Notes on Coronavirus – Testing’s Importance Overstated

coronavirus green

by Ron Roizen

Cable news has been decrying the state and national shortages of coronavirus testing capacity.

But I’m not convinced the shortage is as problematic as it’s touted to be.

Why are tests important in the first place?

Testing’s chief purpose is to distinguish the Ps (positives for the disease) from the Ns (negatives).

Distinguishing Ps from Ns makes possible sequestration, thus in theory protecting Ns from infection.

In the case of coronavirus however transmission of the virus most often originates with asymptomatic people.  And people not experiencing symptoms don’t usually seek out medical testing.  Most transmission, in turn, will derive from Ps not tested and not identified as such.   

Universal testing would offer one solution.  Yet a rapidly diffusing epidemic would require testing the population over and over again over time in order to keep up with the disease’s spread.  Obviously, that kind of universal testing would strain resources.

Another function of testing is that of sending Ps to appropriate treatment.  But that function’s significance is reduced in the current epidemic.  Current White House guidelines suggest that if one feels sick then one should simply stay at home.  One shouldn’t seek hospital admission or medical treatment unless, or until, one becomes seriously ill.

That sort of guideline reduces the relative significance of testing, too.  If you are experiencing mild symptoms, whether or not you are a P, you stay home; and if you are very ill, whether or not you are a P, you are advised to get medical help.  The decision to stay at home or seek treatment does not actually require testing in this case.

Yet another function of testing is epidemiological.  Without testing, experts have less ability (a) to assess who is contracting the virus and who is not and (b) to know how rapidly the disease is spreading and in what directions its moving.

Aside from epidemiological data’s value for research purposes, however, its value on the ground for ordinary people is dependent on how much difference in one’s life is dictated knowing whether the virus (a) is not here yet, (b) is coming, or (c) is here now.  In the case of a very transmissible disease with a largely unpredictable course through a national population that knowledge’s significance is of course commensurately lessened.

Finally, let me mention another purpose or function for testing, the reduction of anxiety.  One does not have to take a college course in medical sociology to know that patients who have not received a diagnosis for their illness suffer greater anxiety than patients whose diagnosis is securely known.  Knowing one’s diagnosis puts a name on one’s suffering and usually suggests a likely prognosis, plan of treatment, etc.  Good things to know.

In the case of coronavirus on the other hand the course of the illness, the severity it will reach, and its mortality risk are highly uncertain and widely variable.  Treatment for the disease, moreover, is supportive rather than curative.  Hence, although knowing one has coronavirus may offer a modicum of anxiety-reduction, its diagnosis is significantly less illuminating (and thus anxiety-reducing) than in the case of many more familiar maladies.

In light of the above – i.e., testing’s lessened value for coronavirus respecting sequestration, treatment, epidemiology, and anxiety reduction – I’m inclined to think that testing’s value, as it has been touted in the public square of late, has been significantly overestimated.

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