By spit or by swab, testing is powerful pandemic weapon

For two pandemic years, every cough, every sneeze, has come with a question.

The only way to get an answer — is it allergies, or did you just expose everyone at this salad bar to a whole new letter of the Greek alphabet? — is to get tested.

But getting a COVID test can be a test in itself.

Minnesotans are scrambling for appointments at testing centers or shelling out for over-the-counter test kits, as COVID cases rise, hospitals fill, and holiday travel looms.

Which is how I found myself coughing at the back of a long, long line at a community testing site in the Minneapolis Convention Center last Monday.

Vaccines are like seat belts. They can't stop something from crashing into you — but they will vastly improve your odds of walking away from that crash.

Twice vaccinated, freshly boosted, and coughing like a harbor seal, I set out in search of answers.

My neighborhood's free state-run testing site – one of many around the Minnesota – was closed the day I started coughing. I had other options. I could have hunted the drug store aisles for a rapid test kit. I could have driven around in search of another testing site with appointments available. I could have sent away for one of the at-home saliva test kits the state of Minnesota provides free to all.

All of that sounded like a lot of effort, so I took to my bed and spent the weekend figuring out which cough syrup pairs best with Hallmark Christmas movies.

I got to the front of the line in 40 minutes on Monday and had the results the next day. Not COVID. Bronchitis. A win for the vaccine, a defeat for my lungs.

In an ideal America, we'd be testing ourselves for COVID a couple of times a week to stop people from spreading the virus before they even realize they're sick.

But this the America where COVID has killed almost 800,000, while COVID testing remains confusing, time-consuming and — if you're trying to stock up on over-the-counter rapid tests at $14 to $25 for a box of two for a family of four — costly.

"This virus largely spreads before symptoms develop," said Ryan Demmer, an epidemiologist at the University of Minnesota's School of Public Health. "Most people are probably the most infectious the day or two before they develop symptoms... .The fact that this virus spreads asymptomatically is one of the major drivers of the pandemic."

One way to tell if a community is testing enough to catch COVID before a lot more people catch COVID is to study the test positivity rate.

The World Health Organization warns that if more than 5% of COVID tests are coming back positive, it could mean that we're mainly testing the sick, not the asymptomatic.

In Minnesota — a state that has gone to heroic lengths to make testing more affordable and accessible – the positivity rate was 10% last week.

Getting a test even when you don't feel sick is worth the effort, as the Demmer family learned firsthand.

"We were going to go to a wedding and out of caution, we tested at home with at-home antigen tests, just to be safe," he said. "I didn't want to show up to a large wedding, with grandparents and plenty of other vulnerable people." One of the kids tested positive. The next day, the second child tested positive as well.

"And we never would have known that," he said. "We would have gone to a wedding with two people positive in our house and they would have gone on to school."

The rapid tests aren't perfect, but even if they detect only 85% of the COVID-positive people who test, Demmer said, "that's better than what we have now, where a very small fraction of those people ever end up knowing that they're infectious in time to avoid spreading to other people."

This state witnessed the raw power of Always Be Testing when Minnesota hero Pete McGinn returned home from a trip to a New York City with some unwelcome viral baggage.

After hearing that a friend at the anime convention he'd attended had tested positive, McGinn — who wasn't feeling ill at all — took an at-home test. When that test came back positive, he walked into the testing site at the Minneapolis Convention Center and helped the Minnesota Department of Health track down the state's first confirmed case of the omicron variant.

"The good news is that we have a lot more testing available than we did at the start of the pandemic and point-of-care tests are getting better," said Alex Pastuszak, chief clinical officer at Vault Health, which runs Minnesota's mail-order COVID testing program and many of the community testing sites.

America might not have the massive testing infrastructure you see in Europe, but if you're looking for a test, Minnesota makes it easier and cheaper than most states.

"Vaccines work. There's no other way to say it more bluntly and effectively," Pastuszak said. "That being said, people can still get infected, people can still pass it on. What is the way to keep the gate and keep people from getting sick? The answer to that is testing."

If you're looking for help with testing, look no further than the Minnesota Department of Health testing resource page: health.state.mn.us/diseases/coronavirus/testsites/index.html.