As the number of reported coronavirus cases keeps climbing, two big unanswered questions hang in the air: Will we ever get control of this thing? And how will we know when we do?
Answering those questions depends a lot on information gathered through testing. Expanded testing not only can identify individuals carrying the virus, but it can indicate where and how the virus is spreading through Hawaii’s communities.
There’s little doubt that Hawaii needs a strong testing program, so it’s encouraging that public and private entities have ramped up services.
State Health Director Bruce Anderson said that more than 10,000 coronavirus tests have been conducted, mostly by the private sector. This puts Hawaii among the Top 3 states for testing per capita — impressive, yes, but not an indication it will be enough to understand the full dimensions of the spread.
The state also continues its community surveillance, testing 380 negative flu samples between March 1 and 24. One positive result for the coronavirus was found — evidence of “limited and localized” spread of the virus on Oahu — and officials expect many more cases to come.
Private companies are racing to develop tests that can detect the coronavirus, and we may even reach a point where anyone who wants a test can get one.
We’re nowhere near there.
The state Department of Health’s (DOH) website, citing a critical shortage of testing supplies and PPEs (personal protective equipment), cautions clinicians to prioritize testing for certain categories of patients who show symptoms, including the elderly, those with chronic medical conditions, critically ill patients with acute respiratory distress, and health-care workers and first responders.
“It is a common misconception that everyone should be tested,” said Edward Desmond, adminstrator of the state’s laboratories. “The tests are designed for people who have symptoms. Testing people who are not sick can lead to inaccurate results.”
Other experts warn of unintended consequences.
“Getting tested today is no guarantee you won’t get infected tomorrow — and may give you a false sense of security,” said Tom Frieden, former director of the Centers for Disease Control and Prevention, in an article for Vox. If anything, he said, a surge in people leaving home to get tested risks spreading the disease.
There are some developments in the testing field that are cause for both hope and concern:
>> The U.S. Food and Drug Administration (FDA) has given emergency authorization for a quick-result test from Abbott Laboratories that can detect the coronavirus within five minutes. An on-the-spot test would be a vital tool in ICUs and at Hawaii’s airports, where infected passengers could be diverted before they reach the general population.
>> The FDA has eased restrictions on the commercial development and use of diagnostic test kits. This could expand the availability of tests — including defective ones that could provide false information, leading health officials astray. DOH on Wednesday issued a warning against certain rapid antigen tests that may not be reliable. No test is perfect.
>> The FDA also is weighing the use of at-home testing kits, which would allow an individual to collect his or her own sample and send it in for testing. This could free up a lot of PPEs that health-care workers would otherwise use to collect samples. The trick is creating a sampling kit that is safe and accurate. So far, FDA has not authorized any at-home kits.
As scientists learn more about the coronavirus and how it is transmitted, the protocols for public testing, and the tests themselves, may evolve. Researchers in Singapore found more evidence that the virus can be transmitted by people who don’t show symptoms.
That’s why, as the virus spreads in our communities with no way to stop it, the best approach remains the one we already know: Stay. At. Home.