Arguments in favor of universal or mass testing for COVID-19 before the economy can reopen

This page captures the main arguments that have been advanced to support the argument that everyone must be tested for COVID-19 before the economy can reopen. These arguments come from a variety of sources, including public officials, journalists, think tanks, economists, scientists, and other stakeholders. We encourage you to share the debates happening in your local community to editor@ballotpedia.org.

There are three main types of arguments for universal or mass testing:

• Universal testing is necessary
• Universal testing is effective
• Universal testing is possible

Click here to read about arguments against universal or mass testing before reopening the economy.

Argument: universal testing is necessary

This argument says substantially more testing—perhaps even universal testing—is necessary before the economy can be reopened. The Safra Center for Ethics at Harvard University estimated daily testing needed to significantly increase for a safe reopening. As part of that process, the Center said the economy should reopen in phases in proportion to increased testing.

The Center's Roadmap to Pandemic Resilience argued on April 20, 2020, that "We need to deliver 5 million tests per day by early June to deliver a safe social reopening. This number will need to increase over time (ideally by late July) to 20 million a day to fully remobilize the economy. We acknowledge that even this number may not be high enough to protect public health. In that considerably less likely eventuality, we will need to scale-up testing much further."

There are several lines of argument to the effect that universal or mass testing is necessary. These claims are expanded on below.

Claim: universal testing is necessary to avoid a second wave

• Dr. Tom Moore, an infectious disease specialist in Wichita, Kansas, was quoted in an April 16, 2020, CNBC article that “To avoid a second wave of viral spread you have to do what South Korea and other countries, including Germany, have done. You have to have testing in place, and aggressive testing,” said Dr. Tom Moore, an infectious disease specialist in Wichita, Kansas.”

• Fred Guterl, executive editor of Scientific American, wrote in a Newsweek article on April 17, 2020, that "Epidemiologist Marc Lipsitch of Harvard and his colleagues recently performed a computer analysis of how SARS-CoV-2 was likely to behave after lockdown is lifted, which the journal Science published on Tuesday. The authors found that loosened restrictions would almost certainly produce a rebound later in the year. A false sense of security during the summer months in northern states such as New York and Michigan, where the virus might be less active during the summer heat, could lead to a spike in cases in the autumn or winter that's even more severe than the one we're only now recovering from."

Claim: universal testing identifies asymptomatic carriers who don’t yet know they’re contagious

• Umair Irfan wrote for Vox on April 13, 2020, that “For one, [Covid-19] can spread directly and easily between people in close contact. Yet the symptoms of Covid-19 can be confusing, varying person to person, making it tricky to identify suspected cases. Meanwhile, asymptomatic carriers — up to half of the total number infected — can spread the virus unwittingly for weeks, triggering outbreaks in their wake. ... The virus can also turn dangerous and deadly in some people, particularly high-risk populations. But it can also be dangerous in a small percentage of otherwise healthy people.”

• Ashish Jha, the director of the Harvard Global Health Institute, stated in a New York Times article on April 17, 2020, that “If you have a very high positive rate, it means that there are probably a good number of people out there who have the disease who you haven’t tested,” ... “You want to drive the positive rate down, because the fundamental element of keeping our economy open is making sure you’re identifying as many infected people as possible and isolating them.”

Claim: increased testing is a necessary replacement for general stay-at-home orders

• The Edmond J. Safra Center for Ethics at Harvard University's "Roadmap to Pandemic Resilience“ report argued on April 20, 2020, that "Massive testing is essential because it is more finely targeted—more of a precision device than a blunt instrument. Rather than giving an entire city a stay-at-home order of indefinite duration, only those who are infected would need to stay at home or in a medical facility, and only for the specific amount of time required by the course of the disease.”

• Ronald Bailey wrote in Reason on March 30, 2020, that, testing everyone "would also enable researchers to better estimate the COVID-19 case-fatality rate or the percentage of infected people who die of the disease. As it is, case-fatality rate estimates range from something not much worse than seasonal flu to catastrophically high rates worse than the 1918 Spanish Flu epidemic. Pinning that rate down would help us more intelligently evaluate the usefulness (or lack thereof) of lockdowns like that in California.”

Claim: Increasing coronavirus testing should be based on science, not politics

• The Los Angeles Times Editorial Board wrote on August 28, 2020, "Simply put, we started behind and we are still behind. The CDC should be pushing to do more testing — much, much more — because the information the test results provide about where and how the virus is spreading is crucial to safely reopening hard-hit industries, resuming church services and letting students go back to classrooms."

Claim: Testing only targeted populations, instead of universal testing, could lead to discrimination

• Manuel Morales Jr., a plant manager of True Blue Farms in Grand Junction MI, said in a Michigan Farm Bureau press release on September 2, 2020: "Farmworkers 'don’t want to do the test. I don’t want to do the test. I worked earlier this year down in Florida for about three to four months. . .Florida didn’t have to (mandatory test), why does Michigan have to? This governor wants us to do it, and it’s only the Latinos. Why? I work with other American people here; they’re not getting tested.”

