Covid19: Competing purposes of testing

At this stage of the pandemic, I question what is to be gained from testing for infection.

If a person is sick, the testing is valuable to determine whether the person should be quarantined or others should take precautions when in contact or in close proximity to the infected.   However, the testing does not really change the treatment.   Being a viral disease, there is no specific treatment other than giving the body the time to fight it off itself.   Any treatment will be directed to the conditions caused by the infection.  Conditions such as pneumonia that is treated the same as any other case of pneumonia where the only variation is based on the severity.    Knowledge of the type of virus does not change the treatment, although it may help in planning for how much time will be needed to recover.

Earlier in the initial expansion of the virus, the testing provided a measure of the spread itself.   In other words, it provided a statistical measure to estimate the at-risk populations, and to estimate variables such as transmissibility, incubation times, and health outcomes.   These are more valuable for public health planning and preparation than it is for healing the sick or even for reducing the spread.   I understand that these population-scale metrics need refinement and updating, especially as evidence of virus mutation becomes known.   It appears to me that the testing does little the change the outcome of the infected, and it does little to slow the spread of the disease.

Meanwhile, there is a big demand from the general population to be tested.   Unless they have advanced symptoms, this type of test application has personal benefits of giving people the peace of mind that they are not yet infected.    Unfortunately, such peace will last only a couple days, after which they would need another reassurance test.

Reassurance testing for negative results presents a problem in that it builds a misleading sense of confidence.   People with confirmed negative test results will feel justified in ignoring public health recommendations such as social distancing.   As they return to their normal lives, they will tend to avoid people who have not been tested even if those people are at low risk of being infected.   The test results could become a form of a class differentiation: those who have been tested with negative results vs those who have not been tested at all.    They will segregate from each other.

Over time, the recurring testing may build a sense of invulnerability.   There is already a notion that many infected self-heal without ever noticing any symptoms.   Also, there is a sense that there could be natural immunity or acquired immunity.   As time goes on, a person repeatedly getting negative test results will assume he is not vulnerable at all.   I suppose the same thing will happen for everyone as time continues and they have not yet experienced any problems.    The problem with the negative testing is that it will give that subset of people that confidence earlier.    Even if this does not present a public health problem, it could lead to social problems, particularly in terms of how people choose to rearrange their network of relations whether that is involving work, services, or recreation.

There seems to be a parallel between the current situation with the Prohibition era about a century ago.   Both involved massive government intrusion on how people gather socially.   I suspect we will see something similar happening now, where people will recover their social gathering habits by moving what they once did in public establishments.    As during the Prohibition where people moved their social gathering from public bars and saloons to their private residences, I think the same thing will happen now.   Social gathering in comparable numbers will resume but they will be in private “speak easy” locations with restricted entry to those who have the right test results instead of knowing the right password.

As I write in my series on dedomenology, a short interval of intense enforcement of some rule will lead to long lasting behavior changes in the population.   Once lifted, people will resume their new learned behaviors, never to return to their prior behaviors for many generations.

I think we should consider the policies for deciding how to distribute the Covid19 tests in light of the impacts it has on behavior.   Perhaps the predicted change in behavior is in our best interests, getting people to redirect their preferences away from the recent trend of urban renewal and instead focus on a more suburban and secluded pattern of socialization.   This should be discussed and debated instead of falling into the consequences accidentally.

Alternatively from the dedomenocratic perspective, Covid19 testing should be optimized for statistical sampling of the entire population instead of identification of every individual case.   Identifying individual cases does not really make a difference in treatment other than for isolation that is equally warranted for any pneumonia patient.

Statistical sampling is more efficient by extrapolating tendencies from a sufficient sample size.   We can take advantage of this sampling efficiency to gather more data about vulnerable populations, about the extent of asymptomatic populations (and carriers), and about changes in impacts on the same population over time.   Doing this can give us much better information for public policy making than by fixating on the universal testing of just those who are having qualifying symptoms.

From the perspective of governing by data and urgency, the priority should be on gathering data and being very cautious about assessing the urgency of disruptive policy making.    Gathering data in unperturbed populations gives us the best data to understand both the pros and the cons of policy options.   Meanwhile, implementing intensely disruptive policies such as universal social distancing and extensive testing could cause long lasting consequences, unintentionally and perhaps with disruptive changes in how people socialize and thus how the economy operates.

It would be nice if we can make these policy decisions with a better idea of all of the consequences, not just the near-term goals, especially when it becomes increasing clear that those goals are unrealistic.    My predication is that wee are not going to stop the spread of this disease, and the illusion of any flattening of infection rates will eventually be shattered by a new outbreak later on when everyone gains confidence that they are invulnerable.

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