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Even with a vaccine, widespread COVID-19 testing is still crucial, experts say
By Laura Krantz Globe Staff,Updated December 18, 2020, 8:53 a.m.
People follow the arrows on the sidewalk at the coronavirus testing site at Tufts Medical Center. The testing system in Massachusetts is still a confusing patchwork of locations, costs, requirements, and turnaround times. Suzanne Kreiter/Globe StaffSuzanne Kreiter/Globe staff
As collective hope climbs and doses of the long-awaited COVID-19 vaccine fan out across the United States, many are eager to look past the painful nasal swabs, long lines, and slow turnaround times that mark the country's flawed testing system.
It won't be that easy.
The onset of a vaccine only strengthens the need for a robust and responsive COVID-19 testing system, experts say, and we will need more testing than ever in the coming months because the virus is still raging and the vaccine's effectiveness remains unclear.
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"Our current efforts are not cutting it at this moment, and we still have much of the winter and spring to get through," said Ramnath Subbaraman, an infectious diseases physician and epidemiologist at Tufts School of Medicine. "We should be aiming to expand testing in parallel with the rollout of the vaccine."
A host of vaccine variables and unknowns, combined with a still scattershot and slow testing regimen, has Subbaraman and other health experts troubled. Cases have skyrocketed to record levels in recent weeks and it will be a while — at least several months — before the majority of the population will receive a shot.
Meanwhile, experts are concerned people will drop their guard and begin to socialize more. They say the key to getting past the pandemic is more testing, not less.
"I'm really worried, and I think a lot of us in public health and those of us who are also clinical providers are just concerned about a sense of complacency around this," Subbaraman said.
Massachusetts is a national leader in its per-person testing rate, ranking behind only Rhode Island and Alaska, states with much smaller populations. At the same time, the system here is still a confusing patchwork of locations, costs, requirements, and turnaround times. People stand in line for hours and results are often delayed up to a week. Despite some small improvements, there are no large-scale plans to dramatically increase the amount of testing in the months ahead.
Experts cited several reasons why the need for testing remains high during this phase of the pandemic.
First, vaccine supplies are limited and the rollout will be staggered. The first doses, which arrived this month in Massachusetts, will go to health care workers and residents of long-term-care facilities.
The general population in the state won't start receiving initial vaccine doses until April at the earliest, state officials have said. It's this population — not health care or emergency workers — that is responsible for much of the virus's spread, according to most experts.
A second point of caution: uncertainty about how long the vaccine stays effective. It is also unclear whether the shot protects only the recipient or whether it also prevents that person from transmitting the virus to others. The only way to know? Again, testing.
State officials have stressed that the need for social distancing and mask-wearing will not evaporate anytime soon.
Dr. Paul Biddinger, who chairs the COVID-19 Vaccine Advisory Group, has said that even those who are vaccinated will have to continue to take those precautions.
"Until we get to high enough levels of vaccination, we need to be following the same guidance all together," he said. "I can't take my mask off because I've been vaccinated; it's why we're all in this together and need our vaccines."
The plan for distributing the vaccines to the general public has yet to crystallize. If some sort of mass vaccination sites are utilized, they could also become a risk for spreading the virus, said Iain MacLeod, a research associate in the Department of Immunology and Infectious Diseases at the Harvard T. H. Chan School of Public Health.
MacLeod said it might be necessary for people to be tested before they receive the vaccine.
"The vaccine rollout is not going to replace testing anytime soon," he said.
MacLeod is also cofounder and CEO of Aldatu Biosciences in Watertown, which is working on developing a nasal swab that will test for the flu and COVID-19 at the same time.
The state has acknowledged the need for more testing. Governor Charlie Baker announced this month several new testing sites in areas that had been relative deserts, including Western Massachusetts and Cape Cod.
He also pledged to supply over the next month up to 150,000 rapid tests for community health centers and community hospitals that have been besieged with requests. The Abbot BinaxNOW tests return results in 15 minutes.
The changes will help, but without increased testing on a much wider scale, they are unlikely to drastically improve the state's ability to quickly detect cases and curb spread.
Among the many priorities outlined for 2021, officials have cited the need to keep schools open in the spring. Experts said that widespread, frequent testing is likely the key to continuing some form of in-person learning until the vaccine is widely distributed. (The drug has not been tested in children and they are not eligible at this time to receive the shot.)
Colleges and universities successfully employed this so-called surveillance testing approach this fall, conducting tests of all on-campus staff and students at least once a week. It's largely worked. The institutions avoided any widespread outbreaks.
Related: From campus, a lesson in controlling the virus
Now, some experts suggest an expansion of that approach, which would lean heavily on widescale, quick turnaround tests.
"I don't see why we wouldn't be aiming to expand surveillance testing right now given the success we have seen in colleges and universities," Subbaraman said.
Several instances of this tactic have proved to be successful. In October, the Wellesley Public Schools used privately raised funds to begin testing middle- and high-school students and teachers once a week. The district spotted a small cluster at the high school mid-November that prompted a two-week shutdown.
Wellesley has formed a consortium with several other communities, including Watertown, Somerville, Brookline, Revere, and Chelsea, to trade ideas and to talk to state education and government leaders about the need for testing equity across all school districts.
Phoebe Olhava, a radiologist at St. Elizabeth's Medical Center, helped set up a similar testing program at the after-school preschool program at Temple Beth Shalom in Needham.
The school swabs its staff once a week, she said, through a partnership with the Cambridge Innovation Center. The specimens are sent overnight to a lab in Tennessee, which pools the samples together in batches to be tested, a cheaper way to process results.
Olhava said the after-school program is a case study in how that method could be used in other settings to prevent outbreaks.
"Even with the vaccine coming, we are going to continue to need testing," said Olhava, who also works with Rapid Tests, a volunteer group directed by Harvard epidemiologist Michael Mina that advocates for rapid tests to be made legal and widely available.
"Widespread vaccination is a goal, but it's not tomorrow, it's not next week, and it's not next month. We have a long way to go," she said.
Laura Krantz can be reached at laura.krantz@globe.com. Follow her on Twitter @laurakrantz.
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