The Dangerously Unjust Practice of Coronavirus Testing in the U.S.
Earlier this week in a piece for The New York Times, Max Fisher and Emma Bubola highlighted the ways “inequality itself may be acting as a multiplier on the coronavirus’s spread and deadliness.” They identify low socioeconomic status as a third major risk factor that will make the coronavirus deadlier for those exposed to it, in addition to old age and preexisting conditions, and they identify low socioeconomic status as a factor that will make it difficult, if not impossible, for some people to risk exposure to it.
Certainly, the current pandemic has brought into stark relief the degree to which deferred health care, underlying chronic health conditions, and the lack of paid sick leave have made the “have-nots” in our society far more vulnerable to the coronavirus. What Fisher and Bubola do not discuss, however, is the degree to which inequality has been insidiously shaping who has access to coronavirus testing in the United States.
While there has been widespread demand for more testing and growing outrage over the fact that we do not currently have enough tests to even begin to manage the crisis, little has been said about the classist assumptions of the current criteria for testing. Currently, the Centers for Disease Control and Prevention lists three categories of individuals that health care professionals should prioritize when making decisions about who should receive a test.
The first two categories address patients either already hospitalized and who show signs of the virus or other symptomatic individuals with underlying medical conditions that place them at higher risk. The third priority goes to “any persons including healthcare personnel, who within 14 days of symptom onset had close contact with a suspect or laboratory-confirmed COVID-19 patient, or who have a history of travel from affected geographic areas . . . within 14 days of their symptom onset.”
Given that we are weeks beyond the first identified community spread case of COVID-19 in the United States, it boggles the mind how we can continue to prioritize testing only to those with exposure to confirmed cases or a history of international travel. I live in the state of Indiana, where access to testing has been virtually non-existent. While I am not suggesting we need to abandon the existing prioritization categories, they urgently need expansion.
As of this moment, Indiana has conducted 193 tests. So far there have been 39 positive cases of COVID-19, including two deaths. This past Friday, State Health Commissioner Kris Box told reporters there are likely tens of thousands of people infected with the virus, and yet it would appear to be easier to win the Hoosier lottery than to receive a test for coronavirus in Indiana.
Community spread is here in Indiana, but our current system for prioritizing who has access to testing assumes otherwise. If a sick person can demonstrate they have been in contact with a confirmed COVID-19 case, they can get tested. But with only 30 confirmed cased in Indiana and countless sick people being turned away from testing, how can anyone demonstrate that they have been in contact with a confirmed COVID-19 case if we refuse to actually put the effort into confirming cases?
The final path to prioritization — having a history of travel to particular geographic regions of the world — is just as unlikely to yield the level of testing we have needed for some time now in Indiana and elsewhere. While data about which states in the country and which socioeconomic classes produce the most international travelers are hard to come by, one can make educated guesses about who is most likely to afford and have ease of access to such travel. I predict that studies completed years from now will show that the states testing the most aggressively are those with high numbers of international travelers, even as community spread put everyone at risk. And while international travel may well have put the wealthier among us at higher risk of exposure initially, it is those of low socioeconomic status who are now among the most vulnerable and who will remain the most vulnerable over the next several weeks.
While such testing patterns made sense at the very beginning of the virus’s arrival to the United States, the Center for Disease Control and Prevention now reports more confirmed cases traced to community contact than to travel. But this knowledge has yet to result in a revision to the criteria for prioritization, and it certainly is not trickling down into testing practices. Indeed, no revisions to the criteria have been made since March 9.
This past weekend a close friend of mine took her teenage daughter to an Indiana urgent care facility because she was exhibiting symptoms associated with the coronavirus that had worsened to the point that breathing had become difficult. The doctor assessed her symptoms, ran tests for multiple flu viruses, which were all negative, and sent her home without a coronavirus test since she had not recently travelled abroad or come in contact with someone who had. The physician’s unofficial diagnosis: she may well have a case of COVID-19 and therefore should self-quarantine and carefully monitor her breathing difficulties at home. Social media is now full of similar stories from people in Indiana and elsewhere unable to get tested, despite all indications that would suggest they are carrying and displaying symptoms of the virus.
Reading about these stories is especially frustrating when they appear alongside announcements about the latest NBA player to get tested. Will testing come to Indiana once we get through every player in the NBA? Or must we wait for all the players across all the various professional sports to get tested first?
To be fair, the Brooklyn Nets paid for a private company to conduct tests on its players, despite only one of them exhibiting any symptoms. As of today, four team members have tested positive for the coronavirus; three of them are still asymptomatic. How comforting for them that they can be so aggressive in their efforts to contain the virus.
The rest of us will wait and play a game we cannot win simply because we are unable to enlist private companies to conduct tests of those sick and exposed in our communities. This is not only unjust; it is dangerous for everyone.