Evelyn Gosnell and some friends are planning a camping trip next month for a birthday celebration. Gosnell, a Bay Area-based behavioral scientist in her 30s, said the group has agreed to quarantine for two weeks ahead of the trip to reduce the risk of exposure to Covid-19.
They're also considering an at-home coronavirus test that they would each order by mail and drop off at a local FedEx or UPS location. Gosnell said she would stay home for a few days before taking the test and be careful while waiting for the results.
But she has reservations about the whole plan, because in the U.S. there remains a limited number of tests and a backlog at the labs that's delaying results by a week or more. Gosnell doesn't want to add to an already overburdened system or take away a test from someone who may need it more.
In San Francisco, local health officials classify outdoor activities like camping as among the "safer social interactions." But guidelines don't include information on whether asymptomatic people should get tested.
"The messaging is confusing," Gosnell said.
Public health experts and infectious disease doctors are happy to weigh in on the matter, but their views differ because the testing infrastructure is such a mess, the situation varies by region and there's no cohesive national strategy.
Susan Butler-Wu, an associate professor of clinical pathology at the University of Southern California's Keck School of Medicine, said it's problematic that these decisions have largely been left up to individuals, but they're important questions to consider before engaging in activities.
"I love that people are thinking about it in such a lovely way," said Butler-Wu. "It involves considering the needs of their community."
Some regions will have greater capacity to test asymptomatic people than others, she added. In other states, supplies aren't being directed where they're most needed.
"It should be free and it should be widespread," said Dr. Peter Chin-Hong, a professor of medicine focused on infectious disease at the University of California, San Francisco. "With Covid-19, you can have the virus and be asymptomatic so knowledge is power."
But Chin-Hong recognizes that resources are constrained and that the situation may get worse as more schools and offices reopen. Many organizations will require that students or staff get tested before returning to school or work. That would make it more challenging for people like Gosnell to get a timely result.
"This whole discussion is painful because it's so anti-public health," he said.
Even those who do get tested before seeing friends and family should take added precautions, he said. Tests can show false negatives, and the delays in the system mean that people could get exposed between the time of their test and the time they receive their results.
"It might give people a feeling of confidence that may be unwarranted," said Dr. Steven Pergam, an associate professor in the vaccine and infectious disease division at Fred Hutchinson Cancer Research Center. "I'm anxious about it."
Pergam fears that people with negative results won't wear masks or will choose not to maintain social distancing. His concerns could be addressed if a new test came to market that's cheaper and has a rapid turnaround time, though it would still have to be accurate.
His advice to Gosnell and people in similar situations is to consider whether getting the test would put them ahead of those most in need.
"Be thoughtful," he said. "But I know it's hard because we're getting incongruous messages from politicians versus those who are on the front lines."
University of Washington professor and infectious disease expert Carl Bergstrom said he's been thinking a lot about this question. In Seattle, where he's based, there's a push for more people in the community to get tested, particularly those who have attended protests.
Bergstrom said that getting tested before seeing an elderly relative or a group of friends falls in a category called clearance testing. If you're in a city like Seattle, where doctors and public health groups want people to get tested for data collection, surveillance and mitigation purposes, then it's good to go in for clearance testing, "because you are contributing to a fight against disease," he said.
But in communities where they only test people who are symptomatic, his recommendation may be different. It's an unfortunate reality for people who are just trying to stay safe in a pandemic.
"I don't feel individuals should be burdened to take on public health allocation decisions," Bergstrom said.