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Long lines for COVID-19 testing are becoming more commonplace. Boston Globe/Getty Images
  • Some business owners are encouraging “healthy” people to get tested for COVID-19 to reduce the positivity rate and avoid lockdowns.
  • The approach goes against CDC guidelines and may overwhelm labs, epidemiologists say.
  • Attempts to game the system demonstrate misunderstanding and discontent with the way governments have approached shutdowns.

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Can you manipulate COVID-19 positivity rates to avoid lockdowns?

A number of business owners and people seem to think so.

In recent social media posts and media interviews, they’ve been encouraging “healthy” people to get tested in droves.

The idea is that it can help lower the positivity rate — a critical measurement government officials use to determine if schools, restaurants, and other businesses should close.

While the math may work out on paper, the advice flies in the face of testing recommendations from the Centers for Disease Control and Prevention (CDC).

Experts say that trying to game the COVID-19 positivity rate is deeply problematic. Here’s why.

There’s a simple formula used to determine positivity rates. It typically involves dividing the number of people who tested positive by the number of total tests given or number of people tested on a particular day.

Some business owners are trying to bring that rate down by driving up testing, according to some news reports. Their reasoning is: If people who think they haven’t been exposed to the new coronavirus get tested, it may help keep COVID-19 positivity testing rates below a threshold that triggers a lockdown.

A handful of social media users have also created posts that urge people with COVID-19 symptoms not to get tested to avoid increasing the positivity rate in their communities.

“It’s a terrible idea,” said Dr. Aaron E. Glatt, chair of the department of medicine at Mount Sinai South Nassau, where he also serves as the chief of infectious diseases and the hospital’s epidemiologist. “If you’re only testing people who are negative in order to artificially decrease the percentage of people who are positive, that’s silly.”

Even though that approach may work in theory, the reality is that flooding testing sites with people who think they’re unlikely to test positive probably won’t get business owners the results they’re hoping for, said Susan Hassig, DrPH, associate professor of epidemiology at Tulane University’s School of Public Health and Tropical Medicine.

“You have to recognize the magnitude at which people would need to mobilize in order for that to work,” she said, adding that there would inevitably be some additional positive cases that are revealed when many people with asymptomatic infections get tested.

Increasing testing of people who don’t think they have the virus isn’t a black-and-white issue. On the plus side, the approach could offer researchers more data and uncover new cases of COVID-19.

“Therefore, you will be contact-traced, you will be asked to isolate, and we may break a few more chains of transmission,” Hassig said.

The problem is that most communities don’t have enough resources to accommodate that level of testing. When huge numbers of unnecessary tests need to be processed, it uses up limited supplies and creates lengthy backlogs at labs.

That means everyone, including people who have COVID-19 symptoms or have been exposed to the virus, needs to wait longer for their results.

If they’re unable to quarantine until the results come in, they may end up inadvertently transmitting the virus to others and driving up case rates.

“It may be diverting much-needed resources away from discriminating the infected from the noninfected in needy populations,” Hassig added. “In an environment where testing is not readily available, I see it as being a counterproductive activity.”

The tests aren’t perfect, and not everyone needs to be tested, according to the CDC.

The considerations for determining whether you should get a test include having COVID-19 symptoms, being in close contact with someone who has the disease, or receiving a request from a healthcare provider or health department.

“To do rapid testing on populations with a low risk means you’re more likely to get false positives,” Glatt said. “They’ll isolate and quarantine when not necessary or appropriate.”

What’s more, people who receive a false positive may later think they’re immune from the disease, thus running the risk of contracting and transmitting the virus down the road.

The fact that people believe they can game positivity rates reveals growing discontent with the current approach to lockdowns in many communities.

“They perceive the benchmark as being arbitrary,” said Hassig, who collaborates with her state and city health departments to help people understand the reasoning behind decision making in public health.

“Usually the explanations are more long-winded than people want to listen to, especially when it’s something they don’t want to hear and tells them they can’t do something they want to do,” she said.

She added that the messaging around testing needs to be more consistent and provide a deeper understanding of the role positivity rates play in determining shutdowns of schools, restaurants, and other facilities.

“Testing is a gateway to applying those distancing and separation strategies to prevent the virus from hopping from one person to another, which will slow down spread in the community at large and the pandemic,” Hassig said. “Testing is a tool, it’s not an end to itself.”

Furthermore, government officials need to consider more than just positivity rates when making major decisions about shutdowns, Glatt said.

Factors such as capacity at hospitals, the rate of hospitalizations, and positivity rate per capita could help officials determine whether it’s appropriate to increase restrictions.

“There are much better markers to go by [than] positivity rate,” Glatt said. “I’m a strong advocate for keeping businesses and schools open, but we need to do it in a way that’s safe and backed by science.”