Its too hard to get tested. Now, before you tell me how easy it was, hear me out. I mean the psychological barrier of testing is too high.
Testing positive brings a host of overwhelming problems for many: they are trapped at home in small apartments with no outdoor space; they cannot work and fear losing their jobs; they may be forced to isolate with young children who are impossibly mentally taxing without activity and space; there may be medical needs they cannot meet; or critical needs they cannot address. The social, personal, and work implications of testing positive or being placed in isolation are enormous. This places the psychological focus on “how can I continue working” instead of “how can I stay well and protect those around me,” and drives people’s personal decisions not to test.
A friend called me the other day, her 2 year old daughter was being sent home to self-isolate for two weeks because a classmate was confirmed COVID positive. She had a lot of questions. Does the whole family need to isolate now? Must the parents not work (-- because they cannot afford that)? Do the siblings need to stay in the apartment? Do they all go for testing? If the results are negative can they leave isolation? If the results are positive, does it make their isolation longer? It doesn’t help that the perception of the test is that it is painful, that access requires long waits in lines, and that delays in reporting mean people miss work even when negative.
A difficult and familiar predicament to be sure. In an effort to shift the psychological burden of decision-making to someone without personal bias, I had her call the MOH. She sat on the line for hours over multiple tries before giving up, “no one ever answers there.” Instead I directed her to their pediatrician. In complete misstep with public health recommendations, the doctor advised her not to test her exposed daughter as she was asymptomatic “and there are not enough tests” – But most children who spread the virus are asymptomatic! Further, when my friend developed cold-like symptoms a few days later, her personal doctor advised her not to test “since those are not typical COVID symptoms”—In fact 50% of COVID patients report runny nose, and 40% have stomach upset. We have long moved beyond the initial phase where we screen for cough, fever, and travel; now any viral symptoms should be tested.
The way to get COVID under control is testing. If we know who has it, we can isolate just those people and support them until they are well, protecting the rest of the population, and opening the economy to the healthy. We need clear, strong, country-wide policy about when and whom to isolate, encouraging testing of everyone symptomatic or not, and providing full government support those who require isolation. To break it down:
1. Publish clear, evidence-based guidelines, in multiple languages about who must be in isolation. These guidelines must be clear to patients, doctors, employers, etc. If we are all working from the same playbook, then the stigma is somewhat addressed, as we are all now just following the public health rules.
2. Testing should available to all, recommended in all cases, and with a same-day turn-around time. If we do not have enough capacity for this, then this must be the priority. People who are out of work can be trained to test and process, let this be a country-wide effort.
3. Pay the salaries and guarantee the jobs of anyone put into isolation. It is better than sending checks indiscriminately to every citizen’s account, and people being able to stay home will slow the spread of the virus and keep the economy open safely
People want to do the right thing. They want to protect their friends, families, and communities. But the psychological strain of risking their jobs, being without income, and trying to make the right decisions while being told contradictory information from medical and public health professionals is too much. To get this pandemic under control and reopen the economy, we need the government to remove all barriers to testing.