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There’s Only One Way to Get the U.S. Back to Work: Testing, Testing and More Testing

4 minute read

Arthur Caplan is the director of the division of medical ethics at the NYU Grossman School of Medicine.

Robert Bazell is an adjunct professor of molecular, cellular and developmental biology at Yale, and the former chief science and health correspondent at NBC News

The CDC just announced new guidelines for “critical” employees to return to work after possible COVID-19 exposure. Take your temperature often. Wear a mask. Stay 6 ft. away from others when possible. Go home if you feel sick. It is well-intentioned advice. But it is not enough—not for “critical” workers, however defined, or for the rest of us.

Until we have a vaccine, which is likely a year or more off, or truly effective treatments, which may be just as far in the future, the answer is, as it has been since the start of this pandemic: testing, testing and more testing.

“Anyone who wants a test can get a test,” President Trump famously proclaimed on March 6. We know how horribly wrong he was. A tragic, preventable combination of errors in the White House, the CDC and FDA kept this country from having tests to detect the new coronavirus as it spread through the population almost unnoticed. By March 6, when Trump insisted America had sufficient testing for all of us, fewer than 2,000 Americans had gotten a test.

The testing situation is improving. By April 14, around 3 million Americans had gotten COVID-19 tests, according to the COVID Tracking Project. Tests are becoming easier to access. The Department of Health and Human Services just promulgated rules allowing tests to be administered in pharmacies, and its civil rights division said it would not enforce HIPAA rules to allow more widespread community testing. Gates Ventures is funding a demonstration project that can deliver and pick up testing material for homes in the Seattle area. Abbott Labs won FDA approval for a test that can deliver results in less than 15 minutes.

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So what will adequate and repeated testing mean for going back to work and returning to some semblance of normality? We think before anyone flies out the door to head to work or participate in other aspects of public life, we need what some have dubbed the “immunity passport.” Everyone in the country who wants one should get a booklet or a phone app that has verified information from your local pharmacist, doctor or another authoritative source on your COVID-19 infection status. That is the proof that it is safe for you to be in close proximity to other people.

Safety will require frequent, perhaps daily, testing and documenting. Being negative today says nothing about tomorrow. While this system would be expensive to implement, such a cost would be trivial compared to the economic pit into which the virus is driving this country and the world.

It would not infringe on civil rights since no one would be required to carry this passport. And it would be perfectly ethical for a business such as a factory, grocery store or restaurant (remember restaurants?) to require them of employees before starting work and of customers before entering. The same could be required of anyone wishing to board a plane or train. Everyone would know they were in a COVID-19-free environment.

The test we’ve been discussing so far is the one to detect infection with the virus (the so-called RT-PCR test). There is a second test that is even simpler, one that detects antibodies to the virus in a drop of blood, which would presumably indicate a person has been infected and recovered or had an infection with no symptoms. An antibody test could mean that a person is immune to infection for months or years. But that has yet to be proven. It’s why the British government, which had said it would distribute antibody tests widely, has backtracked on those plans.

But the best guess of most experts in the field is that a positive antibody test will indicate protection from future infection. And while you would need repeated RT-PCR tests to ensure you remain negative, once you are positive on an antibody test you would be home free, at least for a certain period of time. That, if true, would convert some folks to first-class passport status.

With testing and documentation, even in the absence of a vaccine or treatments, we could start to live in a world where we no longer fear COVID-19. If we are going to rescue our sanity and our economy, sufficient testing and a new kind of document are the answer.

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