The Problem: Symptomless Spreaders Won’t Get Tested

Today’s Philadelphia Inquirer editorialized to “Move Quickly on Tracking” “Tracing is necessary as the Region prepares to go back to work “. This follows the Washington Post Weekly’s reporting that “Several states have dramatically upped their capacity, but now there’s too few people to test”. Simply, you can’t trace and track if you don’t test.

Currently, people being tested generally fall into two categories. First, those who have symptoms and want to ascertain if they have the virus. Second, those who are asymptomatic but want to know if they are healthy or have immunity. These groups are self-motivated to obtain testing.

It is axiomatic that in an environment where there is no readily available vaccine or cure, testing is critical for continued physical and economic recovery. This is because those who test positive can be assisted through contact tracing organizations and their public health protocols. They could be advised to quarantine, provided with social services, followed, and if necessary, referred to clinical follow-up. Thus, there is containment and prevention of spreading. If contract tracing is not effective, then the curve will increase, and we again could be flooding our hospitals and addressing higher sickness and death rates simultaneously jeopardizing human and economic recoveries.

There will reach a point when the health of the population and the economy are perceived as rebounding and there will be greater physical and economic commerce. Already social, political and government attitudes about the virus are becoming more relaxed. Fear, anxiety and uncertainty are, for many, abating.

In the short-term that is certainly good but in the longer term it could threaten the recovery. It is likely that people who are asymptomatic but still spreaders will no longer be self-motivated to be tested. Consequently, they will not be in the contact tracing system sidestepping lifesaving public health protocols. Thus, there could be a serious increase in the virus curves and the concomitant rises in illness and death. Through our individual and collective experiences, we know, in real time, what it means to live through a pandemic with its tremendous toll on human and economic health.

The Solution: Incentivize Testing.

Whether through tax credits, direct payments (preloaded debit cards, script, vouchers) prioritized access to vaccinations, more or longer periods of unemployment compensation (retaining the $600 federal add on for longer), cash bonuses after proof of 6 months of testing, or a combination of methods, provide real value to motivate people to get regularly tested per medical protocols.

This is not a foreign concept in the medical or in the financial worlds. For instance, although on a different scale, in the medical world it is an extension of the widely accepted and utilized practice of compensating and/ or reimbursing clinical trial participants. In the financial setting, through the CARES Act and other programs, the U.S. Treasury is already using financial incentives to counter the pandemic. The U.S. Federal Reserve Bank has also taken aggressive actions. It is “buying” securities (quantitative easing) and setting the federal funds rate (the rate banks pay to borrow from each other overnight) to an effective range of 0 percent to 0.25 percent. Paying or providing real value to people to get tested is the further extension of our existing spending programs and consistent with the actions of the Central Bank.

Conclusion: For Contact Tracing to Be Effective Take Action Now

Congress is debating the next round of stimulus and payments. My advice is to tie these concepts together so that 1 plus 1 can equal 4. This proposal benefits everyone. We all get more bang for the buck! Versions of the bills currently being debated already contain direct payments to the population and also money for contact tracing. One simple model is to enhance the direct payments. So, for example, a payment of $1,200 could be enhanced to $1,500 if the recipient can demonstrate that he or she was tested once a month for 6 months. Thus, they would get an additional payment of $300.00 after the six months testing period. Of course, the specifics would be designed by public health authorities. If Congress fails to act this too will also fall to the states.

Intuitively, in this pre-vaccine environment the cost of incentivizing testing (and therefore the ability to trace) is far less than the human and economic tragedy that is likely to result from doing nothing—a return to virus peaks. While one size may not fit all, having, for instance, $50 to $100 more a month (or its equivalent) on a non-taxable basis could be an incentive for people to get tested.

Time is of the essence. As those responsible for testing and contact tracing begin or continue to ramp up their efforts, they should anticipate a decline in testing of asymptomatic virus spreaders and the threats that presents to health and economic recovery. A way to solve this problem is to incentivize people to be tested and to accept contact tracing protocols.

We need to act on this immediately.