The development of reliable tests for COVID-19 was one of the first major triumphs in the pandemic, but rollout in the United States was plagued with failed technologies,1 inconsistent messaging,2 limited data on who had access, and testing facilities that could not keep up with demand or provide real-time data publicly.3 Over time, states were able to adapt to demand and provide testing and real-time testing data updates. Data aggregation services had access to consistent, reliable data, in the aggregate, about tests for over a year. COVID-19 testing has been one of the most important mitigation strategies for controlling Covid and some of the most essential data, but states have been neglecting it.
After the rollout of vaccinations, testing and testing data took a back seat. Many state and federal testing sites closed4 while others were converted into vaccination centers,5 significantly reducing access to testing. Where once every state had clear instructions to help its residents find a local testing site along with explanations of cost and insurance, it is now incredibly difficult to find a convenient testing site or at-home tests. This lack of access to testing has been personally experienced by multiple members of the staff here at the Coronavirus Resource Center, who should be well-equipped to find available COVID-19 tests.
Removal of testing accessibility negatively impacts the quality of testing data and diminishes the capacity of a key strategy for controlling Covid in the community. Some states have even stopped regularly publishing testing data. For these states, the CRC sources testing data from the U.S. Department of Health and Human Services’ dataset,6 which is often itself incomplete due to reporting delays. Even among states that report testing data on their dashboards, testing data has persisted as the worst performer when it comes to data available broken down by demographics. Only a handful of states provide test data disaggregated by demographics, which is a critical tool to better understand disease transmission and stop community outbreaks. As shown below, 40 states do not provide testing data broken down by age, 42 do not disaggregate for sex or ethnicity, and 47 do not provide racial breakdowns of testing data as of Sept. 24.
Testing data remain essential. COVID-19 is and persists to be a disease that has significant impact on local communities and interventions are best applied at the community level. Testing informs public health officials and epidemiologists on disease spread within states, municipalities, and communities. If testing data are restricted and only available from certain groups within a state, then the data become highly biased. Interpretation of this skewed, incomplete data can result in the implementation of ineffective mitigation and relief strategies. If testing data only comes from a wealthy area of a given state, then the impact of COVID-19 on poor populations is completely unreported. There is no way to detect COVID-19 spread in a community and provide assistance if there is no testing data.
Testing is also essential to protect the unvaccinated, including children. Rapidly identifying and isolating people who are infected is essential to stopping onward transmission and for connecting people to life-saving care. Many employers are offering the option to provide daily testing in lieu of receiving an FDA-approved COVID-19 vaccine. While the CRC strongly supports vaccination, there are people who will need access to testing to continue to work, go to school, travel, or attend concerts and sporting events. There are also many who still cannot get vaccinated because they are underage. Testing helps protect teachers, staff, and families that interact frequently with young children. This is crucial since there are additional barriers to testing children themselves, such as requiring a pediatrician’s order when testing sites cannot test young children.7
In addition to raw testing data, we also need information on accessibility and timeliness — testing location, supply, and test type. There is no national-level understanding of testing availability by location or demographic characteristics, creating gaps in our understanding of who is being tested. States should collect and publish testing accessibility data to help identify social barriers to testing that can be addressed through funding or policy changes. To continue testing everyone who needs a test, we must first clarify who is receiving tests and who isn’t. Additionally, testing accessibility data will allow researchers to investigate how testing inhibits SARS-CoV-2 transmission. This knowledge could significantly impact mitigation efforts and the response to future public health crises. We also need to know what kinds of tests are being used. Home tests, while essential to quickly diagnosing and limiting the spread of infection, may not be captured by public health surveillance systems.
This data should go far and beyond the “number of tests conducted” metric, which was used early in the pandemic to promise adequate testing coverage. We need real-time monitoring of testing availability. Once those data are collected they need to be provided to the public in a manner that is useful for locating and utilizing testing services. When people do get tested, we need to make sure that health departments continue or begin to collect detailed demographic metainformation and data on vaccination status.
States used to be much better about providing testing earlier in the pandemic. Dashboard pages and telephone hotlines to lead callers to the nearest available test were kept up to date with the most accurate testing availability information. That passion and infrastructure for testing needs to return. State health department websites and COVID-19 dashboards are well suited to provide testing accessibility data, but the CDC could also take the lead. In fact, the CDC has already produced a vaccine accessibility site (shown above for Baltimore, MD) that tracks vaccine location, type, and stock.8 This kind of database should be created for testing as well.
At its heart, this issue of testing accessibility speaks to equity and health disparities that continues to hinder pandemic response in the United States. We need to ensure everyone who needs a test can get one. If we do not adequately support testing, then this pandemic is not going away any time soon.
References
1. S. Kaplan, C.D.C. Labs Were Contaminated, Delaying Coronavirus Testing, Officials Say, The New York Times, 18 April 2020.
2. N. Weiland, Anyone Who Wants a Coronavirus Test Can Have One, Trump Says. Not Quite, Says His Administration., The New York Times, 7 March 2020.
3. Hopkins Launches COVID-19 Testing Insights Initiative, 29 April 2020. https://hub.jhu.edu/2020/04/29/covid-19-testing-insights-initiative/. (Accessed 4 October 2021).
4. M. Marchante, Florida-run COVID testing sites closing at the end of May. Where can you go next?, Miami Herald, 20 May 2021.
5. K.d. Leon, C. Herrera, C. Pascucci, W. Burch, Dodger Stadium coronavirus testing site to turn into mass vaccination center: L.A. city, county officials, 10 January 2021. https://ktla.com/news/local-news/dodger-stadium-coronavirus-testing-site-to-turn-into-mass-vaccination-center-l-a-city-county-officials/. (Accessed 4 October 2021).
6. U.S. Department of Health & Human Services, COVID-19 Diagnostic Laboratory Testing (PCR Testing) Time Series, HealthData.gov, 4 October 2021.
7. S. Kliff, M. Sanger-Katz, It’s Not Easy to Get a Coronavirus Test for a Child, The New York Times, 8 September 2020.
8. Centers for Disease Control and Prevention, https://www.vaccines.gov. (Accessed 4 October 2021).
This content was originally published here.