Test prudently
I do not advocate testing for any person vaccinated against SARS-CoV-2 unless they display severe symptoms or live with those who for whom vaccines are not yet approved. I understand that testing and isolation are mechanisms to break virus transmission chains and were used at the beginning of the pandemic to control virus spread. To continue to follow this same philosophy today, more than 2 years later, suggests that little or no progress has been made to control or understand the virus and the pandemic. Furthermore, excessive testing inhibits our ability to make the proper ‘risk-benefit’ analysis necessary to generate programs that enable society to move forward with SARS-CoV-2.
My rationale for not testing vaccinated people is very simple and is based upon the precedents set for other pathogens for which vaccines exist. We do not test people for poliovirus, measles virus, influenza virus, or human papillomavirus after vaccination. If we tested the general public, vaccinated and unvaccinated, for rhinovirus or influenza virus infection/exposure, a significant amount of the population would be found positive. Following the CDC COVID-19 guidelines, those who test positive isolate for 5 days. Economies and society would grind to a screeching halt.
The measles, mumps, influenza and poliovirus vaccines were developed to prevent severe disease, not infection. These vaccines are some of our most successful biological products against infectious diseases. Many of these vaccines were developed when occurrence of severe disease caused by infection with these viruses was high or to mitigate the economic burden of the associated disease. Studies published investigating the mechanisms by which these vaccines protect us, demonstrated significant differences between the mechanisms of protection. For instance, administration of the oral poliovirus vaccine is via the natural route of infection, and confers immunity to the primary site of infection, the gut. It is gut immunity which is believed to protect the vaccinated from subsequent disease. Furthermore, when vaccination rates are high within a population, the community is protected, and virus transmission is interrupted. However, vaccinated people shed infectious neurovirulent poliovirus 30-90 days after vaccination into the environment, which can then infect those who are immunocompromised or unvaccinated and lead to the development of vaccine associated paralytic poliomyelitis. Approximately 1 in every 1.5 million vaccinees develop vaccine associated paralytic poliomyelitis.
