Thread by @sdbaral

Warning!!!!

Unpopular #COVID19 opinion:

Testing is not an intervention
Diagnosis is not an intervention

Testing and diagnosis will only have as much public health and clinical impacts as they facilitate decreasing onward transmission risks or access to care, respectively

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For sexually transmitted infections, testing and diagnosis are critical because they are linked to interventions or actions that directly decrease onward transmission risks including:

1) Curative antibiotics
2) Antiretroviral therapy for HIV
3) Condoms
4) Avoid sex

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For respiratory infections, how will a diagnosis help if your:

1) Living situation does not allow for isolation?
2) Work does not provide paid or even unpaid sick leave?
3) Family is dependent on your income to meet basic needs?
4) Access to care is linked to employment

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In the absence of structural support, testing and delivery of diagnosis:

1)Serves epidemiological needs including prevalence, incidence, and trend analyses
2)Helps higher income communities already at lower risk given ability to work remotely and isolate in private rooms

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Optimizing impacts of testing and diagnosis necessitates case management with risk mitigation:

1) Housing for people especially with vulnerable people in the home
2) Income relief to avoid undue pressure to work when sick
3) Address any barriers to accessing health care

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This may sound expensive, but so does social collapse through sequential shelter-in-place/lockdown mandates.

Public health is more than slogans. It is more than modeling. It is more than diagnoses.

Public health has to get back to the business of prevention and mitigation.

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