Stack-Push-Pop COVID Testing

NYTimes: Most people who are tested for the virus do not receive results within the 24 to 48 hours recommended by public health experts to effectively stall the virus’s spread and quickly conduct contact tracing, according to a new national survey by researchers from Harvard University, Northeastern University, Northwestern University and Rutgers University….People who had been tested for the virus in July reported an average wait time of about four days. That is about the same wait time for those who reported taking a test in April. Over all, about 10 percent of people reported waiting 10 days or more.

…“A test result that comes back in seven or eight days is worthless for everybody — it shouldn’t even be counted,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security and a physician in Pittsburgh. “It’s not a test in any kind of effective manner because it’s not actionable.”

One seemingly severe but potential solution is to change how tests are processed. Right now it’s mostly first come, first-served but this means we can easily have a situation where everyone eventually gets a test result but all the results are useless because they take a week or more to process. I propose instead that any test that can’t be reported back in 3-4 days be thrown out immediately. Labs should focus only on processing tests that can be reported back quickly.

One way of thinking about this is to use a stack or last-in first-out (LIFO) model for testing. In a stack model the newest test request is pushed onto the top of the stack and the next test to be processed is popped off the top of the stack. One disadvantage of this model is that some test requests will never be processed (they should be removed from the bottom of the stack and returned as null results). Some people will be angry.

But the stack model of testing has a huge advantage over first-come, first-served. Namely, just as many tests will be completed as under the current model but the tests results will all come back faster and be much more useful. What would you rather have, guaranteed stale test results or fresh results with some possibility of a null return? Since a stale result is not much better than a null it seems obvious that the stack system is superior. Most importantly, faster, more useful tests will help to end the crisis by reducing the number of infections.

Addendum: See also my posts Pooled Testing is Super-Beneficial and Frequent, Fast, and Cheap is Better than Sensitive on other methods to improve testing.