Perhaps you’re not convinced. Perhaps you think testing wouldn’t have made a big difference. If that’s how you feel, consider this hypothetical. Imagine a parallel universe where Americans were tested massively, constantly, without care for cost, while those who tested negative continued more or less about their daily life.
In fact, that parallel universe exists. It’s the National Football League.
When the NFL season started, in September, I was deeply pessimistic that it would end in anything other than mass infection and cancellation. This is, after all, a league with a deplorable public-health record, whose players spend large amounts of time in indoor facilities and locker rooms, when they’re not smashing their helmeted faces into one another on the field. But somehow, the NFL played all of its 256 games with no coronavirus-related deaths reported among its thousands of players and employees.
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How did the league do this, even as the U.S. faced a surge in the winter? After an October outbreak, the NFL moved to daily testing of all its players and instituted new restrictions on player behavior and stricter rules on ventilation and social distancing. The league also used electronic tracking bracelets to trace close contacts of people who tested positive. Throughout the season, the NFL spent about $100 million on more than 900,000 tests performed on more than 11,000 players and staff members. In January, the CDC published an analysis of the league that concluded, “Daily testing allowed early, albeit not immediate, identification of infection,” enabling the league to play the game safely.
You could write off the NFL’s season as the idiosyncratic achievement of a greedy sport with nearly unlimited resources. But I can think of another self-interested institution with nearly unlimited resources: It’s the government of a country with a $20 trillion economy and full control over its own currency. Unlike the NFL, though, the U.S. never made mass testing its institutional priority.
“The NFL was almost like a Korea within the United States,” Alex Tabarrok told me. “And it’s not just the NFL. Many universities have done a fabulous job, like Cornell. They have followed the Korea example, which is repeated testing of students combined with quick isolation in campus dorms. Mass testing is a policy that works in practice, and it works in theory. It’s crazy to me that we didn’t try it.” Tabarrok said we can’t be sure that a Korean or NFL-style approach to national testing would have guaranteed Korean or NFL-style outcomes. After all, that would have meant averting about 500,000 deaths. Rather, he said, comprehensive early testing was our best shot at reducing deaths and getting back to normal faster.
At this moment in America, deaths and hospitalizations are plunging as the U.S. vaccinates millions of people a week while tens of millions more retain some form of immunity from previous infections. The basis of vaccination is immunological memory—the immune system’s ability to recognize and respond to pathogens that would otherwise ransack our bodies.
Just as important as immunological memory is institutional memory. A nation can learn from its mistakes: South Korea did better against COVID-19 in part thanks to a national familiarity with airborne viruses. The U.S. can use the brutal experience of 2020 to recognize and respond with greater speed and precision to the next dangerous pathogen. In this pandemic, testing was America’s original sin. In the next pandemic, and there will be a next pandemic, it can be our first step.