The Trouble with Testing

Deborah Birx is at it again, urging mass testing for the detection of bird flu. She wants cows and dairy workers examined to ferret out asymptomatic infections and exposures in animals and people. We have the technology so why not use it, she demands to know. We are making the same mistake we made with Covid early on, she argues.

The role of testing is relatively uncontroversial but it probably should be. Early on in the Covid crisis, though completely against the lockdowns, I was an enthusiast for testing simply because I thought doing so would overcome the epistemic void that was driving public panic.

If you are scared of a disease and have no means to discover whether or not you have it, what is your choice but to hop around in a frenzy and comply with every edict? That was my thinking in any case. We live and learn.

What’s left out of the testing issue is the great question of why. Is it track, trace, and isolate? That has been proven impossible – and long known to be impossible – in the case of a fast-spreading and fast-mutating respiratory virus with a zoonotic reservoir. They tried it anyway with many states quickly hiring tens of thousands of contact tracers.

The iTunes and Google app stores had contact tracing programs you could download. That way if you came close to someone who had tested positive, you would be alerted. It worked like a digital leper’s bell. In fact, even now, the airlines are still doing Covid contact tracing for flying in and out of the country.

Another possible rationale is likely the one in the mind of Birx. She was formed in the AIDS era where the goal was zero infections. Early on, she was a proponent of zero Covid and made that very clear. She is a virus exterminationist: every policy is structured to drive infections, cases, and even exposure to zero, despite the utter impossibility of this goal.

Another possible rationale would be to discern early intervention therapies for people who need them. But realizing that goal is contingent on two other conditions: having therapeutics available and knowing with some sense of confidence that an asymptomatic infection is certainly going to get worse.

Think of the movie Contagion (2011) in this way. It was a killer virus that you get and get worse and then die, all rather quickly. In the movie, the job of the health authorities was always to find the infected and notify everyone with whom they had contact. By the way, this didn’t even work in the film but we are presented with some impressive disease forensics that ended up isolating patient zero.

Again, the question beckons: why are we doing all this? The goals of stopping the spread, driving exposure to zero, and actually treating the sick (if they are sick versus just exposed) are certainly in tension with each other. If you are going to embark on an elaborate and invasive scheme to find and isolate every instance of the pathogen, it’s a good idea to know what precisely you are trying to achieve with the effort. No interviewer has been smart enough to ask this fundamental question of Birx.

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