I recently spent a couple weeks in French Polynesia as a guest on a mega-yacht, which I’ll call “the ship”. To keep the ship Covid-free, residents, guests and staff arriving from outside French Polynesia were tested before being allowed onboard, after which they were subject to a 72-hour isolation period. In addition, everyone on the ship was tested for Covid twice a week (roughly 700 individuals). We all had to wear masks outside our cabins, except when drinking or dining, and were advised to wear masks off-ship whenever social distancing could not be observed, even outdoors. Despite these precautions, three residents and one staff member tested positive for Covid on the third day of our trip. These Covid-positive individuals and their social contacts were not allowed to leave their quarters for 10 and 5 days, respectively, during which they were tested daily. No one else on the ship tested positive for the remainder of our stay.

Which got me to thinking…If all US households were provided free home testing kits, without having to request them, and were advised to test themselves whenever they had symptoms or had been exposed to infected individuals…wouldn’t that alone slash Covid case rates? Add in better treatments, and I wouldn’t be surprised if Covid case and mortality rates quickly dropped to flu-like levels. My reasoning is as follows:

Per the CDC, just 1 in 4 Covid infections are reported in the US, most of which are symptomatic cases.

I suspect unreported infections are largely responsible for the spread of Covid in this country. Given that medical providers and labs are supposed to report positive test results, it’s pretty safe to assume that untested individuals make up the lion’s share of unreported cases.

Testing would increase if most households had free self-testing kits, which provide fairly accurate results within minutes. And as more Americans self-test, more would confirm they’ve been infected. Most of these individuals would limit or avoid risky behaviors, thereby reducing the spread of Covid.

Americans would also be more motivated to self-test if better treatments were available – especially during early stages of infection - thus eliminating the “what’s the use?” excuse for not self-testing.

That’s the theory anyway. So far, Covid testing and mortality rates are not clearly linked in most countries – understandably so, given the many factors that contribute to Covid death rates, e.g., demographics, quality of medical care, prevalence of obesity and diabetes, vaccination rates, social distancing compliance, etc. Plus the direction of causality can go either way: higher death rates = more testing; more very sick individuals = more testing; more testing = fewer deaths; more testing = more deaths attributed to Covid. In other words, it’s complicated, which is why it’s difficult to find any pattern in country-level test and mortality rates. Case in point:

Same data in table format:

Denmark is an outlier in the above countries, with the highest Covid test rate and second-lowest death rate. Is there a connection? Maybe. Perhaps testing has to reach a certain critical mass before its effects are discernible. If so, free and widely distributed self-test kits could play an important role in ending this terrible pandemic.