I had a curious phone call this week from a patient who was inquiring about COVID-19 testing. Asking her if she had any concerns about symptoms or potential exposure she said “what do I need to tell you to get a test?”
My stock response since I began COVID-19 testing in March has been to reference President Trump’s now infamous March 6th remark – “anybody who wants a test gets a test.” I have put zero restrictions on testing – even though I have had to scrounge for testing kits to accomplish such. I have not yet, and nor do I plan to deny a COVID-19 test for somebody who wants one.
You may have read this week that L.A. County has moved to a tiered testing system. I could not disagree more strongly with this approach. It is reactionary, short sighted and will ultimately lead to more cases.
There are now four general categories of people who are eligible to receive tests from the County:
- People with symptoms;
- People who live or work in high-risk congregate settings — homeless shelters, nursing homes, or correctional facilities;
- People with exposure — such as those contacted by a contact tracer or a close contact with a person who has recently tested positive for COVID;
- Essential workers.
In terms of restriction #1, it makes little sense to test only those with symptoms. In some cases, symptoms may be mild – particularly among those that are younger. Further, a preponderance of evidence thus far has shown a significantly long presymtomatic / asymptomatic phase for COVID-19 during which one is quite capable of spreading the virus.
Testing those in categories #2 and #3 has been a consistent recommendation since the beginning of this epidemic. Protecting high risk populations and contact tracing are both basic and essential functions of the public health department. At this point, they should not need to be reiterated.
Lastly, testing “essential workers” as outlined in category 4 should no longer be a gating item. During March and April when most people were sheltering-in-place and only a small proportion were eligible to return to work, this testing approach made sense. But, at this point, with the population at large no longer under such orders, testing criteria should reflect reality.
The other reality is that Los Angeles has fallen short in testing since the end of May. The graph below depicts the acceleration of testing seen in San Francisco as compared to the (essentially) stagnant per capita testing rates in Los Angeles.
Simply put, Los Angeles County and the Department of Health need to do more, not less.