Thoughts on COVID-19 testing

As Alberta residents now know, the only place to access COVID-19 testing is via 811 and then assessment centers or other designated public health locations.

People are finding this frustrating, because the waits are long, and even when they get through they may not meet testing criteria.

I think there’s some confusion about why exactly we test.

There’s an old joke in medicine: “Don’t order a test if it won’t change what you do.”

For most people, that’s the situation with COVID-19. If you are positive and you have symptoms what are we going to have you do? Go home and self-isolate for 14 days.

If you have symptoms and you aren’t tested, what are we going to do? Send you home to isolate for 14 days.

If you’ve travelled since 12 March 2020, you’re to go home and isolate for 14 days, symptoms or no symptoms, positive or negative swab or not.

So in most cases, the swab status doesn’t change what YOU do (or what we do for you) at all.

So why swab at all?

INITIALLY, swabbing at risk people was important because it’s a public health tool. We have to track what’s out in the community and what’s happening. If we find a case, we want to pounce on it, isolate all their contacts, and try to prevent the outbreak. (This strategy worked very well for a coronavirus related to COVID-19 — SARS. Problem is that the containment strategy didn’t work. This honestly isn’t surprising. It’s a tall order, esp in a free society. The time to stop it was China, but the Chinese Communist government made a number of bad choices that made that impossible until it was too late.)

When you’re trying to contain, swabbing is important, because you want a bead on what the rate of cases is out in the community. Why? Because public health and government need to know when to pull the trigger on very disruptive and costly isolation measures–just like we’re in now.

Once you’re to that phase, testing really has much less helpfulness. We’ve already locked down. We should be social distancing already. Knowing there are more cases out there won’t change that. (More data is always nice, but you get diminishing returns in terms of what you do.)

At present, medically, the time when being COVID-19 positive will really matter is if you’re sick enough to be in hospital. That will affect what treatment you might get, and where you might be located.

But, if you’re not sick enough to be in hospital, the swab won’t change much.

So, if 811 tells you not to test–don’t stress. Shelter at home, self-isolate, just like everyone else is. If you get sick enough to need testing, you’ll get it. You don’t need to race around trying to find someone to swab you.

In an ideal world, we’d swab everyone whenever. But that costs money, and scarce supplies, and scarce testing time and personnel. In most cases, those aren’t worth the benefit.