The social value of testing has been ignored by public health responses to the Covid-19 outbreak, writes Dr Alice Street in the Scotsman.

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Testing and Trust is a rapid social study to investigate public understandings, expectations and experiences of COVID-19 testing in Scotland. This study will help the Scottish Government understand how to build public trust in their COVID-19 testing strategy and health services.

This research is funded by the Chief Scientist Office’s Rapid Research in Covid -19 programme.

We are interviewing members of the public in Lothian about their experiences, concerns and expectations of COVID-19 testing, and opinions about the government’s response to the pandemic.

The study is being conducted by a team of social science researchers at the University of Edinburgh.

Original title was; The social value of testing. (‘De Maatschappelijke meerwaarde van testen’)

Knowing if you have a corona infection can help contain the virus and increase the willingness to adhere to strict rules of isolation. Therefore, Eva Vernooij, medical anthropologist, and Daniël Warmerdam, molecular biologist, argue for a comprehensive testing policy which takes the social value of testing into account. Investing in innovative diagnostic technologies can help expand testing capacity.

In the first month of the coronavirus outbreak in the Netherlands it was not possible for people who are not hospitalised to get tested for coronavirus because this was not considered to have additional clinical value. This decision was informed by the advice of the Outbreak Management Team (OMT), who argued in favour of a restrictive testing policy because of changes in the epidemiological situation, high workload and a looming shortage of testing materials.

Recent discussions amongst politicians and the media have mainly focused on the scarcity of testing materials underlying the restrictive testing policy. However, we argue that besides the epidemiological and clinical value of testing, there is a social value of testing which is not sufficiently taking into account. Further, we think there are untapped opportunities in the field of innovative diagnostics which can help increase the test capacity in the Netherlands.

From our experience and knowledge about the role of testing in infectious diseases, such as HIV and Ebola, we know that people who are aware of their infection contribute less to onward transmission of an infection compared to people with unknown disease status. Knowing if you have a corona infection can therefore help to contain its spread. In addition, testing can increase peoples’ sense of responsibility, as well as the willingness to (continue to) comply with increasingly strict rules of social distancing and isolation.

We hear from many people, both young and old, that they would like to know whether their flu or severe cold is caused by a corona infection. Should we not applaud the eagerness of people to test? If it turns out that people who have been infected have built up immunity, they could leave their house again, and resume work or daily activities, without the fear of infecting others.

Recent early scientific insights[1] indicate that people who have been infected with Covid-19 develop immunity. Expanding testing capacity therefore has another kind of value, as an increased percentage of diagnosed infection will enable a more effective use of vaccines, when they become available. People who have tested positive for Covid-19, will likely not require to be vaccinated. So even if we don’t invest in mass testing now, it will be necessary to roll out large-scale immunity testing in the near future. Since the demand for these tests will increase worldwide, the availability of such tests is extremely uncertain. Investing in research to develop innovate diagnostic solutions is therefore desirable. New technologies such as Crispr-cas can be used to develop high quality diagnostic tools, are easier to scale-up than the existing corona test, and its production is not dependent on pharmaceutical companies.

In the press conference from 7 March 2020, the Dutch Minister of Health indicated that the test capacity will be increased in the coming weeks through collaborations with various diagnostic laboratories. Hence, more testing is possible after all, and logically it will first be focused on increasing the testing capacity for health workers. We believe that a more comprehensive approach to testing is still desirable, which includes mass testing for immunity.

We hope that in a subsequent meeting from the Outbreak Management Team, the increasingly important social value of testing will be taken into account. We also hope that scientists from other disciplines, including the social sciences and biotechnology, will be invited to take a seat at the table at the next meeting to discuss alternative diagnostic solutions and the social value of testing.

[1] https://www.medrxiv.org/content/10.1101/2020.03.02.20030189v1

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