26 Time August 17/August 24, 2020
Michael Mina of the Harvard School of
Public Health has been a major proponent
of this idea, and has pushed the idea of a test
that costs as little as $1, which the govern-
ment could mass- produce and provide free
of charge to every one. In fact, these technolo-
gies exist today. Antigen tests are significantly
cheaper and faster than the RT-PCR tests that
are at the heart of America’s current testing
infra structure, which is collapsing.
As coronavirus cases surge around the
country, laboratories are facing crippling
shortages of key supplies and growing back-
logs of samples. In many states, it can take 10
to 15 days to get test results— rendering these
tests useless as a tool to prevent transmission
and bring the pandemic under control. For
most people, the peak period of infectiousness
lasts about a week. And in the middle of this
testing collapse, cities and towns are prepar-
ing to return mil-
lions of children to
school this fall with
neither the inten-
tion nor the capabil-
ity to test them.
At this critical
moment in our na-
tion’s fight against
COVID-19, it is time
to radically rethink
our approach to
testing. The way for-
ward is not a perfect
test, but one offering
rapid results. Over
the past months, much of the conversation
around testing has focused on accuracy. Tests
have been touted for their high sensitivity, and
the FDA requires diagnostic tests to correctly
identify 95% of positive cases. The intuition
behind this is clear: we want a test that won’t
miss positive cases and send infected indi-
viduals back into the world to spread the virus.
These RT-PCR tests have become the back-
bone of our testing infra structure, yet their
high cost and slow rate of analysis have under-
mined any attempt to put their high sensitivity
to good use. CDC analyses suggest that we are
identifying only about 1 in 10 cases of COVID-
19, mostly because we are testing so few peo-
ple. By putting a premium on the accuracy of
tests, we fail to test a majority of people with
COVID-19, and these built-in delays actually
undermine our ability to identify cases in a
timely manner.
The Quidel company has already received
FDA approval for its antigen- based test on
a strip of paper. Researchers are testing an-
other $1 antigen test for widespread use in
Senegal. Why, then, have these cheap and
rapid tests not become the foundation of our
national testing strategy? The answer lies in
test sensitivity. Antigen tests require higher
levels of virus than RT-PCR to return a posi-
tive result. There has been significant push-
back from those who believe it would be irre-
sponsible to widely use a test that might miss
many positive cases.
But the frequency of testing and the speed
of results counter that concern. The RT-PCR
tests are currently slowing laboratories to a
crawl. If everyone took an antigen test today,
even identifying only 50% of the positives,
we would still identify 50% of all current in-
fections in the country—five times the 10%
of cases we are likely identifying now be-
cause we are testing so few people. Accuracy
could be increased
through repeated
testing and through
the recognition that
quicker test results
would identify viral
loads during the
most infectious pe-
riod, meaning those
cases we care most
about identifying
would be less likely
to be missed.
Even better, we
would be identify-
ing these cases while
they were still infectious rather than 10 days
later, when the virus might have already been
transmitted repeatedly. Speed matters much
more than test sensitivity in controlling a pan-
demic. The evidence makes clear it is time for
a paradigm shift on testing. Cheap and rapid
antigen testing can identify and prevent every
cluster of COVID-19.
It is time for the federal government to take
strong leadership on directing our resources
toward this new strategy. The U.S. has the abil-
ity to print paper-strip antigen tests in mas-
sive numbers and to distribute them all over
the country. If we do these things, we can move
past 10-day delays, quash the current outbreaks
and ensure that we can safely go to work, do our
shopping and send our kids to school.Jha is the K.T. Li Professor of Global Health at
the Harvard T.H. Chan School of Public Health.
In September he will become dean of the Brown
University School of Public HealthHealth care workers in Kolkata check rapid antigen
test kits that the U.S. could be using to reduce delaysTheView Opener
SHORT
READS
▶ Highlights
from stories on
time.com/ideasHaunting
memoriesFor her book Wandering
in Strange Lands,
Morgan Jerkins spoke
to a woman who
played a key role in the
police response to the
Watts riots. “She was
traumatized,” Jerkins
writes. “There were
things that she chose
to forget, or that her
body made her forget,
in order to protect
herself and stay alive.”A better
InternetAs hate speech,
disinformation and
conspiracy theories
continue to spread
on Internet platforms,
it’s time to get serious
about regulating
Big Tech companies,
writes Zucked author
Roger McNamee:
“Their stonewalling
over the past four years
has cost them the
moral high ground.”Blurred
linesAs federal agents
recently deployed to
cities across the U.S.,
former U.S. Attorney
Joyce White Vance
issued a warning:
“The use of federal
law enforcement
capabilities against
citizens exercising
their rights, whether
in Washington, D.C.,
Portland or elsewhere,
should not be equated
with normal law
enforcement activity.”