Experts split on rapid tests as ‘tickets’
Epidemiologists and other public health experts are debating whether to use rapid COVID-19 tests as admission tickets to schools, businesses and entertain- ment and sports venues.
Even with the quickening pace of vaccinations, it will be months before all Amer- icans who want COVID-19 vaccines receive them. As a result, testing could become ubiquitous as a requirement for students, office workers, spectators and visitors seek- ing to gather indoors.
Many enterprises have been doing such testing for months, from colleges and universities to Hollywood movie productions to professional sports teams. In New York, Democratic Gov. Andrew Cuomo has said he wants to use extensive test- ing to enable Broadway to reopen.
More venues will take up testing as K-12 schools expand in-person instruction and a wide array of businesses and entertainment venues welcome people inside.
Manufacturers of tests say they are seeing a surge in interest from both public and private sources.
But some epidemiologists think that with uneven test and lab quality and vary- ing skill levels among people administering the tests, the effort isn’t worth the time and money.
“With that kind of testing in most situations, the juice isn’t worth the squeeze,” said Dr. Daniel Morgan, a professor of epidemiology at the University of Maryland.
But others hold the oppo- site view. “Active disease testing is the missing link for schools and employers to give them full confidence to come back in person,” said Mara Aspinall, a professor of health diagnostics at Arizona State University who advises the Rockefel- ler Foundation on COVID- 19 research.
The testing debate coin- cides with arguments over whether proof of a COVID- 19 vaccine should determine access to public spaces.
The skeptics’ chief complaint is the tests’ uncer- tain reliability. “We don’t have a gold standard,” said Dr. Anthony Harris, who is also a University of Maryland infectious disease doctor and epidemiologist. “There is not one test that is perfect.”
The U.S. Food and Drug Administration approved all COVID-19 tests and vaccines on the market under an emergency use autho- rization. During a public health emergency, the FDA can waive or loosen certain evaluation requirements to get essential products to the public as quickly as possible.
Harris said that because of time constraints, the COVID-19 tests now on the market were mostly studied for their effectiveness on those exhibiting symp- toms of the disease. “They are not necessarily evalu- ated on asymptomatic peo- ple,” Harris said, who would likely be the majority of the people being to screened to determine if they can safely enter a venue.
There are two general categories of diagnostic COVID19 tests. Molecular tests, usually referred to as PCR (for polymerase chain reaction) tests, can detect the genetic material of the virus. Antigen tests detect protein fragments specific to the virus that causes COVID-19.
The PCR tests are considered far more reliable, but are pricey and take hours to produce results. The Testing Wisely website, led by Morgan, lists PCR tests as producing 10% false negatives compared with 37% for antigen tests. (A false negative result occurs when a test shows someone is negative for the infection when it is actually present.)
“I’ve been involved with [antigen] tests that have up to 40% false positives and negatives,” said Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy.