The Case for Universal Mandatory COVID-19 Testing

Without a vaccine, it’s the only safe pathway back to something resembling normal life.

The Trump administration has failed miserably to test and track the initial spread of Covid-19 infections, as South Kora did. Its failure has brought terrible suffering to thousands of Americans and enormous economic costs.  That’s why dramatic measures are necessary to establish a nationwide system for universal testing and tracking. Otherwise, we will continue to live in a state of dangerous uncertainty. It doesn’t matter whether the virus dissipates this summer, fades and then roars back in the fall, or sticks around until well into 2021. Eventually, new infections may fall substantially and on a sustained basis. When that happens, Americans will need a safe pathway back to life outside their homes.

Of course, the best outcome would be the development of a vaccine. Once it is approved by the Food and Drug Administration (FDA), manufactured en masse, and ready for nationwide deployment, everyone can be vaccinated before returning to work and congregating with others.

In the meantime, the federal government has to work with the tools at its disposal. That means it should enact a program of universal mandatory testing once the outbreak has receded—i.e., require that everyone get tested for the virus. Only, then, when testing shows that they are not infectious, can they end their practice of social isolation and distancing. Everyone found to be uninfected or immune after being infected and recovering could receive a certificate authorizing them to return to work and congregating with others so certified.

While a few legal experts may question the government’s authority to make testing mandatory, the government clearly has powers to promote people’s safety on a mandatory basis, from legally enforceable clean air standards and child labor laws to the requirements to use safety belts.

All Americans will fall into one of three groups: Group 1: the millions of people who have contracted the coronavirus and recovered. Of course, scientists are not yet fully certain that those people will develop immunity, but there is some basis for optimism. The CDC has said that people infected with a similar coronavirus, MERS, were highly unlikely to be re-infected after recovering.  Other researchers report that the Covid-19 virus does not mutate easily, a prerequisite for the antibody response that would make people immune to reinfection.

There is less evidence, however, about whether those who have recovered are unable to infect others. But we can derive a reasonable answer from undertaking a round of mass tracking. The United States, China, Italy, Spain and many other countries need to start collectively tracking recovered coronavirus patients to see how many, if any, show up re-infected or have infected others.

If two-sided immunity holds, those recovered from the infection would be the first wave to return to work and community life.  In Germany, scientists from the Helmholtz Centre for Infection Research are conducting a pilot program along these lines, testing 100,000 people for Covid-19 antibodies and issuing “immunity certificates.  ”What about everyone else? They fall into Groups Two and Three.

Group Two would be the majority of people who have not been infected and are still vulnerable to catching Covid-19.  In theory, they also could return to something like normal life—but only if they are protected from contact with those actively infected.

Those people comprise Group Three, current COVID-19 patients, including pre-symptomatic and asymptomatic carriers. They will pose an enormous risk. Once new infections slow, some people actively infected will try to forgo any universal testing and return to work and social life, where they will infect others with the virus.

Therefore, the testing regime with require sanctions. One idea: Employers who take back or hire anyone without the requisite certificate would either forgo or have to repay any of the financial support Congress has provided businesses. Those actively infected who try to masquerade as a member of Groups One or Two could be placed in government quarantine and held legally liable for anyone they infected.

This path to a relatively safe, new normal will also require simple, reliable tests that produce their results quickly. In the last two weeks, the FDA issued Abbott laboratories an emergency authorization for a portable coronavirus test that can detect the virus in five minutes. Bodysphere, Inc. received a similar emergency authorization for a serological testing kit that can establish a positive or negative result in two minutes. The FDA is also considering new finger-prick blood tests that can detect the antibodies produced by the immune system to fight the virus.  Such blood tests are simple to carry out and the results can be quickly known without laboratory equipment. China has deployed such tests, and at least one company, Scanwell Health, is seeking the FDA’s approval for it as a home test.

As soon as the FDA approves simple, reliable, safe and rapid tests, the president should use his authority under the National Production Act to direct manufacturers to produce the hundreds of millions of tests that will be needed for a safe pathway back to normal life. Of course, we don’t have enough tests now for all the Americans who need them. The government will need to take dramatic actions to ensure that there will eventually be enough tests for every American, period. It will have to start now.

In fact, the infection’s path across the country suggests that universal testing could occur not everywhere at once, but on a rolling basis. New infections have slowed markedly in California and Washington State, , and the locations of new viral hot spots appear to be determined by factors that differ markedly across cities and states—including population densities, how quickly and strictly people adopted social isolation, or at least social distancing, and other factors that scientists will establish after the fact. As a consequence, the substantial and sustained declines in new infections that should trigger where universal testing and certification should occur in a serial fashion, moving from place to place across the country.

Admittedly, this approach is an imperfect one. But until scientists develop an effective vaccine, universal testing to certify each of us as uninfected is the best path available for a relatively safe return to something resembling life as we once knew it in America.

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Robert J. Shapiro

Robert J. Shapiro, a Washington Monthly contributing writer, is the chairman of Sonecon and a Senior Fellow at the McDonough School of Business at Georgetown University. He previously served as Under Secretary of Commerce for Economic Affairs under Bill Clinton and advised senior members of the Obama administration on economic policy.