Last May, the city of Los Angeles turned a fabled baseball park into a mass test site for the coronavirus. In its prime, Dodger Stadium tested 16,000 people for the virus every day, making it the largest testing site in the world, said Dr. Clemens Hong, who oversees coronavirus testing in Los Angeles County.

But in January the city turned and turned the stadium into a huge drive-through vaccination station. Local demand for coronavirus testing has dropped, said Dr. Hong. He said he saw the evidence firsthand recently while visiting a community hospital: “The test site had three people and the vaccination site had a line around the block.”

Los Angeles is not an anomaly. Across the country, attention has largely shifted from testing to vaccination. According to the Johns Hopkins Coronavirus Resource Center, the US is currently running an average of 1.3 million coronavirus tests per day, up from a high of 2 million per day in mid-January.

In some ways, the decline is good news and can be partly attributed to falling case numbers and the increasing pace of vaccination. But the decline is also worrying many public health experts, who find the prevalence of Covid-19 remains stubbornly high. More than 50,000 new cases and 1,000 deaths are counted every day, and only 14 percent of Americans are fully vaccinated.

“We’re very concerned about the resurgence,” said Jennifer Nuzzo, an epidemiologist at Johns Hopkins University. “Everyone was mentally concerned with vaccines. Vaccines are of course very important. But until most of us are protected, testing remains essential. “

The $ 1.9 trillion stimulus package that went into effect this month includes $ 47.8 billion earmarked for testing, tracking and monitoring the virus.

However, with the reopening of society and the spread of vaccines, testing strategies are evolving. Here are four reasons testing is still important, and how officials see the next months and years.

Case numbers remain high and doctors still need to identify people who have contracted the virus so that those people can receive appropriate treatment and care. The gold standard for diagnosing Covid-19 is the polymerase chain reaction or PCR test, which can identify even small traces of genetic material from the coronavirus.

This type of testing will be required while there are Covid-19 cases. However, because the disease is less common, diagnostic tests are less likely to be centralized.

“The game has changed a bit,” said Dr. Hong. “Before, there was just one infection anywhere and we just needed comprehensive access to comprehensive testing. Now we have to be much more focused. “

According to Dr. Hong are shifting diagnostic testing from large, government-run locations to smaller, more dispersed locations that are spread across local communities. Ultimately, if vaccination rates are high enough and cases are low enough, no special testing sites are needed at all. “Then we just get back to the health system,” he said, and coronavirus testing will simply be one of many options on the doctor’s office menu.

Tests are important not only to identify individual patients in need of treatment, but also to public health. If the system works, a timely Covid-19 diagnosis triggers the tracing and quarantine of contacts and can stop the transmission of viruses.

“The vaccine – wonderful, wonderful as it is – is not going to contain this pandemic in and of itself,” he said A. David Paltiel, Professor of Health Policy and Management at the Yale School of Public Health.

Slowing transmission means fewer people will get sick, but it also gives the virus fewer opportunities to mutate. And that reduces the likelihood that dangerous new variants – some of which may potentially evade vaccine-induced immunity – will appear.

If community prevalence is kept low, vaccines can be given “a chance to fight,” said Dr. Paltiel. “The less work we put into the vaccine, the better.”

As schools and offices reopen, routine screening of asymptomatic individuals will help minimize the spread of virus. These screening programs are now starting to run. Many will rely on rapid antigen tests, which are less sensitive than PCR tests but are cheaper and can give results in 15 minutes. (Antigens are molecules like the well-known spike protein that are present on the surface of the coronavirus that stimulate the immune system to produce antibodies.) When used routinely and frequently, antigen tests can be effective in identifying infectious individuals and in several ways Analysis suggests reducing virus transmission.

As vaccination rates increase, these screening programs can become more targeted. If 70 to 80 percent of Americans are vaccinated, the prevalence of Covid-19 is dropping, and there are no outbreaks in groups, it may be possible to simplify comprehensive screening, said Dr. Mary K. Hayden, an Infectious Disease Specialist at Rush University Medical Center in Chicago. “Then, yes, I think we could relax the surveillance tests,” she said before adding.

Frequently asked questions about the new stimulus package

How high are the business stimulus payments in the bill and who is entitled?

