Random testing could help North Carolina better fight COVID-19

President Trump appears headed for a showdown with North Carolina Gov. Roy Cooper and other governors over whether it’s time to send Americans back to work or whether it’s urgent that most workers and school children stay home to prevent the further spread of COVID-19.

One way to assess which course is right for North Carolina is to launch broad random testing for the new coronavirus. Those results will help state officials estimate how far and fast the disease is spreading and how many are infected without symptoms. Eventually, new tests still being developed may show how many have had the disease and perhaps have acquired immunity.

With that data, Cooper and state health officials can better weigh social distancing measures against the damage that those measures do to state and local economies when taken to the extreme.

Dr. Zack Moore, the state epidemiologist, said surveillance of the disease needs to progress, but he does not think random testing is the next step. Instead, he told the editorial board, the state will begin monitoring COVID-19 the way it monitors influenza, by using a network of emergency department and hospital admissions data. “These tools will help us track where we are with COVID-19,” he said.

But could the state do better? Among those advocating random testing is state Sen. Andy Wells (R-Catawba). In a statement issued Monday, he said: “Random sampling is a proven method of accurately measuring large populations and has been utilized for decades to inform all manner of decisions in both public and private spheres.”

Wells noted a recent commentary by John P.A. Ioannidis, a professor of medicine and epidemiology at Stanford University School of Medicine. Writing in the science and medicine journal STAT, Ioannidis said, “The most valuable piece of information for answering those questions would be to know the current prevalence of the infection in a random sample of a population and to repeat this exercise at regular time intervals to estimate the incidence of new infections. Sadly, that’s information we don’t have.”

Some governors are calling for better information on how the disease is moving. In Minnesota, Democratic Gov. Tim Walz initially held back on having his state join other Midwestern states that have imposed shelter-in-place orders. “I think (other governors) are making their best judgment that, with the lack of data, (shelter in place) is the way to go,” he said. “There are different epidemiologists that see this differently.” Walz eventually issued a stay at home order but wants to see more computer modeling of the disease.

In California, Democratic Gov. Gavin Newsom, who has imposed a statewide shelter-in-place order, said testing needs to be refocused to provide surveillance of the disease in the general population rather than only testing people who show symptoms. He noted that that approach is already being taken in Los Angles, Orange and Santa Clara counties.

The federal government’s failure to provide sufficient test kits has left North Carolina and other states partially blind to the full dimensions of the new coronavirus. But North Carolina is acquiring more test kits from the federal government, and private testing companies and universities are adding more. North Carolina can use a portion of that added capacity to randomly assess the state’s population.

Random testing may show officials that there is a need to do more, or that they can protect the public and the economy by doing less. To see the right path, North Carolina should refocus testing to get a clearer view of the COVID-19 landscape.

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