As the coronavirus crisis rages across the U.S., reaching new record daily highs some four months into the pandemic, the country is still struggling to create a coordinated, nationwide testing system. With cases skyrocketing in dozens of states, the need for adequate testing has never been more dire. Meanwhile, spurred by fear and confusion, misinformation about COVID-19 testing continues to spread in step with the virus.
As an emergency room physician and medical director providing COVID-19 care since the start of the pandemic, I encounter this daily from concerned patients. Here are five of the most damaging myths about testing in the United States.
Myth 1: COVID-19 test results aren’t accurate
This coronavirus is new and we are still in the early days of understanding how the disease is diagnosed and transmitted. It’s true that fumbles by both the FDA and CDC at the start of the pandemic made early tests invalid. Offers to sell unauthorized tests from around the world inundated our spam folders and further put into question testing accuracy as the FDA warned us not purchase these tests. However, much has changed since those early days.
Although no medical test is 100% accurate, the coronavirus swab test comes close for those who test positive. The FDA has authorized multiple swab and saliva collection tests that are highly specific, and reliably confirm if you’re actively infected with COVID-19. If you test positive, you have been correctly identified as having the disease. However, the same can’t be said for testing negative. In that case, there is a 2% to 29% chance that you’re actually infected. Why? The dearth of clinical real-world studies means that we don’t know the exact likelihood of false negative tests; the range will narrow as more data becomes available. But we know you may test negative if you’re tested too soon after exposure to the virus, if the sample is not collected properly, or if the test isn’t sensitive enough to identify traces of the virus in your sample. To ensure as accurate a result as possible, it’s important to only get an FDA-authorized test.
In contrast, when it comes to blood antibody testing, only a negative test result is useful. These tests can very reliably (with nearly 100% accuracy, excluding human error) determine that you’ve never been exposed to or mounted an immune response to coronavirus. However, a positive result isn’t conclusive. No test can definitively confirm that you have been exposed to coronavirus. Many find this information meaningless, since a negative test means you remain susceptible to infection, and a positive test isn’t reliable enough to provide peace of mind that you’re unlikely to be reinfected. Here’s a guide to interpreting your results.
Myth 2: The U.S. leads the world in testing
The White House has repeatedly claimed that the U.S. leads the world in testing—an assertion that isn’t true in any meaningful way. The U.S. has one of the lowest testing rates among developed countries and ranks only in the middle of the pack worldwide. As of July 19, 2020, the U.S. performed about 12 tests per confirmed positive patient, as compared to New Zealand (369), Australia (304), Taiwan (175), South Korea (105), Italy (26), Canada (32), the United Kingdom (27), South Africa (7), Iran (8), and Mexico (2).
Moreover, our high case fatality rate—4.5% of patients who test positive, compared to 2.16% in South Korea, and 1.26% in Australia—also demonstrates how the U.S. isn’t testing enough of its population. Because the case fatality rate should be similar across countries, that means that the U.S. isn’t accurately capturing the number of infected people. Our testing shortfall endures, despite the widely accepted understanding that we are grossly undercounting COVID-19 deaths by 28%.
Myth 3: Kids don’t need to get tested
While children are less susceptible to COVID-19, they can still catch the disease and spread it to others, though not as efficiently as adults do. Since kids are less likely to wear masks and wash their hands properly or socially distance sufficiently from others, testing them is even more critical if they’re exposed to or exhibit symptoms of the virus. Children typically present with slightly different symptoms like headache, rash, and in rare cases, blood vessel inflammation called Pediatric Inflammatory Multi-system Syndrome (PIMS), which further complicates the complex puzzle of COVID-19’s impact on them.
As an emergency room physician, I’ve had the misfortune of informing parents of their children’s positive diagnosis. Despite kids’ relative resilience to the disease—a small mercy of this pandemic—it remains difficult news to deliver. Since many viruses in kids appear the same and there are no clinical criteria that can be used alone to diagnose COVID-19, widespread testing remains critical to assess whether an unwell child has COVID-19.
Myth 4: Anyone who wants a test can get a test
On March 6, 2020, President Trump told reporters that “anybody that needs a test gets a test”—a false contention both then and now. The commercial laboratories that run more than half of the nation’s tests warn that they’ll take longer to process them because soaring testing demand is far outpacing processing capability. Beyond the supply problem, there are also infrastructure issues—namely healthcare deserts across America that face a lack of access to testing facilities and lack of capacity at overwhelmed community hospitals.
In April, Harvard University’s Center for Ethics published its bipartisan finding that the U.S. would need “to deliver 5 million tests per day by early June to deliver a safe social reopening.” On July 19, the U.S. performed 768,000 tests—a fraction of the 20 million daily tests the same report cites as necessary, ideally by late this month, to fully remobilize the economy. Despite this staggering shortfall, many states have reopened haphazardly, resulting in the current surge that continues to break daily records. While the FDA is approving a slew of new tests that are quickly coming to market, current testing availability and accessibility still cannot keep pace with the rampant spread of the virus. That’s why it’s crucial to focus on prevention efforts to flatten the curve as the industry struggles to provide adequate testing resources.
Myth 5: Testing fewer people will decrease the number of COVID-19 cases
On numerous occasions, President Trump has posited that less testing “would show fewer cases” and reduce the number of infections. He’s reiterated this dangerous misinformation at rallies and press briefings, despite the fact that confirmed cases nationwide reached three million on July 8 and in just a week are nearing 3.5 million on July 15—roughly a quarter of the world’s total. Hard-hit states, including Texas and Florida, edge closer to running out of ICU beds.
Though the President continues to parrot false assertions designed to downplay the alarming breadth of the coronavirus crisis, the truth remains unassailable. Fewer tests will not result in fewer cases. On the contrary, less testing will ultimately lead to more cases of COVID-19, as people unknowingly transmit the disease to others—perhaps chalking up their shortness of breath to asthma, or their coughing and fatigue to allergies. We’ve seen this scenario play out in other countries where testing lags while deaths escalate, such as Mexico and Brazil. Looking to countries that have successfully mitigated COVID-19’s spread—including South Korea, New Zealand, and Italy—it’s clearer than ever that widespread, readily available testing must be our number one priority if the U.S. hopes to stop the scourge of this once-in-a-century disease.
Caesar Djavaherian M.D is an emergency medicine specialist and the cofounder and medical director of Carbon Health.