• The Association of Michigan Farm Owners filed suit against the State of Michigan to block a state order mandating coronavirus testing for all Michigan farmworkers, arguing it "unfairly targeted farms and was discriminatory since the workers affected are mostly Latino." US 6th Circuit Court of Appeals upheld the State’s order, saying that blocking the testing "... poses a substantial risk of harm to others given that identifying and isolating COVID-19-positive workers limits the spread of the virus. The virus’s effects on individual and community health is well documented. . .legitimate government purpose of protecting migrant workers, their families, their communities, and the food supply chain."

Claim: Mass testing is expensive, but less costly than economic shutdowns to reduce virus exposure

• Robert F. Service wrote in Science on August 3, 2020: "Even with federal help, broad screening programs are likely to be costly. Paltiel’s study estimated that testing 5000 students every 3 days for an abbreviated 80-day semester would cost about $1.5 million, which may be beyond the reach of many universities, let alone high schools and small businesses. But if organizations won’t or can’t make the investment, Paltiel asserts, 'they have to ask themselves if they have any business reopening.' Quick adds: “Investing [in expanded coronavirus testing] will be far less costly for the nation than another economic shutdown, which will happen if we don’t contain the outbreaks."

Claim: Not providing universal testing creates problems and inefficiencies across public health system

• Dr. Joseph Shin, assistant professor of medicine at Weill Cornell Medicine/Cornell Center for Health Equity, wrote in The Hill on August 13, 2020: "Congress has repeatedly failed to ensure access to testing and treatment for tens of millions of people, including some of our nation's largest and most vulnerable populations. Many green card holders have been left out, in addition to DACA recipients, those with Temporary Protected Status, victims of crimes and domestic violence survivors (U visa holders), undocumented immigrants, and so many more. People with limited access to testing and treatment are often left to seek care through a patchwork of local community health centers — many of which face shortages and lack adequate COVID-19 testing capacity — or to hope that their state, like New York, will provide testing and treatment to those not covered by Congress' relief packages. But these options are limited, adding to fear and confusion, and creating another barrier for people to access vital testing and treatment services."

Argument: universal testing is effective

Claim: universal testing has been successful in other countries

• Umair Irfan wrote for Vox on April 13, 2020, that “We now know you can’t effectively fight the coronavirus pandemic without widespread testing to find out who has the disease. Developed countries that have managed to keep their case counts and deaths tolls low or bring them way down — including Iceland, Germany, and South Korea — have generally tested a greater proportion of their population than the United States.”

Claim: massive testing will increase confidence among the populace about the safety of a reopened economy

• Robert Reich wrote in The Guardian on April 16, 2020, that “The economy will fully reopen only when the vast majority of Americans feel it’s safe to return to teeming workplaces, crowded shopping malls, packed airplanes, busy downtowns, thronged subways and buses, jam-packed sporting events and all the other places we swarmed before the pandemic. When will we feel safe enough? That will depend in part on testing and tracing sufficiently widespread that Americans see that the virus is under some degree of predictable control.”

• Jeffrey Pfeffer” wrote in the same Guardian article on April 16, 2020, that "the only time to open up the economy is when there are sufficient testing and contact-tracing resources to map the disease... Opening up the economy too soon and confronting an enormous rise in deaths will inevitably scare everyone and lead to worse economic dislocations and a longer period of restrained economic activity as people become more risk-averse.

• Philip Bump wrote in the Washington Post on April 16, 2020, that “Allowing life to return to normal depends on understanding how close to normal things actually are. That means being able to [test and] track how pervasive the virus is.”

Claim: simulations show false negatives can still help with containment

• Ezra Klein wrote in Vox on April 10, 2020, that “The alternative to mass surveillance is mass testing. Romer’s proposal is to deploy testing on a scale no one else is contemplating — 22 million tests per day — so that the entire country is being tested every 14 days, and anyone who tests positive can be quickly quarantined. He shows, in a series of useful simulations, that even if the test has a high false-negative rate, the retesting is sufficient to keep the virus contained, and thus the country can return to normalcy rapidly. Of the various plans, this one seems likeliest to permit a true and rapid economic recovery.”

Argument: universal testing is possible

Claim: government has authority to force production of tests

• Robert J. Shapiro wrote in Washington Monthly on April 10, 2020, that “As soon as the FDA approves simple, reliable, safe and rapid tests, the president should use his authority under the National Production Act to direct manufacturers to produce the hundreds of millions of tests that will be needed for a safe pathway back to normal life. Of course, we don’t have enough tests now for all the Americans who need them. The government will need to take dramatic actions to ensure that there will eventually be enough tests for every American, period. It will have to start now."

See also

• Arguments against universal or mass testing for COVID-19 before the economy can reopen
• Taxonomy of arguments about universal or mass testing for COVID-19 before the economy can reopen