COVID testing – why bother?

For many months now, COVID testing has become a part of everyday life. Beyond identifying if you have COVID, the tests have very little additional use. They don’t provide information we have come to expect from the battery of routine medical tests we are subjected to through our lifetime. 

We need global standards for testing, vaccination and documentation

For example,  do they predict the risk of heart disease as testing cholesterol does? No…  nor the likelihood of hospitalization for dialysis as kidney function tests do…. Nor the prediction of future amputations as ultrasounds of the legs do  nor the forecasting of cancer recurrence as PET scans do. And, as there is no current therapy for COVID, they cannot help targeting the most appropriate antiviral as HIV testing does.

Moreover, there is no correlation between testing and hospital admission, nor mortality. Not only does COVID testing lack clinical validity, but it also does little to  control or prevention the disease in the individual.  Often, through contact tracing, it is too late to prevent spread of highly infectious variants as we have seen in the increasing sporadic outbreaks in so called “protected” continents such as Australia.

Worse still, with multiple routine testing in workplaces, we have no idea how much the test changes in response to an intervention such as vaccination, relative to background variation in the testing population. It is estimated 40% of people with SARS-CoV-2 infection have no symptoms but can still transmit the virus to others. 

This means that, if COVID is highly prevalent in an environment, such as a health care institution or aged care facility, a positive test could mean nothing, and precious health resources could be wasted. We already have severe shortages in the health workforce and  repeated testing has led to severe shortages of swabs for testing other infections. Not to mention the continuing cost to the community of testing.

In the US, the cheapest test kit is $5 wholesale but for the more specific PCR test, the cost can increase to $75.  That may not include the cost of the health care personnel who collect the test, usually in a consultation.

As of October, this year, the US, the world’s largest COVID tester, has conducted more than 650 million tests – even at the cheapest rate, that is more than the total health care expenditure of several OECD countries. 

If testing is to become a part of daily workplace activity, it is time it became more sophisticated. Even as vaccination becomes more prevalent, as new variants become more infectious, more and more of us will test positive. COVID testing should move from a simple “yes/no” detection to providing more useful information about individual and community risk.  If that can’t be accomplished, jettison the test.

Fortunately, some countries are now moving to requiring evidence of vaccination rather that testing. Evidence is amassing that this kind of documentation is open to counterfeiting and misinterpretation. It is time for WHO to step in and co-ordinate global standards for testing and vaccination and documentation of both.

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