A picture of myself getting tested for COVID-19 the first time back at the end of April. Testing has gotten a lot more comfortable and easier to get since then.

When we locked down, our collective sacrifice bought our local, regional, state, and national governments time to get their s*** in order. The first and most basic thing that needed to be fixed was testing for COVID-19. Did they (our governments) make good use of the time we bought them? (Note: As I started to examine this question this post exploded in length. Below is a high level overview of the sections in case you want to skip to a particular section.)

What level of testing should we expect?
Grading testing effectiveness by region.
What is going wrong.
Why you should go get tested.
What was my experience being tested.

What level of testing should we expect?

To know whether we’re doing enough testing, we need to know what our testing goals should be. The Bay Area governments have set the bar at 200 tests / per day per 100,000 people. This metric is a numerical target, but one that conceals the point. What should the right amount of testing feel like? Here are four answers to that question. A region is doing well if it meets the first three criteria and is doing really well if it meets all four.

Testing regardless of symptoms: You should not need to report symptoms to get a test

One of the most important and perverse things about the SARS-CoV-2 virus is that people who do not feel sick can infect you, and if you do not feel sick you can infect others. Testing should not and cannot be only limited to people who have symptoms. If you must report that you have symptoms, to get tested that is not enough testing.

Testing to squash COVID19: Appointment to result in a day or less.

Contact tracing and really effective testing working hand in hand can on their own squash COVID-19, Phoenix Data Project- have your cake and eat it too. I’m going to write another post about contact tracing but for now let me talk about testing requirements. For testing to be effective in stopping the spread of COVID-19 getting an appointment needs to be almost immediate and getting the results need to be quick. If the entire process takes more than two days, it becomes ineffective. It is ideal if the entire process, appointment to result, takes under a day.

Testing for everyone: The barrier to testing needs to be incredibly low

The greater the effort needed to get a test the more threatened an individual must feel before getting tested. If one needs to jump through lots of hoops to get a test, then individuals will wait to get tested until they have symptoms, or even worse they might wait until they start feeling really sick. When you have a disease that is passed along by non-symptomatic individuals, a high barrier to testing becomes dangerous.

Consider the circumstance where you would like to visit with a vulnerable individual. If the last time you got tested and it was easy then you will likely get tested again and you will be protecting that susceptible individual. If getting a test was challenging then you are less likely to get tested. You might say to yourself “well my previous test wasn’t positive so I don’t need to get tested now.” This is a dangerous way to think because the chances of getting COVID-19 now are probably higher than they were at the start of this pandemic. You will be putting the individual you are visiting with at risk.

You can even see this in the testing data. Look at July 4th the number of tests on July 4th were low and the positivity rate was abnormally high. I suspect that this means that only people who were really actively sick went to get tested. There were probably many more people who should have gotten tested on the 4th of July but didn’t because it was inconvenient.

During the July 4th weekend highlighted in orange the number of tests run was abnormally low and the percentage of tests that came back positive was abnormally high.

Testing for socialization: You can be tested for any reason.

Testing is incredibly useful for socialization and reopening. If you want to shift from one social pod to another responsibly, all members of each pod should ideally get tested. If you are starting to see vulnerable friends and relatives, you should be able to get tested. If you are going to a medical appointment, you should be able to get tested prior to the visit. There are a myriad of reasons that one needs to get tested.

Grading the effectiveness of testing by region.

San Francisco: A-minus Good but needs better messaging

I’ve been able to get tested when I’ve needed it and gotten results back fairly quickly. That is the status for me, a privileged, pushy, white man, it is not the status for most people in SF. I’m concerned that the easy testing reality and messaging isn’t getting to the most vulnerable people. San Francisco’s messaging needs to scream ease and yell about SF’s support. The messaging needs to reassure everyone that they can get tested no matter what their situation.

Bay Area: B Lagging where it should be

My relatives and friends in the Bay Area haven’t had as easy a time getting tested as I have. I would like to chalk this up to the fact that I am pushier than they are, but looking at the Bay Area counties’ testing websites I fear that is not the case. They have needed to go through their health care providers and in some cases make up excuses. To my knowledge other Bay Area counties are not plastering neighborhoods with “Go get tested” door hangers and posters the way San Francisco’s neighborhoods are.

