Opinion

The Checkup With Dr. Wen: Who should still be tested for the coronavirus?

But that doesn’t mean doing away with testing entirely. To protect high-risk individuals from covid, there are four groups of individuals who should still be tested for the disease:

1) People eligible to receive treatment. There are two treatments for individuals diagnosed with covid-19 that reduce the risk of progression to severe disease.

The easiest one to take is the antiviral pill, Paxlovid. When taken within five days from the onset of symptoms, Paxlovid is 80 percent effective at reducing the risk of hospitalization and death. The other option is remdesivir, though it is more cumbersome to access as it requires infusions or injections.

Everyone should have a plan for what happens if they contract covid. They should know if they are eligible for these treatments and how to access them. Because prompt diagnosis improves outcomes, anyone who intends to take Paxlovid or remdesivir should get tested if they have symptoms or exposure. This group would include those older than 65 and people with immunocompromising or other serious medical conditions.

2) Individuals in close contact with those vulnerable to severe illness from covid. Readers often ask about who should be tested before group interactions. Juliet from Wisconsin, for instance, wrote that her school-aged grandchildren and their parents are visiting her soon. “I’m undergoing chemotherapy, so should we all get tested to keep each other safe?” she asked.

I don’t think so. Assuming that Juliet’s kids and grandkids are generally healthy, Juliet doesn’t pose a risk to them, but they could to Juliet. They are the ones who should be tested, not her.

People at high risk for severe illness should ask those in close contact with them to test before seeing them. To be extra safe, visitors should reduce their risk by wearing high-quality masks in crowded indoor settings for five days before seeing the vulnerable person, then test just before arrival.

What if a low-risk person lives with someone who is high risk? That’s the case for Enid from Oregon, who takes care of her elderly parents. Like her parents, she should test if she has symptoms or is exposed to someone who has covid, and she should take precautions in her daily life to reduce her risk of infection.

3) Those living in congregate settings. I think it’s reasonable for nursing homes, jails and other facilities where outbreaks can be deadly to implement routine testing. Nursing homes, in particular, should also consider requiring up-to-date boosters for residents, as these individuals are among those most likely to require hospitalization if they become ill.

For this reason, I understand why hospitals continue to test for the coronavirus. Even if someone comes in for a reason unrelated to covid — for example, if they have a broken arm — they might be placed in a room with a high-risk individual. I’ve written before about how hospitalizations need to be categorized as those with covid versus those for covid. But just because it needs to be clearer when hospitalizations are attributed to covid doesn’t mean hospitals must stop routine testing.

4) People who are living with strict covid precautions. Recent recovery from infection conveys robust protection for at least a few months. The added protection is strongest in vaccinated individuals, who benefit from hybrid immunity.

That means that for folks who are still taking precautions to avoid covid, testing could help them decide when they can let their guard down for at least a few months. Knowing whether they just had covid could make a difference in their daily lives. They can choose to continue to test if they develop symptoms.

The end of the national emergency around covid means that testing will become more limited. It makes sense to direct tests and other resources to where they are most needed.

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