Next Time, Testing First

Biomedical science had an astounding, unprecedented year. Two vaccines were developed for a new coronavirus in under 12 months. An entirely new mRNA technology proved sound. Clinicals trials of several therapeutics completed trials and were approved for use with patients. Less impressively, the centerpiece of coronavirus disease control, Covid-19 testing that can be available where people work and live and go to school, an at-home test with no delay in results, became available only in the final weeks of 2020. That it arrived so late in the year, after the US had experienced a per capita rate of testing far lower than most other high-income countries, has been one of the great public health disappointments of the pandemic.

Also lacking a rapid home test, other countries were able to make better use of the medically-supervised, slower, “gold standard” Covid-19 tests than the US. Asian countries had testing machines spread across their nations, and systems to evaluate which locations had excess capacity. With their smaller numbers of infections, contact tracing, isolation, and quarantine were successful for disease control, and were culturally acceptable.

We left every state to its own devices, literally. State after state had insufficient supplies and inadequate testing capacity. For a disease like Covid-19 where a person without symptoms can infect others, regular testing (for the sake of others) is critical, and an accurate, inexpensive, non-prescription, self-administered, quick-answer, home-based Covid-19 test—such that infected persons could have protected others—would have been our best chance of limiting spread of the disease.

One public health lesson for the next epidemic is that spending federal dollars to help develop at-home self-diagnostic tests from the start, will save lives. After all, the public prefers convenience and self-determination. Thus, our best hope of infection control of the next Covid-19 will be a simple test (a swab of the nose or mouth) which provides results in minutes and detects the early part of the disease when people are most infectious. And we need it to be widely available and affordable, with an easy reporting system so that local health departments can be informed of positive results. The Federal government spent tens of billions of dollars researching and purchasing vaccines this time, and to good effect. Next time, let’s work out the testing first.


Michael Stein & Sandro Galea

As we re-emerge from the pandemic, 2021 stands to be a turning point year for public health. In The Turning Point’s weekly essays, we reflect on what we learned during 2020, and what we are learning during 2021, that can guide us to the creation of a better, healthier world.