We Are Flying Blind With COVID-19; States Can Help Change That

As the federal government has floundered about in its response to COVID-19, states have stepped to the fore in taking bold and unprecedented actions to slow the spread of the disease. Because of the delays in rolling out testing for the novel coronavirus, they have needed to make these decisions on the basis of very incomplete information about the extent and dynamics of the epidemic.

A priority for states should be the allocation of some testing capacity to test random samples of the population to detect both the extent of current infection and whether individuals have been infected in the past.

This idea has been endorsed by the epidemiologist Larry Brilliant. Studies resulting from random sample testing would give state governments and the federal government better information on which to base forecasts for their needs for medical resources and allow better targeting of suppressive measures like the closure of businesses, public transport, or travel. Given that our medical resources are limited and may need to be moved around or rationed, more accurate forecasts can save lives.

Many infectious disease experts believe the disease is much more widespread in the United States than positive tests would indicate because we have been late in rolling out widespread testing. This is means that forecasts based on the fragmentary data being collected are less accurate than they could be.

Thus far states have varied widely in the intensity with which they are testing as some have put greater emphasis on increasing capacity. New York has tested 5,319 people per million residents while Michigan has tested only 437 even though both states lead in the number cases detected per-capita.

Tests are currently being directed primarily at those who are already quite sick, though rules differ across jurisdictions. In words, tests are being used to support treatment, not to help make decisions about public health. This is a good idea when testing capacity is highly limited, but more capacity is coming on line.