As more U.S. residents receive their COVID-19 vaccine, testing for the virus has dropped, dropping by a third in two months.
This is a positive development wrapped up in a potentially disturbing one, say public health experts.
They say the decline reflects the loads on COVID-19 and suggests that fewer Americans fear being contracted or exposed to the virus. This relief leaves people less inclined to be tested.
The big departure from January to March is a success story in many ways, said Christina Silcox, a policy associate at Duke University University Center for Health Policy.
But the dramatic drop in testing could hamper epidemiologists’ ability to detect and stop new waves of deadly infection, months before enough of the population is vaccinated to achieve herd immunity.
I’m concerned about starting to create this blind spot, said Jennifer Nuzzo, a senior epidemiologist and researcher at the Johns Hopkins Center for Health Safety. We could be struck by a really disappointing surprise.
Public health officials say recent calls to the Federal Centers for Disease Control and Prevention have focused on the need to convince the public of the continued importance of testing, especially for people with symptoms and unvaccinated people who may have been exposed to the virus.
If we do not make that message now, we will prepare for the dots and revival at this critical time when vaccines are not at 100%, said Lori Tremmel Freeman, CEO of the National Association of County and City Health Officers, who was in one of those CDC Calls.
The CDC did not respond to an interview request regarding its concerns about test dropout.
Some states have already encouraged people with potential symptoms or exposure to get tested. Last week, the Missouri Department of Health and Higher Services reminded residents that as vaccines become more available, testing remains an important weapon against the virus.
“We quickly learned in the early days of this public health crisis how important testing was to prevent the virus from spreading,” said Dr. Randall Williams, director of the agency, in a press release. For the remainder of March, Missouri will host community testing events two or three times a week in the Kansas City and St. Louis areas. Louis.
The $ 1.9 trillion COVID-19 aid package that President Joe Biden signed earlier this month includes nearly $ 48 billion that local and state public health agencies can use to boost testing. The legislation also calls for the development of a national, evidence-based strategy to assist public health agencies with testing and tracking contacts.
Separately, the package embezzles $ 1.75 billion to increase genomic ranking, which is used to track evolving variants of COVID-19, some of which are more transmissible and may be able to infect people with COVID-19 antibodies. .
The United States has been slow to increase its rankings. The Rockefeller Foundation, a private foundation that promotes economic opportunities and health care for all, reported that only nine states were ranking as much as 1% of their positive cases last month. Some epidemiologists say the US should determine 5% of positive cases, the pace set by the UK, which is considered a leader in the rankings.
We have been on the right trajectory, but we really need to grow, said Dr. Jonathan Quick, managing director of the Rockefeller Foundations pandemic response team.
As of last week, the CDC had reported 5,795 cases of the most troubling variants, a number that does not reflect true figures, epidemiologists say. CDC officials think the variant first discovered in the UK will become the dominant type of disease in the US in the coming weeks.
Data from the Johns Hopkins Coronavirus Resource Center show that the number of COVID-19 diagnostic tests administered has dropped significantly in almost every state from the highest levels of the period between November and January, when waves hit many parts of the country.
There is also a large difference between states in the number of tests performed in relation to the population. According to the CDC, over a seven-day period in mid-March, Vermont conducted the most PCR tests considered the most reliable diagnostic test for COVID-19 with 10,302 tests per 100,000 people.
Oklahoma performed less, with 428 tests per 100,000.
That week, most states fell in the range between 1,000 and 3,000 tests per 100,000 people. Across the country, the 14-day average of administered tests fell by a third from mid-January to March, according to Johns Hopkins data.
Unlike last spring and summer, supply problems do not explain the drop in testing. Capacity has grown steadily and is expected to continue to grow until the end of the year, according to Mara Aspinall, a professor at the Arizona State University College of Health Solutions and a Rockefeller Foundation adviser who publishes a follow-up testing capacity. of the newspaper in the United States.
She said labs are no longer overwhelmed by the testing requirements that plagued states over the summer.
