Florida surgeon general proposes children skip COVID-19 tests

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  • Joseph Ladapo
    American physician

ORLANDO, Fla. — As omicron’s spread outpaces an overwhelming demand for COVID-19 tests, Florida Surgeon General Joseph Ladapo has a solution that contradicts advice from myriad public health experts: test fewer people.

In a Monday news briefing, the surgeon general took aim at mass testing and said the Florida Department of Health will soon recommend people forgo testing unless it will be what he labels “high-value.”

The Centers for Disease Control and Prevention currently recommends people get tested if they have symptoms, have had close contact with someone with COVID-19, or if they are not fully vaccinated. Some federal vaccination mandates require weekly testing in lieu of vaccination.

The coming guidelines will discourage tests for people at lower risk of severe outcomes, such as children and people without symptoms, but encourage tests for people more likely to need treatment for COVID-19, such as the elderly, he said.

“My department’s goal ... doesn’t restrict access to testing, but reduces the use of low-value testing and prioritizes high-value testing. ... High-value testing is testing that is likely to change outcomes,” Ladapo said during the news conference at Broward Health Medical Center in Fort Lauderdale. “We need to unwind this … planning and living one’s life around testing.”

Florida International University epidemiologist Mary Jo Trepka said Ladapo wrongly implies that the highest value gained from testing is determining whether someone needs to be treated for COVID-19, when in fact, perhaps more valuable is the ability of tests to tell someone whether they need to isolate, thus reducing community spread.

Trepka pointed to recent evidence that Florida’s go-to treatments, monoclonal antibodies, do not work as well against omicron as they have worked against past variants. One brand, GlaxoSmithKline’s Sotrovimab, seems to work better than others but it is in short supply nationwide, she added.

“We don’t really have an effective treatment for COVID-19 with the omicron variant. There’s really only one monoclonal antibody,” she said. “But I would argue that you can really prevent a lot of infections if you test widely because then those people who are asymptomatic or very mildly ill can find out if they have COVID-19 and then they can ... avoid spending time with highly vulnerable people.”

The CDC points to ample evidence that shows that though children are at lower risk of severe outcomes from COVID-19, they can still spread the virus to others, as can asymptomatic people who may not know they have COVID-19.

Elena Cyrus, an infectious disease epidemiologist at the University of Central Florida’s College of Medicine, said community testing has guided public health responses for decades and helped control viruses alongside measures such as vaccination.

“In all epidemics from HIV to previous SARS, screening remains one of the most cost effective ways to help prevent and control the spread of a disease/virus,” she wrote in an email.

Accurate testing data guides decisions such as whether to reopen schools or initiate mandates. Orange County Mayor Jerry Demings ended the county’s state of emergency in October because its COVID-19 test positivity rate remained under 5% for two weeks, for instance.

Gov. Ron DeSantis in Monday’s news briefing affirmed Ladapo’s decision and suggested that reduced testing would also help increase access to tests statewide for vulnerable populations such as the elderly.

“What you are seeing is there are people going to the drug stores, buying all these tests. They’ll go multiple times per week to the sites and test, without symptoms. That is just going to contribute to some of the crunch that you are seeing,” DeSantis said.

Long lines and depleted resources have plagued testing sites in recent weeks. Demand was so extreme in Seminole County, for instance, that cars lined up for a test kit giveaway starting at 6 a.m. The line was closed shortly after the giveaway began at 10 a.m., with nearly 11,000 tests distributed in total, Seminole County officials said.

There are ways to make testing more efficient without decreasing the number of people who get tested, however.

Dr. Ethan Berke, chief public health officer for UnitedHealth Group in Minnesota, has helped organizations across the country design COVID-19 mitigation plans throughout the pandemic. One strategy involved testing multiple people’s samples with a single device at a school in Washington, D.C. that required students to have negative COVID-19 tests each week.

Groups of eight to 14 students’ individual cotton swabs were put in a single test device. In the vast majority of groups, everyone was negative and no further testing was needed. As a result, the school saved tests and money, he said.

“One way to increase capacity is to put more people on the bus, instead of everybody driving in their own car,” Berke said. “That’s a huge advantage, then, of being able to test frequently enough and not burn through resources that then they become unavailable ... So that’s an example of how there are ways to get creative at that population level in looking at what’s the prevalence in the community.”

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