America needs a free and accurate COVID-19 testing infrastructure.

Apart from lack of PPE, another staggering feature of America’s cataclysmic COVID-19 response was our unique failure among wealthy first-world nations to identify and diagnose coronavirus cases. Unless you’re the only person in the world still gullible enough to believe this (oops, hi Trump 2020 voter, didn’t see you there…), you probably understand that it’s difficult to get tested for COVID-19 in the USA. We have the biotechnology and the talent to compete with any country in the world, yet our government stuck its head in the sand and utterly failed to provide the cohesive framework necessary to put our tech or talent to use.

Even today, test availability depends upon what state you’re in, what your profession is (understandably, healthcare workers and first responders are prioritized), how old you are, and what preexisting conditions you may have. Until March, the CDC only allowed testing of patients with a reported foreign travel history, even as COVID-19 spread like wildfire, seeding itself throughout America. I hope to God that the people responsible for America’s initial testing catastrophe will be held to task, but for now, let’s learn from this lethal mistake of under-diagnosis and not continue to replicate it.

The result of under-testing for COVID-19 in America was that we didn’t know where community spread was occurring in the USA until hospitals and nursing homes became overwhelmed with sick and dying patients. We still don’t know where new hotspots of community spread are emerging, and even within existing hotspots and surrounding areas many patients are being missed because of restrictions on testing.

Backlogs still plague the testing system. The tests being ordered by doctors and hospitals right now may or may not be accurate. As if to make up for their contemptible failure in January and February to approve even well-validated COVID-19 tests conducted by practiced research labs, the FDA now seems to be rushing to approve commercial COVID-19 tests that might not be accurate.

Because of the shortage of testing, we also can’t answer some very basic questions. For example, we don’t know when in the course of the disease patients should be tested for the most accurate results, we don’t have the testing capacity to retest patients with suspected false-negative results, and we don’t even know what the prevalence of false negatives is. Apart from possibly being denied care, another danger of false negatives is that people will assume they are negative even when they aren’t and continue to spread the virus. Some of these people could reenter their workplaces or be forced to return to work by their employers because they don’t have documentation of a COVID-19 positive test.

Imagine trying to fight fires without the ability to even detect smoke until entire towns are engulfed in flames. That’s what people who are demanding to reopen the economy without a COVID-19 testing infrastructure will force to happen. We need to test, isolate, treat, and repeat for all contacts of known cases. If we can’t do this, the disease, like wildfire, will continue to spread throughout our country, detected only when it burns down entire communities.