Shivani Ranchod | March 2020
As with so much surrounding the SARS-CoV-2 virus and the associated Covid-19 illness, people world over are faced with trade-offs between the individual desire to be tested and the collective good. The desire to be tested makes sense when we experience symptoms, no matter how mild. There is a strong desire for certainty, in a world that feels increasingly uncertain. Knowing your status means that you can make clearer decisions about whether to self-isolate, and just how careful you need to be. But given that there is no treatment at present, the true value of this knowledge for a mildly-ill individual is mostly psychological.
The problem is that the supply of tests and the ability of labs to process those tests cannot keep up with the large-scale and rapid spread of the virus. In a situation where there is a mismatch between supply and demand, the price would usually rise. That would be an unfortunate outcome in a global crisis. Governments have attempted to mediate this tension between individual preference and the collective good by putting in criteria for who can be tested, with the intention of prioritising testing for seriously ill patients. The drop off in testing is associated with other strategies to slow down the spread of the virus – social distancing, self-isolation and various degrees of shut down.
South Korea are an exception to this. They were able to roll out wide-spread testing – testing more than 270,000 people in a population of 50 million. They were able to illustrate the social value of diagnostics at scale – they combined knowledge of the epidemic with case isolation and contact tracing to bring the epidemic under control (although there does seem to be some risk of a resurgence). The question is whether case isolation can be achieved without the costs and logistics required with such extensive testing, by appealing to the judgement of individuals to err on the side of caution.
At present tests are imported from places like Europe and South Korea and there is significant global competition to access test kits. Even if the price of tests were to drop, there is still the issue of laboratory capacity and the cost of primary care consultations to assess patients for symptoms.
It is useful to frame social-distancing measures as mass action to protect the collective. Similarly, avoiding panic testing helps to ensure that those who need it most have access to it. The SARS-CoV-2 is a vivid test of our humanity, asking in numerous ways to override our fears and to act wisely.