California: B or C unknown

I don’t have good friends in CA but outside of the Bay Area so I don’t have a lot of insight into the state of CA’s testing. I do not know how Gavin Newsom is helping or hurting the statewide cause. The grade above is my best impression about how things are going at a state level. Certainly the positivity rate of 8% in CA is decent but not great.

National: F No support being given

The fact that the national government has pitted the states against each other for resources actively hurts the national response to COVID-19. This is especially true in the testing arena. In an ideal scenario the national government would be procuring testing resources cheaply and helping those resources go to the neediest places. This national coordination would allow for the most efficient use of scare resources. Unfortunately this coordination takes trust in the national government and trust between states and regions. All the governmental entities and citizens would need to believe that allocation decisions were being made wisely. Even without our current dysfunctional leadership it is hard to see that happening in the current political climate and this dysfunction is so sad.

What is going wrong: Dysfunction in American health care is harming COVID-19 testing.

The fact that hospitals who have contracted with one highly impacted testing provider cannot easily make use of a second un-contracted testing provider with excess capacity is just stupid. The fact there is under-utilized testing capacity is insane. The Daily Podcast- State of Testing (This is from back the end of April. I .can’t believe it is still relevant.)

The fact that Santa Clara county was depending on Kaiser to make testing more widely available in Santa Clara county to get the county’s testing rate up is dysfunctional. San Francisco Chronicle- Health officials demand major Bay Area private hospitals, clinics ramp up coronavirus testing

Individuals should not have to navigate the disjointed American health care system to get tested.

The take away: Go get tested, go get tested, go get tested

Given that COVID-19 spreads asymptomatically, you need to be advocating for others to go get tested at the merest whiff of an excuse. You cannot do a good job of advocating if you don’t know what the process is like yourself. Go get tested at least once so you can tell others how to do the same.

Once you’ve been tested look back at your experience.

Testing barriers: Was it at all hard to get a test? If so, complain to your leaders.

If you encountered any barriers, even minor ones, in your path to getting tested, complain to your local department of public health and your local leaders.

Turnaround time: Did the process take more than two days? Of so complain.

If it takes a long time for you get an appointment and / or to get your results back, you should complain to your public health department and your local leaders.

Postscript: My experience getting tested in San Francisco

I have now been tested four times for COVID-19. Here are the circumstances and my experience each time.

One: Testing just to get tested.

In late April I volunteered for the Unidos en Salud / UCSF Garfield Park study and they offered tests to volunteers. I took the opportunity just for the experience. Both the active infection test and the antibody test came back negative which wasn’t at all surprising. The nasal swab was deep and really uncomfortable.

Two: Testing after volunteering to help test others.

In late May I volunteered for the District-10 testing push. I was working at the symptomatic tent. After this event I wanted to be able to visit my mother-in-law who is a vulnerable individual and so I got tested again. Instead of getting tested at this D-10 event I waited a couple of days to make sure that an infection could become active and detectable. In the online registration form I said that I didn’t have any symptoms but that I might have come in contact with someone who was positive. I was able to get a same day appointment and got my results back the next day. The nasal swab was much easier and not as deep.

Three: Testing before visiting my elderly parents.

In mid-late June my family traveled to Portland, OR to visit my parents. I wanted to get a test to protect them. I could have gotten a same day appointment but I decided on a next day appointment and received my results the following day. I again indicated possible exposure to COVID-19. My wife got tested the same time I did but received her results three days later. The swab was again easy.

Four: Testing after returning from Oregon and before going to the dentist.

The trip to Portland and back took me through many regions that had very lax protocols and very little mask wearing. I had an extensive dental appointment coming up soon and wanted to reassure my dentist (and write on their intake survey form) that despite my trip to Oregon I was negative. This time when I went to get an appointment the first appointment available to me was 10 days away way and after my dental appointment. I went in person to the testing center and talked to the person at the gate. She told me that as long as I had an appointment, even if it was a week in the future, I could get tested. I waited in line and was tested two days after scheduling an appointment. I received my result back three days after the test. This is not ideal but it worked for my needs.

A Rant About Testing