To test or not to test: that is the question

In Updates by Beth

 

It goes without saying that the COVID-19 pandemic has quickly impacted the world resulting in numerous infections and fatalities. In correctional facilities, the situation seems to be even more dire, as inmates are unable to maintain social distance and live in very close quarters. So one might think – “simple, let’s just test everyone – staff and inmates – regardless if they are symptomatic or had an exposure. Then just quarantine the positives and go from there.” Is it really that simple? This situation is much more complex and intricate than meets the eye. 

It is important to consider that in correctional facilities inmates are at risk of being infected and transmitting the coronavirus, but staff might be at even increased risk. Correctional workers enter the microcosm of a facility on a regular basis, but also get in contact with people “on the outside,” whether they are engaging with their family or going grocery shopping. 

When we get back to the original plan, “let’s just test every single person in a facility regardless if there is a clinical indication for testing,” what would that really mean? Would it be actually useful? If so, how?

Currently we have two very different types of tests: diagnostic test for COVID-19 and antibody test. The diagnostic test works by detecting viral genetic material in swabs of the nose, throat or saliva samples, revealing if a person is currently infected with the virus. Conversely, the antibody test can only detect if the person had a past infection by looking into the immune response mounted by the body against the virus. The diagnostic test is not quite 100% accurate and false results are possible, while positive antibodies do not exactly guarantee that a person is now immune to future infections. 

Considering these are the options, there are a series of questions that we have to stop and think about when considering the pros and cons of widespread testing:

  • Is testing everyone, even those who are not symptomatic, actually important or useful?
  • If so, should everyone be tested at once or in stages?
  • If staff members are all tested in a small window of 1-2 weeks, what happens if 50%…or 60, 70% are positive?
  • If staff is tested in stages, how will the facility address positive cases and asymptomatic exposures?
  • How often should everyone be tested if they are positive? What if they are negative?
  • How about the incarcerated population, how often should they be tested? Is it worthwhile to test across the board regardless of clinical symptoms? Why?
  • Can facilities everywhere access testing? If yes, can they afford it? 
  • Would testing everyone regardless of symptoms create a culture of anxiety and hypervigilance? Could it set a precedent for indifference and carelessness because people would think of it as “too much?”

These are just some of the questions, but certainly not an exhaustive list. One needs to keep in mind that inmates, or staff for that matter, have the right to refuse testing. Staff might fear jeopardizing their income (e.g. worked shifts, overtime) while inmates could be concerned that a positive test would result in a quarantine that is de facto segregation in special housing. 

As we progress through this pandemic as a correctional community, we will need to examine and contemplate a number of these issues and likely many others that will arise as we learn more about this devastating virus. In the meantime, we need to continue taking a close look at our resources and policies, deciding how to best allocate our efforts and energy. This has to occur in a manner that ensures the safety of our incarcerated population and staff, in a manner that is viable and administratively sound. If you find a simple objective solution, please let me know.