19). (n.d.). Retrieved March 22, 2021, from https://www.cdc.gov/coronavirus/2019-ncov/hcp/testing-overview.html
(17) COVID-19 Story Tip: Organ Transplant Recipients Can Develop Immunity After Covid-19, Despite Immunosuppression. (2021, February 09). Retrieved from https://www.hopkinsmedicine.org/news/newsroom/news-releases/covid-19-story-tip-organ-transplant-recipients-can-develop-immunity-after-covid-19-despite-immunosuppression
(18) How well do COVID vaccines protect after organ transplant? (2021, March 15). Retrieved from https://www.independent.co.uk/news/how-well-do-covid-vaccines-protect-after-organ-transplant-vaccines-covid-johns-hopkins-university-pfizer-moderna-b1817611.html
(19) “General Business Frequently Asked Questions.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, www.cdc.gov/coronavirus/2019-ncov/community/general-business-faq.html
(20) Testing for COVID-19. (n.d.). Retrieved March 23, 2021, from https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/testing.html#:~:text=COVID%2D19%20tests%20are%20available,(NAATs)%20and%20antigen%20tests
(21) At-home testing. (n.d.). Retrieved March 24, 2021, from https://www.cdc.gov/coronavirus/2019-ncov/testing/at-home-testing.html
(22) Godwin, C. (2021, March 23). Covid: DoorDash Delivers at-home test kits. Retrieved March 25, 2021, from https://www.bbc.com/news/world-us-canada-56504961
(23) Overview of Testing for SARS-CoV-2 (COVID-19). (n.d.). Retrieved March 22, 2021, from https://www.cdc.gov/coronavirus/2019-ncov/hcp/testing-overview.html
(24) “How Well Do COVID Vaccines Protect after Organ Transplant?” The Independent, Independent Digital News and Media, 15 Mar. 2021, www.independent.co.uk/news/how-well-do-covid-vaccines-protect-after-organ-transplant-vaccines-covid-johns-hopkins-university-pfizer-moderna-b1817611.html
(25) COVID data Tracker Weekly review. (n.d.). Retrieved March 31, 2021, from https://www.cdc.gov/coronavirus/2019-ncov/covid-data/covidview/index.html
