Vermont’s daily new Covid-19 infections and hospitalizations are higher than they’ve been in months, bringing back a dilemma vaccinated people thought they had put behind them: Should they get tested, and if so, when?
The answer isn’t quite as straightforward as it was last year. Complicating matters, state and federal officials have conflicting advice.
Mike Smith, secretary of the Vermont Agency of Human Services, said at a press conference Tuesday that vaccinated people should get swabbed only if they’re symptomatic. If a vaccinated person has had exposure to an infected person but has not developed symptoms, they do not need to get tested, but they can if they would like to be “reassured,” Smith said.
However, the Centers for Disease Control and Prevention has said that vaccinated people who were exposed to coronavirus should get tested even if they don’t have symptoms.
The differing guidelines are just the latest sign in the marked tone shift when it comes to navigating the pandemic. The testing question, as with everything else in the pandemic, depends on who and where you are.
VTDigger contacted several health experts to help guide Vermonters’ decisions on whether and when they should get tested.
Neither guideline is perfect
Health officials have used throat and nasal swabs to identify outbreaks since the early days of the pandemic. Though vaccinated people catch and spread the Delta variant at relatively low rates, there’s value in testing all people who have sustained contact with an infected person, according to epidemiologist Liz Winterbauer, who teaches at St. Michael’s College and the University of Vermont.
“I’m concerned that we’re not going to be able to identify as many breakthrough infections without that guidance,” she said, especially when a substantial number of people in the state, including all children under 12, remain unvaccinated.
Widespread testing of vaccinated people could also yield information that guides future decision-making, she said, from who is susceptible to breakthrough Delta infections to a deeper understanding of how the infection spreads in older or sicker people with the vaccine.
But there’s a drawback to increased testing, said Pam Berenbaum, public health professor at Middlebury College. Personnel, testing supplies and time are finite, especially since the same health care providers who run testing clinics are also responsible for vaccine clinics and ongoing care for people with other illnesses.
The other issue with such widespread testing is that it could yield false positives more often, said Jose Mercado, infectious disease specialist at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire.
Ruling out false positives involves even more testing. Current guidelines require two negative results 24 hours apart, Mercado said.
On the flip side, a negative test in a person without symptoms is not useful. That’s because it’s hard to tell if the test isn’t detecting the virus because it isn’t there or because there isn’t enough of it to detect, as is possible during the incubation period of the disease.
“At some point, we’re going to have to transition from this pandemic mode wherein we’re kind of reliant on public health guidance into this endemic mode wherein [guidelines on when to test vaccinated people] becomes more of a personal [decision],” he said.
Bottom line: If you’re sick, get tested
One thing is clear: Vaccinated people with a runny nose, sore throat and other common-cold or allergy-like symptoms should get tested for Covid-19, even if their symptoms are mild, experts said. But if you’ve spent time indoors with someone who got coronavirus and do not have symptoms, you may want to wait a few days, Mercado said.
Delta symptoms tend to show up three to five days after exposure, and there’s no value in getting tested before that time, since a negative result does not mean you don’t have the virus. Mercado said it’s important to evaluate your individual risk. Being in a room with someone who got coronavirus is only part of that assessment.
Mercado advises people to think about the type of exposure they had. Your chances of getting a breakthrough infection from a passerby at a supermarket are very low, especially in areas where community transmission of coronavirus is uncommon. Your risk drops even more if you wear a mask during such exposures.
If, on the other hand, someone you live with or come in contact with a lot is sick, the risk of catching the virus is higher.
You also may want to get tested more frequently if you come in regular close contact with unvaccinated or immunocompromised loved ones, Berenbaum said.
Don’t rely on the test alone
Vaccines work and remain the most effective tool against Covid-19, experts said, including against the highly transmissible Delta variant. They’re particularly effective in protecting against hospitalization and death.
Still, it’s especially important for people to understand the vaccine doesn’t offer absolute protection against contracting the virus, Mercado said. A negative test in an asymptomatic vaccinated person isn’t much assurance either, he said.
Other precautions, such as staying home when you’re sick and wearing a mask in indoor public spaces, are important even if you’re vaccinated.
“All this information is so confusing and it changes all the time,” Berenbaum said. “But people need to think, ‘What can I do to protect other people?’ and you can wear a mask and protect other people without getting tested first.”
