If you are sick, do not test for COVID19; If your child is mildly sick, do not test & send them to school

Time to return to sensible policies

In this essay, I will build the case that if you are sick, you should not test for COVID19. If your child is sick, you should not test them, and you should send them to school if they are mildly ill. This is the only logical position, and that of the UK.

How do I and the UK experts arrive at this position?

Let’s agree to some facts.

First, nearly no one is currently being hospitalized with ARDS caused by COVID19; Instead, we have a sea of incidental hospitalizations. People who got a COVID19 test, which happened to be positive, admitted for elective procedures, or entirely unrelated complaints. Chemotherapy and other life saving services are being delayed by covid19 positivity— with no evidence that these policies benefit patients or third parties.

Anyone who works in a hospital will say, ‘we are no longer living in the dark days of 2020’— and ‘this is not the same disease’. This is also why I think all therapeutic data needs repeat RCTs. These trials were not conducted against current variants, and pertain to different disease presentations.

The second fact is no covid test manufacturer nor NIAID has shown that voluntary COVID19 testing (among those who want to do it) or even mandatory or systematic testing of healthy people (screening) or sick people (diagnostic/ isolation) slow the spread of COVID19 over 60 or 90 day time horizons. In fact, it is implausible that it does. These efforts are like pouring a glass of water on your lawn before you evacuate for a forest fire. Given all the uninterrupted pathways in society, 100 billion + human interactions a day, having a few rich people in a a few rich nations test a few days a year is laughably naiveté.

Third, there is a misguided moral element to this. I do not want to spread COVID. Ergo, I should test myself, and isolate. Yet, if my actions ultimately do not change covid’s spread over the next 60 days in my community, then my actions are futile. There is no moral virtue to *trying to* not spreading COVID19, if in short time horizons, the same fraction of people get it anyway. The burden is to prove that these actions exert benefit against a backdrop of unabated transmission, which has not been met.

Fourth, COVID19 is going to circulate for the next 10,000 years or until human beings destroy themselves in nuclear war— a topic near and dear to the hearts of the editors. ;)

Now let’s consider the two claims.

If your child is sick, should you test them? No!

School is a huge boon in the lives of kids. It should only be disrupted if someone can prove that the disruption helps others, or if the child is unable to participate in the day. If a kid has a cough or runny nose, you should just send them to school. Here is UK guidance

Testing for COVID risks prolonged absences, and already 90%+ kids have documented serology for prior COVID19. All kids will get COVID now and repeatedly in their lives. Subsequent reinfections will be milder until they reach nursing home age. This is just how life works. If you want to keep a kid home for a positive antigen test and the sniffles, you have to prove there is some benefit to others that outweighs the harm to children’s education. That has not been shown, and is unlikely.

Look at UK guidance on other viruses. So sensible!

Should you test yourself for COVID? No!

Of course, you should not test yourself for COVID19. First, there is no specific therapy that is proven to work in 2023 against current strains. As I detailed in a prior post— EPIC SR (paxlovid) is negative in vaccinated people. No trial— for any drug— is for current strains of COVID. All need repeat RCTs. A person who has a mild illness should do what you have always done. If you feel too sick to work, stay home. If you feel up to going to work, go for it.

Doctors send tests if the information can change behavior. But it is irrelevant which respiratory virus you have, the course of action is based on how you feel. If I feel lousy from rhinovirus, I am going to spend the day in bed.

If someone disagrees with my strategy, ask them to prove their strategy is superior. The test manufacturers have been re-infused with hundreds of millions of dollars (from the Biden admin). Run a randomized trial showing testing (however you like) improves clinical outcomes. Until then, no one should test. It’s been 3 years of hysteria— a singular focus on one virus— ultimately you have to generate data if you want to push for continued interventions. Testing, and altering behavior, is an intervention.

Consider one argument I saw online. An ENT doctor complaining that her practice is closing b/c all the doctors have covid, and masking is needed. Shall we list the errors?

1. She doesn’t make it clear whether the office is closed b/c doctors tested positive, or because they are too sick to work. If the former then there is a harm (disrupted medical service) and no clear benefit (people will keep getting COVID anyway) to testing. Furthermore, on any time horizon, the cases may be similar among all the people touched by the practice.

2. She didn’t prove that they all got COVID b/c one person came in when sick with COVID. If so, did they not test? Had they tested, would the office not be sick? If you take 1000 offices and randomize to test or no test, and follow for the next 18 months, I suspect fewer staff absences and more open days in the no-test group. What evidence does the person who is selling the tests have to offer otherwise? The burden is on her and other proponents.

3. Testing positive leads to prolonged disruption b/c people don’t work when they feel better, some keep testing till antigen is negative— an insanely disruptive strategy that has no evidence it slows spread in communities, or that such reduction in spread offers any tangible benefit.

4. They re-instituted masking, but they might as well have re-instituted slaughtering chickens to gain favor among the Gods. No evidence that community practice masking policies slow spread, and no evidence they offer benefit in clinical settings.

Ironically, the post really drives home the opposite conclusion. Go to work if you feel up for it; stay home if you are too sick to work. Don’t test. And if you feel otherwise, run a randomized trial— after all test makers are earning billions.

Here is another interesting discussion on the topic.

Jennifer Nuzzo is more worried about spreading COVID than rhinovirus b/c there are more deaths, but rhinovirus is not benign, and COVID deaths among the elderly are dropping each year. So who decides what is ok to spread?

She is ok to spread rhinovirus, but not COVID. She practically will spread RSV (but wishes there was a test). But who decides which viruses are ok to spread and which are not? What is the threshold where it is ok to kill some people?

The answer is it is not the severity of the virus that matters, but whether the action itself promotes health. In all these cases, that is unproven, but in one case (rhinovirus) we are indifferent.

Now see Oregon, which is moving towards my thinking, but not there yet.

For these reasons, going forward, we have to treat COVID19 like any other respiratory virus. Use your common sense if you are sick, but testing has to prove it adds value if we are to advise it, and children should err on the side of going to school. With time, everyone will come to this view.