Atlas, who has no background in infectious disease, has advocated for a so-called herd-immunity approach, asserting that the federal government should protect only the elderly and the most vulnerable from COVID-19. This would lead to many more American deaths—Sweden, which pursued a similar policy, has a higher case-fatality rate than the United States, the European Union average, Iran, and more than 100 other countries, according to data from Johns Hopkins University—and it may not even work. But more important, herd immunity has nothing to do with testing. There is no reason that advocates of the herd-immunity approach should oppose testing, unless their goal is to let an outbreak spiral beyond control before anyone notices, Andersen said. “If you don’t test [asymptomatic people], you have a lower reported number of cases, but you end up with more cases overall. And you end up with more deaths and more hospitalizations, which you can’t hide, because you lose control of the virus.”
The change to the CDC guidance is not the only disruption of the testing landscape. In the past month, doctors and hospitals have started to use faster but less sensitive tests to look for the coronavirus. Unlike the gold-standard PCR tests, which detect genetic material from the virus, these tests look for the presence of chemicals, called antigens, that make up the virus. As we’ve written, these antigen tests will be a crucial tool in defeating the pandemic, because they will let offices, nursing homes, and other semipublic places identify contagious but asymptomatic people before they spread the virus.
We believe that dark testing is happening, because we see a hole where data about antigen testing should be. Millions of antigen tests are now being manufactured every month. Quidel, a $6 billion company that makes one of the most widely used antigen tests, says that it began producing at least 1 million tests a week earlier in the summer. In recent days it has upped that rate to nearly 2 million. “We don’t have any inventory,” Doug Bryant, its chief executive, told us. “We ship every day with what we have.” Becton Dickinson, which makes a competing antigen test, has predicted that it would be manufacturing 2 million tests a week by the end of September.
Some federal agencies have made these tests central to their national strategy. In August, the Centers for Medicare and Medicaid Services announced that it would buy antigen tests from Quidel and Becton Dickinson, for nursing homes nationwide. Estimates calculated from agency data suggest that it will distribute 2 million to 4 million tests to more than 13,000 nursing homes by September 30.
Yet these millions of tests are missing from the public data. Only six states, representing 50 million people, make separate antigen-test data readily available. Those data show that a mere 215,000 antigen tests have been reported since early August, when they first appeared on state dashboards. Even if the data are taken as representative of the U.S. as a whole, and scaled accordingly, they imply that only 1.4 million antigen tests have ever been conducted—far fewer than the number of tests that companies have shipped since June, which is on the order of tens of millions.