In the new normal there will be three types of people: COVID infected, COVID immune and COVID susceptible, and two types of tests used to classify us all. Based on our COVID status a person may be in isolation, able to do certain front-line jobs or be wearing a mask in public.  

All this may sound scary or surreal, but it will help keep us all safe. Here is how it may work and what we need to do to make it happen, get us back to work and reopen our state quickly. First, a little about the tests and then about the COVID status.

Two tests, three statuses

Former Senate Majority Leader Bill Frist

Former Senate Majority Leader Bill Frist (Photo: Submitted)

There are two major tests for COVID.
First is a PCR (polymerase chain reaction) test, which through a nasal swab identifies viral particles signifying active COVID infection. Second is an antibody test, which through blood samples checks for viral antibodies signifying whether we have had an infection in the past and are immune.  

There are three types of COVID statuses.
First, a COVID-infected person would be one who has the PCR nasal swab test positive. They may or may not be having symptoms such as a cough or a fever. This test identifies a person who is having active disease either symptomatically or asymptomatically and can infect others.

Cars line up for coronavirus testing Saturday, April 18, 2020, at the Williamson County Health Department in Franklin, Tenn.
Cars line up for coronavirus testing Saturday, April 18, 2020, at the Williamson County Health Department in Franklin, Tenn. (Photo: Shelley Mays / The Tennessean)

Second is COVID-immune status. This person is one who has a positive COVID antibody test. They have had an infection in the past and are likely protected from another COVID infection (for how long we do not yet know), and can work on the front lines with low or no risk of reacquiring COVID infection.  

Third is COVID-susceptible status. This is an individual who has a negative COVID antibody test and is susceptible to becoming infected with COVID because they have no natural immune protection and must use masks and additional physical distancing precautions to avoid becoming infected.

The flow chart of who should be tested, when to be tested, which test should be used and how often to be tested is a complex flow diagram not unlike a maze, and further complicated by the uncertainty and lack of availability of test kits and personnel when needed.

Centralized command center, czar needed


Dr. Manoj Jain

To address the urgency and complexity of testing and reopen our economy safely, a centralized command center for COVID testing is needed at the federal, state and local levels.  An assigned testing czar at each level can identify and unclog the pipeline at four essential steps in the testing matrix: 1) testing machines, 2) testing kits and reagents, 3) testing personnel, and 4) people who need to be tested.   WHAT TO KNOW Coronavirus in Tennessee. The latest coronavirus numbers in TennesseeGov. Lee extends closure of bars, salons, limits gatherings in 89 of 95 TN countiesGov. Bill Lee won’t say whether he will intervene in Nashville, Memphis plans to delay reopening businessesTennessee gyms, fitness centers to open Friday, excluding state’s largest urban areasHere’s how to get unemployment benefits in Tennessee

An identifiable czar will know real-time capacity at various facilities and reallocate resources and kits. Furthermore, a czar can communicate and divert people to a testing site, and also divert test kits and testing samples to various places in the state when a specific need is identified or where COVID reemerges. In short, the right hand will know what the left hand is doing.

In the new normal our safest bet is to test more frequently, beginning by prioritizing those who are sick, then those who are at risk and finally those who wish to be tested and know their COVID status for a safer normal.  

Dr. Manoj Jain, M.D., M.P.H., is an infectious disease and health policy expert, and Dr. Bill Frist, M.D., is a former U.S. Senator and heart-lung transplant surgeon. This is part of series of article to help us understand and adjust to the new normal of COVID-19.

Source: Tennessean