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Rapid Covid-19 tests are being deployed by the millions across the nation. The federal government is sending these tests, which can provide results in minutes, to states for educators, students, nursing home patients, first responders, and other sites.

That’s a good thing. But in a rush to get individual test results, we’re making a dangerous public health mistake: We’re losing critical data about Covid-19.

For months, the U.S. has struggled to get accurate information about Covid-19 cases and testing about different demographic groups. As rapid tests surge — and are performed at sites that don’t follow specific Covid-19 data reporting processes — even more information will be lost.

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Accurate data are essential for fighting public health crises like Covid-19. Policymakers need complete, timely information about who is getting the disease to track its spread, identify hot spots, and form effective, equitable solutions. Without data, public health strategies will be haphazard and ineffective.

The Covid-19 pandemic has been a data horror story from the beginning. For months, Americans struggled to get Covid-19 tests, leaving cases of the infection undetected. The data that did exist were woefully incomplete, often lacking important information like a patient’s race and ethnicity.

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Data collection has improved since then, but is still lacking. The Centers for Disease Control and Prevention website has race and ethnicity data only for half of Covid-19 cases. And the Trump administration is under investigation for tampering with the CDC’s Covid-19 reports.

Without significant changes, rapid tests will make this data deficit worse.

Laboratories are required to provide extensive data to accompany Covid-19 tests. According to federal guidance published in June, they must collect and report for each test demographic information such as the patient’s age, race, ethnicity, sex, and ZIP code.

Those are sound reporting requirements. But thousands upon thousands of testing sites nationwide are beginning to operate outside of laboratory facilities and are not equipped to comply with state and federal reporting regulations. That includes the vast majority of nursing homes — major hot spots for Covid-19 — as well as many urgent care and physician offices. It also includes unconventional sites like community testing pop-ups.

So a site could test hundreds of people in a day and not report comprehensive data to local and federal authorities. And if reporting does occur, it could take a while to be entered into a digitized system. That means missing crucial data, particularly information on racial inequities.

Gaps in data reporting will become more common in the months to come. Rapid at-home Covid-19 tests that give on-the-spot results will soon hit the market. These tests provide immediate results, but it’s unknown if they will require people to report their results or demographic information to health departments. That means we could lose millions of data points about Covid-19.

To be sure, quick test results are critically important to combat Covid-19. But those tests should come with the requirement to report comprehensive, accurate data back to local or state public health agencies.

We should be moving forward on data collection efforts, not backward. Fortunately, several legislators and organizations are leading the way. Sen. Elizabeth Warren (D-Mass.) and Rep. Ayanna Pressley (D-Mass.), for example, with others have proposed several bills aimed at accurate, timely data collection. The Data: Elemental to Health Campaign aims to secure $100 million in federal funding over 10 years for the CDC and state, local, tribal, and territorial health departments to modernize health data and create a more effective data system for public health.

And the We Must Count coalition — a collection of racial and health equity organizations for which I serve as a senior adviser — is pushing for uniform data collection and reporting on Covid-19 testing, cases, and health outcomes disaggregated by race, ethnicity, socioeconomic status, and other factors.

We must stop at nothing to get accurate data about the results of Covid-19 tests and other aspects of the pandemic. Otherwise, we will lose our battle against it.

Joia Crear-Perry is an OB-GYN and founder and president of the National Birth Equity Collaborative.

  • I completely disagree with the desire to have every test reported. Testing for COVID to date is a self selected/severe illness report. What is largely being done with rapid tests is to fill in big gaps where testing has never been very helpful in preventing infection.
    Making it more difficult to employ preventive testing would be counterproductive. This is fast moving so everything has to move faster to get ahead of it.

  • One can monitor coronavirus prevalence at a city-wide level by testing the sewage.

    As Harvard prof. Michael Mina has convincingly advocated, we need cheap, rapid, at home, self-administered covid saliva paper-strip tests at around $1-$2/test. These shouldn’t be viewed as or held to the high sensitivity standards of medical tests like PCR, since they would be used rather as public health surveillance tests aimed at breaking transmission chains, catching people while they were able to infect others, catching the asymptomatic, and thereby ending the epidemic. They don’t have to be as sensitive as PCR, just sensitive enough to catch people with contagious levels of virus. Current PCR tests are NOT catching the asymptomatic and with slow turnaround times they don’t even stop transmission. Our current testing regime is not stopping the epidemic. It’s time to do something better and get paper strip tests in production to be used in the home setting. By all means, still use PCR in the hospital to test suspected late-stage patients, ones whose immune systems have already reduced viral titers by many orders of magnitude from those seen early in the course of infection.

  • The FAR bigger issue with rapid tests is their “accuracy.” Accuracy is a loaded term in biostats so I would phrase it as specificity and sensitivity for those people who understand. In laymans terms many of these tests are WRONG delivering both false negatives and false positives (with the tendancy towards false positives given the parameters used to develop the tests). Given that many of these people will be asymptomatic anyways this only really matters for reporting (and political) purposes.

