The multiple efficacies of coronavirus testing

It has been over two months since the fateful “lockdown,” and testing remains as contentious as ever. To make sense of the roles of — and demand for — “mass testing” in the country, we can look at its “multiple efficacies” not just in terms of its effectiveness and utility as a biomedical tool, but also with its latent, emergent, roles in the pandemic, from the personal to the political.

Of course, the foremost efficacy of testing still lies in its ability to determine if individuals and populations have the virus, and corollary to it, to measure the progress of our pandemic responses and to guide future policies (e.g. to reopen or not). Over the past months, the Department of Health (DOH) has expanded its testing capacity, but questions of efficiency, adequacy, and accuracy persist: Why is it still taking weeks for people to get their results? What about the asymptomatic ones? Are we decreasing the numerator, increasing the denominator, or seeing both cancel each other out, hence the plateau of cases?

Regardless of the answers to the above questions, testing has other “efficacies”—meaning to say, they do more than reveal an individual’s infection status or provide a picture of coronavirus prevalence—which can further explain the value politicians and ordinary citizens alike attach to it.

First of all, at a personal level, testing contributes to what psychologists call “self-efficacy” or belief in one’s ability to deal with various situations. Positive or negative, the certainty of a diagnosis can give people confidence to carry on with their lives, without doubts about their health. One caveat here is that with the stigma, discrimination, and uncertain fates faced by those who test positive (e.g. being quarantined in a miserable facility), some people may actually not want to get tested; we also cannot discount the “fear of diagnosis” among people. Even so, most people want to know if they and the people around them have the virus.

There are pragmatic considerations, too: Worryingly, employers are also beginning to require them, some of them placing the burden of getting tested—and paying for it—on employees. Soon, we might also see test results as a requirement for traveling and immigration.

Coronavirus testing also has symbolic efficacy, giving people a tangible way to apprehend the pandemic—and as an equally tangible sign of government action (or inaction). As the anthropologist Kristin Hedges noted in a Sapiens article, “testing itself brings symbolic power to a physical object that can transform the threat of a virus from being unseen to becoming seen.” This explains why watching the DOH’s 4 p.m. pressers has become a ritual for many people: It offers them an observable and reliable measure of progress, and by extension, hope.

Finally, testing has political efficacy as a powerful populist trope that simplifies crisis and dramatizes politicians’ responses to it. Thus, mayors and governors alike have scrambled to demonstrate that they are doing “mass testing” —s ome even distributing vouchers for “free testing.” Whether or not people actually use those vouchers, they communicate good leadership.

This “political efficacy” also explains why politicians are keen to pursue rapid antibody tests despite the DOH’s misgivings. Experts acknowledge the value of such tests provided that they have been validated. However, epidemiological concerns regarding false positives and negatives will always be less convincing than the populist logic of simple and spectacular solutions which we see not just in the Philippines but also around the world (Hello, Donald Trump!).

The multiple, often overlapping, efficacies of testing can explain why minor mistakes in reporting elicit major reactions from the public; why there was fury over “VIP tests”; why there is such a popular clamor for mass testing; and why it is not helpful to engage in semantic debates or make unnecessary epidemiological claims (e.g. “We flattened the curve!”) — regardless of the validity of those claims.

Recognizing the multiple efficacies of coronavirus testing should hopefully make our officials redouble their efforts to improve its scale, efficiency, and transparency, without sacrificing quality and accuracy. Coronavirus testing may be the object of people’s present anxieties and concerns — but it is also key to giving people confidence and hope that we can overcome this pandemic.

glasco@inquirer.com.ph