We have state after state telling us they have no more backlogs, she said.
Instead, public health officials point to other reasons for the recent decline.
Dr. Clemens Hong, who runs the rehearsals in Los Angeles County, said the decline is a positive sign. Much of the decline is due to declining cases as well as fewer hospitalizations and deaths, Hong said.
But Hopkins’s Nuzzo is less sanguine. Testing began to fade even when cases were still on the rise, she said. She and other public health experts attributed part of the decline to pandemic fatigue, but also to the public shifting its focus to vaccines.
The Freeman of the county and the group of city health officials agreed. With the announcement of the vaccine, people have focused on what is the cure for everything, she said. I think people are just enduring getting a vaccine rather than getting tested.
The bulk of the vaccine testing was clearly visible. In mid-January, Los Angeles moved from Dodger Stadium from one of the largest testing sites in the country to one of the largest vaccination centers. Other states, such as Florida and Nevada, closed mass testing sites as well, shifting more attention, jobs and resources to vaccination.
Los Angeles County officials concluded that maintaining a mass testing center such as Dodger Stadium was less profitable than setting up smaller-scale operations in communities, Hong said, especially places located near vulnerable populations. The county is moving toward more accessible test sites where people live and work, he said, in places such as grocery stores, parks and subway stations.
We were trying to increase the convenience of testing, he said.
In California, as in some other states, test volume is closely related to the level of COVID-19 limitations. California sets standards for how much testing local jurisdictions must perform. Areas that fail to hit those signs are presumed to have more infections than they have recorded, which may delay the alleviation of COVID-19 restriction conditions there.
Hong said Los Angeles County has managed to stay above that threshold, but the same is not true for Riverside County in the east.
The state says that if you are not doing enough testing, you are not finding all your cases, said Dr. Cameron Kaiser, health officer of Riverside Countys health department.
California has the right to set testing standards, Kaiser said, though he opposes what states consider arbitrary changes to what the standards are.
PCR tests are considered more reliable than rapid diagnostic tests for COVID-19 antigen, but they are more expensive, more difficult to administer, and require more time to produce results, although turnaround times have greatly improved since inception. of the pandemic.
The disadvantage of antigen tests is that positive tests are often not reported to public health authorities, which means that they do not serve one of the most important purposes of testing in a pandemic: identifying and contacting residents who have been exposed.
The loss of contact tracking is the biggest loss from a public health perspective, said Kelly Wroblewski, director of infectious disease programs at the Association of Public Health Laboratories.
Some areas are testing environmental tests to detect localized outbreaks of the virus. Arizona, California and Massachusetts are trying to analyze the wastewater. Duke University, Silcox, said another promising alternative would be the classroom routine. If the virus were to be detected, all teachers and students in that class could be tested, rather than the entire school.
Many public health experts think the quietness of the test will be short-lived as more people are vaccinated and the hunger to return to normal is strengthened.
They expect the test to be used as a ticket to admission, not only for the opening of schools, but for businesses, houses of worship, entertainment and sporting events. Freeman said in the coming months, businesses are likely to set up their own testing programs to entice employees and customers to come back. New York Gov. Andrew Cuomo, a Democrat, has talked about Broadway being able to reopen soon with the proper fast-track testing set.
Quidel Corporation, which produces PCR tests and the COVID-19 antigen, saw demand shrink by 30% to 40% after the new year, in part, said its CEO Doug Bryant, because many medical devices were over-ordered as mounted cases. after Thanksgiving. The company had invested $ 300 million to boost production, which Bryant admitted caused him some anxiety when he watched demand fall. Would I have eggs on my face? he wondered.
But as the country predicts a return to normalcy, he has heard from interested schools and businesses to take quick tests, especially home-based ones, that would enable them to test students, staff and clients. He said he expects the calm of demand for his products to be short-lived.
Anyone who has my phone number has called, he said.
Testing, Freeman said, should become ubiquitous. We have not yet made testing easy enough for the average person, she said. There has to be a bigger plan that puts testing in the hands of people wherever they go.
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