    This is unlike HIV/AIDS where testing standard were really honed. There is a reason why PCR is the standard. Because the screening test for HIV (not PCR) dumped out too many false positives resulting in widespread panic. Hence the much more specific PCR test as the 2nd test in the series.

    Widespread testing of asymptomatic patients is just stupid because if a person tests negative today (assuming that is even correct) then are you going to test them again tomorrow? You can not test the whole population every day. These tests should only be used in cases where people are dealing with high risk populations (nursing homes, hospitals, etc) not for showing up to play in the NFL (for example). Tests run $25-$150 a shot. Lots of waste here.

  • No. No. No. This article shows the tendency to expect government to solve our problems. Everything has to be under institutional control. what needs to happen is for government to give good information to its citizens not the other way around. As for needing good reporting, the government isn’t even recording or reporting the information is gets now correctly. More data points won’t help. We don’t know cases, we know positive tests. We are not reporting hospitalizations or deaths from CLI. The numbers being reported are agenda driven and not helpful for any decisions.

  • Yes, not having accurate data is a hidden “problem,” not a danger.

    Do you know what a hidden danger of not having rapid tests? People not getting tested and spreading the disease to others. Yes, the PCR test is the gold standard. However, a golden standard is useless if you can only get one when you are sick.

    Data reporting is reactive, not proactive. A dashboard is helpful to visualize the pandemic, but it isn’t going to stop the pandemic. Do you know what would stop the pandemic? A 50 cent test that someone can spit on and make a decision about living your life without the potential of making others deathly ill. Why? Because people are living their life anyway or they don’t leave the house, risking mental illness, unhealthy living, and substance abuse.

  • “To be sure, quick test results are critically important to combat Covid-19. ”
    This is a very false statement. A positive test has nothing to do with being sick. This type of data only serves to support lockdowns, mask mandates and quarantine, all of which harm citizens and businesses in many ways. This whole co ro na crisis is a hoax. Many brave doctors have spoken the truth about this scam. You, Joia Crear-Perry are not one of them. Our doctor here told us personally that when our father dies at home (terminal cancer) to NOT call 911 as he will be taken to the hospital and his death will be labeled as co19. Explain that.

    • @Irene. You are wrong. The hospital will most likely label it COVID to get the extra 30% billing bump for COVID. And they wont be wrong as the bump is for treating COVID patients not for people dying of COVID. Most estimates show that 6-30% of the COVID related deaths are FROM with the rest being WITH. His doctor (and I say this as a fellow doctor) is right. And if he dies just call the funeral home and have them pick him up. You do not need to go via a hospital or EMS of the determination has been made that he is chosing to pass at home.

    • This is Deplorably true. Most people are not even aware that at the onset of Covid-19 the medical industry were not even required to test people that passed away for Covid-19 before attributing the deaths to Covid-19. As long as a patient showed one of, I believe it was 5 “clinical symptoms” of Covid-19 they could say the death was result of the person having contracted the virus. Despite the likelihood that the individual may never have even had Covid-19 at all. That was on the CDC web site. That Doctor is not incorrect. That Doctor is honest, & is calling the corruption like he sees it, & there are more Doctors out there saying the exact same thing. The Doctors who are “treating” patients for covid-19 are being paid more for the exact same treatment they would give a patient with pneumonia who was hospitalized so they are lying, & they are unnecessarily hospitalizing patients that have manageable cases.

  • Accurate data is important, but what is much more important if we want to beat this virus is *fast* identification and isolation of people most likely to be contagious. Delays of even two or three days in getting lab test results back, allows plenty of time for viral spread. Longer delays than that are not uncommon in much of the country experiencing surges. Those delays make all those lovely, highly sensitive PCR tests useless for screening purposes. Perhaps it would help to think of inexpensive rapid antigen tests as a huge improvement over the thermometer as a screening tool. No, we won’t catch every positive case. But we will identify many multiples more than we are now — and those will be told to isolate and be given a confirmation test, which *will* be reported.

    • Solution: tie test result availability to health care cards (use technology, app on cell phone, etc). Test results would not be held up. And ALL the required info would be immediately attached. But this might be a huge challenge for America where nothing seems to be tied in with efficient systems.

    • We have had the flu vaccine for over 50 years but we still have the flu. The only reason that we still have smallpox is BECAUSE of the vaccine. .when is the medical system going to focus on prevention and cure? More pills, more injections. These are not beneficial to sustain healthy human life. Our mindset is flawed on our view of maintaining healthy lives.

  • Seems strange to carp about old data being so horrible as an excuse for fast testing being horrible. PCR data taking 2 weeks is useless data except statistically. If we had a decent CDC and FDA, the fast test approach could have required using an app to evaluate AND report. With challenged leadership, I’ll take quick results

    • But Joe- without constant reports of of “spikes” record numbers of cases” etc in the news CONSTANTLY however will the powers that be use the crisis to do whatever they want while we cower in fear? If the infection (truly infectious with the rapid tests, not finding dead virus long after infectious period passesPCR tests) slows dramatically why isn’t that a good thing? Instead bureaucrats do what bureaucrats do- which is taking something effective and easy and make it cumbersome with tons of paperwork to be sure to efficiency is lost and decrease compliance!

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