Several experts, myself included, have argued that cheap, widespread rapid testing is critical to containing the Covid-19 pandemic in the United States. An article published in Wired Magazine on Monday, while not disavowing the importance of diagnostics, did claim that a strategy too dependent on them cannot accommodate the “messiness of real life”—which is to say, the messiness of human behavior.
In this respect, the author of the article is absolutely correct. All the rapid tests in the world, even if distributed plentifully amongst American households, won’t make the difference if we don’t act on their results. Some of us, the author also rightly points out, have neither the means nor the flexibility to drop everything and quarantine for 14 days straight. That is why, in addition to home tests, I make a case for assisted home isolation—a cushion of economic and social supports that will make the decision to stay home that much easier.
If manufactured and deployed en masse, low-cost home tests would serve one primary function: to identify infections at their most contagious. Although it hasn’t been definitively proven that the peak of contagiousness coincides with that of viral load—the amount of active virus present in the body—enough evidence has accumulated behind this hypothesis for it to be actionable. Studies pinpoint this moment, when billions upon billions of viral particles are swarming and escaping our airways, as occurring early on in the disease course, when symptoms haven’t yet or have only just begun to appear. For no small number of us, they never will. Either way, no matter how many precautions we take, we risk spreading the virus to others.
The problem, given that our current testing regime reaches few beyond the worried and already ill, is that many of those who contract the virus will be least aware of their own infectivity precisely when it matters most. During this critical time window, rapid tests can not only pick up on infection quickly—in as little as 15 minutes—but reliably as well, with some manufacturers claiming upwards of 95 percent accuracy.
As the amount of virus declines, so does the ability of a rapid test to detect it. There is only so much utility, however, in confirming infection when contagion is no longer a possibility, as the industry standard PCR tests do. While the Prevention Policy Modeling Lab at the Harvard T.H. Chan School of Public Health estimates that 41 million people in the United States have had Covid-19, the number of cases confirmed via PCR testing is only 7.4 million. Widespread rapid testing would allow us to intercept infections as they occur and apportion resources accordingly. Yes, false negatives and positives are bound to crop up, and yes, faulty equipment and human error will fudge a fraction of results, but better to miss five percent of cases than over 80 percent. The goal isn’t perfection, but to mount a response closer in size and scope to what Americans actually need—and what we’re actually capable of.
The same goes for my proposal of assisted home isolation. Should anyone test positive for Covid-19 and need to self-isolate, they would receive a daily cash stipend to compensate for any wages lost and, if need be, accommodation in a hotel or hospital to keep other members of their household safe. Meals and medical supplies would be provided on request, as would additional assistance from health workers. Let’s say for three months, 100,000 new households applied for assisted isolation per day. If costs for food, shelter, and wage compensation amounted to $500 per family per day, the total cost of this program would amount to about $50 billion—far less than the many trillions of dollars we’ll rack up from national debt and lost economic opportunity if we allow this crisis to persist. Like home testing, this plan is ambitious, yet also the bare minimum of what should be done given the exceptional circumstances at hand.
In a country of 350 million people, no nationwide public health intervention will ever go exactly according to plan. To account for those who cannot or will not report test results from home, we must shore up the diagnostic capabilities of our schools and workplaces as well. But one of the reasons why the individual behaviors and actions of Americans in response to the pandemic have varied so widely is because there has been next to no plan at all. We need to move forward with a program as expansive as home testing and assisted home isolation, and we need to do it fast. It may be messy, but it will be worth it.
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