The stimulus payments would be $ 1,400 for most recipients. Those who are eligible would also receive an identical payment for each of their children. To qualify for the full $ 1,400, a single person would need an adjusted gross income of $ 75,000 or less. For householders, the adjusted gross income should be $ 112,500 or less, and for married couples filing together, that number should be $ 150,000 or less. To be eligible for a payment, an individual must have a social security number. Continue reading.

What Would the Relief Bill do for Health Insurance?

Buying insurance through the government program known as COBRA would temporarily become much cheaper. Under the Consolidated Omnibus Budget Reconciliation Act, COBRA generally lets someone who loses a job purchase coverage through their previous employer. But it’s expensive: under normal circumstances, a person must pay at least 102 percent of the cost of the premium. Under the Relief Act, the government would pay the full COBRA premium from April 1 to September 30. An individual who qualified for new employer-based health insurance elsewhere before September 30th would lose their eligibility for free coverage. And someone who left a job voluntarily would also be ineligible. Continue reading

What would the child and dependent care tax credit bill change?

This loan, which helps working families offset the cost of looking after children under the age of 13 and other dependents, would be significantly extended for a single year. More people would be eligible and many recipients would get a longer break. The bill would also fully refund the balance, which means you could collect the money as a refund even if your tax bill were zero. “This will be helpful to people on the lower end of the income spectrum,” said Mark Luscombe, chief federal tax analyst at Wolters Kluwer Tax & Accounting. Continue reading.

What changes to the student loan are included in the invoice?

There would be a big one for people who are already in debt. You wouldn’t have to pay income taxes on debt relief if you qualify for loan origination or cancellation – for example, if you’ve been on an income-based repayment plan for the required number of years, if your school cheated on you, or if Congress or the President whisper $ 10,000 debt gone for a large number of people. This would be the case for debts canceled between January 1, 2021 and the end of 2025. Read more.

What would the bill do to help people with housing?

The bill would provide billions of dollars in rental and utility benefits to people who are struggling and at risk of being evicted from their homes. About $ 27 billion would be used for emergency rentals. The vast majority of these would replenish what is known as the Coronavirus Relief Fund created by CARES law and distributed through state, local, and tribal governments, according to the National Low Income Housing Coalition. This is on top of the $ 25 billion provided by the aid package passed in December. In order to receive financial support that could be used for rent, utilities and other housing costs, households would have to meet various conditions. Household income must not exceed 80 percent of area median income, at least one household member must be at risk of homelessness or residential instability, and individuals would have to be due to the pandemic. According to the National Low Income Housing Coalition, assistance could be granted for up to 18 months. Lower-income families who have been unemployed for three months or more would be given priority for support. Continue reading.

Even then, officials may want to do some level of surveillance testing in high-risk environments such as nursing homes or on high-risk individuals such as travelers, she said.

Tests can help public health officials assess whether efforts to end the pandemic are paying off.

“Do we want to know how well vaccines work? We need to test, ”said David O’Connor, a virologist at the University of Wisconsin, Madison. “How do we know if the variants are more contagious? We have to test. How do we know if the vaccines are effective at controlling the variants? We have to test. “

Large screening programs can also help institutes evaluate the effectiveness of their risk reduction strategies. As cases increase, schools and offices may need to change their mask guidelines, enforce greater social distancing, or increase their ventilation rates.

Testing could also help uncover worrying case clusters that may indicate that a community has not yet reached herd immunity and could benefit from a targeted vaccination campaign.

Many experts today believe that the coronavirus will likely never go away completely. But even if the virus continues to circulate in very small amounts, it’s important to keep an eye on it.

“It’s less about stopping the transmission of the disease and more about understanding where the virus is.” Said Dr. Nuzzo. “What are we missing? And, you know, what could be coming down the road? “

The virus will continue to mutate and new genetic variants will emerge. Some amount of continued testing, even years later, could help scientists identify worrying variants early on.

Tests are of course not perfect and can lead to false negative and positive results. However, they provide a critical window into the activity of a pathogen that is too small to be seen.

“We’re going to want to make sure that after vaccination, people don’t gush up in some other unpredictable way that will get us back to where we started,” said Dr. O’Connor.

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