Now that COVID-19 vaccines are being pumped daily into arms, there’s less discussion about COVID testing, and when and how we should all go about it. Are COVID tests and all those funky little roadside kiosks where they’re administered going to disappear? Are you completely done with getting extra large Q-tips shoved up your nose? And, most practically, should you continue getting tested every other week, even after getting the vax?
The short answer is no; you don’t need to treat testing the same way after your COVID vaccine, as Michael Saag, associate dean of the Division of Infectious Diseases at the University of Alabama Birmingham, told VICE. That means you don’t need to get tested regularly (if that’s something you were doing), you don’t need to get tested before or after travel (unless your destination requires a negative test), you don’t need to get tested before seeing your friends or family, and you don’t need to get tested after hanging around with unvaccinated people (though you should tell them to get their freaking vax). Once you’re jabbed, you can safely trust that the vaccine worked, and is doing its job at preventing COVID infection.
“You certainly can continue to [get routine tests], but it would be highly unlikely that you’re ever going to test positive,” Saag said. “Because the vaccine, we now know, protects against symptomatic infections and also appears to protect against any kind of meaningful transient infections as well. Does that mean that you can never get infected? No, but it's just much less likely.”
When I asked Saag when a person who’s been vaccinated should actually get tested, his answer was clear: When you’re experiencing symptoms in line with those of COVID—fever, fatigue, loss of taste and/or smell, etc.—you should be tested. You can get tested if you think or know you’ve been exposed to someone who has COVID-19, but Saag even said it would be fine to wait to see if you develop any symptoms. He also said it’s not necessary to quarantine; you can safely and reasonably assume you didn’t get infected, unless you start feeling sick. Of course, if you prefer to err on the side of caution, feel free to quarantine and get tested, just the same as you’ve been doing (or should have been doing) since last March.
Otherwise, studies continue to show that the approved COVID-19 vaccines are extremely effective. “The way I like to present it to folks, especially those who are a little bit hesitant to get vaccinated, is the vaccine is your ticket to ride,” Saag said. “And what I mean by that is the vaccine gives you freedom from the constant fear of infection. You can begin to re-engage with your normal life.” Saag added that since being fully vaccinated, he’s resumed going out to eat inside restaurants—something he hadn’t done for the past year.
But as Saag clarified, the vaccines, while extremely effective, still don’t provide a 100-percent guarantee against infection. Researchers are still observing how well the existing vaccines protect against variants. So far, the mRNA vaccines (Moderna and Pfizer) appear to protect against known variants in the United States. The day before I spoke with Saag, the New England Journal of Medicine published a study on breakthrough infections (AKA cases that occur in vaccinated people) from COVID-19 variants. Researchers found only two infections in a pool of 417 fully vaccinated people, suggesting that breakthrough infections are, at this time, rare.
And when breakthrough infections do occur, they appear to be far less severe than a typical infection, Saag added. He mentioned another study, also released last Wednesday, that looked at how COVID infections spread around a nursing home facility after an unvaccinated care worker tested positive. While 18 residents and healthcare workers who had been vaccinated tested positive, only one resident was eventually hospitalized and died—a rate much lower than previous nursing home outbreaks.
Bottom line, Saag said the chore of routine testing, post-vax, isn’t worth it. Unless you are routinely tested by your job or school, you can eliminate the need for regular tests from your life. But that doesn’t mean testing is going to disappear into the ether, and become something we talk about in the past-tense.
It’s easy to think about routine testing—even post-vax—as a form of Good Samaritanism in the name of public health data, especially as it concerns new variants. Saag said the area where testing should evolve now is in genetic sequencing in surveillance, or further testing that examines the variants and mutations of positive COVID-19 samples. “What we need to track, for any positive test, is whether that new infection is caused by a variant, and if so, which variant,” he said. But every test doesn’t necessarily go toward understanding variants; some doctors and labs send tests to be sequenced, but not all of them. So while you might imagine there is a higher imperative to testing in order to track the evolving virus, this isn’t always true (and probably particularly untrue of vaccinated people, unless they have an active infection).
Because the vaccine can’t be administered at the same pace in every country on the planet, and because some countries, like India, are reopening way ahead of significant vaccinated population, variants are emerging and spreading, and prolonging the amount of time we spend in this pandemic. “There's an important adage in infectious diseases, which says that a virus or pathogen isn't eliminated anywhere until it's eliminated everywhere,” Saag said. “So as long as there are hot pockets of infection anywhere in the globe, that means those not only is it a threat to the people who live in that area, but it's a threat to everybody else on the planet.”
So what can you do about it? Unfortunately, beyond getting tested when you feel symptoms, not much, explained MarkAlain Dery, an infectious disease doctor in New Orleans. The United States is ill-equipped to actually do any meaningful genetic surveillance, as Dery explained. The U.S. is poorly ranked in its ability to perform genetic surveillance, “largely due to poor funding of public health infrastructure,” Dery said.
Dery gave the example of the UK’s latest lockdown, after a highly infectious variant, B117, was seen spreading throughout the country’s population. “The UK was able to get on top of 117 so fast because they are number one in the world in genetic surveillance,” he said. “They genetically surveilled 10 percent of their viral samples. At least five or six weeks ago, the U.S. was surveilling less than 0.5 percent. So that's why all these variants are popping up.” (Other estimates say the U.S. is actually only surveying around 0.3 percent of samples.)
Even if you’re diligent about getting tested upon any sign of COVID-19 symptoms, there’s nothing you can do to ensure that your positive sample is genetically surveilled. What surveillance across the United States is likely to look like is individual labs analyzing samples in certain municipalities, like New Orleans, where Dery is attempting to open such a lab. Without a systematic, nationwide surveillance program, like that in the U.K., the U.S. is ill-equipped to do any meaningful tracking of variant outbreaks.
What you can do is get vaccinated, bug all your friends and family to get vaccinated, get the boosters as they’re released, and get tested if you ever develop symptoms. Both Saag and Dery say that COVID testing is not likely to disappear from our regular life anytime soon. We’ll eventually be able to get COVID tests the same way we do flu tests, and continue to have pop-up testing available, especially as we track and manage emerging variants.
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