Tinglong Dai, Shubhranshu Singh, 23 December 2020

The US continues to struggle with insufficient COVID-19 testing capacity. At the same time, US laboratories use ultrasensitive diagnostic criteria in their tests, leading to a large proportion of positive diagnoses associated with negligible viral loads. This column seeks to construct a theory that explains both undertesting and overdiagnosis. The theory predicts both phenomena may arise in the absence of mandatory viral load reporting. Despite the obvious clinical advantages of viral load reporting, mandating such reporting may not be optimal when considering laboratories’ capacity building decisions and potential benefits of widespread quarantining. 

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