Guest Column: A Doctor’s Plea to End On-Set Testing on Film and TV Productions

It is time for the TV and film industry to stop COVID testing as outlined in the negotiated return-to-work guidelines.

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Although these protocols have been very effective at achieving their goal with earlier variants of the virus — allowing Hollywood to safely resume filming beginning in 2020 — our circumstances are very different now. Our sets are no longer closed systems. Our industry is highly vaccinated (with many productions opting for a fully vaccinated Zone A), and vaccination significantly reduces the risk of hospitalization and death. There are also effective treatments available for high-risk people who contract the virus. Even so, cast/crew in Zone A are generally being tested multiple times a week when local case counts are high and the transmission rate is at least 1.1. The very thing that allowed us to return to work safely — testing — is what is preventing us from working now. Among recently delayed or postponed productions and telecasts are NCIS: LA, Star Trek Picard, the 2022 Grammys and Grey’s Anatomy. On Broadway, the following shows recently have been suspended: Hamilton, Ain’t Too Proud, The Music Man, Aladdin, Mrs. Doubtfire.

The return-to-work (RTW) guidelines (which were recently extended to Feb. 13) were developed by the Alliance of Motion Picture and Television Producers’ Industry-Wide Labor-Management Safety Committee Task Force at the beginning of the pandemic and finalized on Sept. 21, 2020. They created a framework of protocols to help this industry return to work safely at a time when most other in-person industries were shut down. To carry out the protocols, a new COVID compliance department was created for each production. COVID compliance departments have one goal: to prevent the spread of COVID in the workplace. In order to succeed in that goal, the RTW guidelines laid out requirements on topics such as building ventilation, social distancing, symptom screening and sanitation.

By recommendation of the task force, the RTW guidelines included another layer of COVID surveillance in the form of on-set testing and productions had a choice of either PCR or rapid testing. At the time, early variants of the virus had a long incubation period (up to 14 days), and asymptomatic spread was common. There were also no vaccines, and our immune systems had never encountered the virus so we had no protection from it. Testing was the only way to know for sure if someone was carrying the virus at work, and testing triggered contact tracing. Those who tested positive had to isolate, and those exposed had to quarantine.

When vaccinations became available, RTW protocols were appropriately pared down in July 2021. Temperature checks, social distancing and mask-wearing while outdoors (if fully vaccinated) were no longer enforced on many productions. Extensive cleaning of surfaces and fogging went by the wayside. Testing cadence was also reduced for those fully vaccinated (if community levels of COVID positivity dropped below 1/100,000 population), and they did not have to quarantine after exposure. By the beginning of summer 2021, COVID protocols were pared down.

With the widespread availability of vaccines and fewer positive cases being reported, other industries and businesses began to reopen last summer as well, but they did so with very little testing. Restaurants, grocery stores, retail stores and even Starbucks reopened without routine testing. Other industries that could afford testing, like the NBA, continued the practice, but most industries relied on vaccination cards and indoor masking to comply with local, state and national regulations.

In late summer of 2021, when the delta variant surfaced and positive cases once again began to rise, many productions increased testing, sometimes to an even greater frequency than before vaccines were available. However, although the positive case numbers increased in the population overall, vaccinations were 94 percent protective against delta. The increased number of hospitalizations and deaths due to the delta variant were primarily in unvaccinated people. (Much of the TV/film industry and all of the Broadway industry are fully vaccinated.) Then, around Thanksgiving 2021, omicron hit.

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We weren’t sure what to expect at first, but here’s how omicron has been playing out:

Omicron is very contagious — the second most contagious virus in modern times. (The first is the measles.)

It replicates very quickly and has a much higher viral load than any previous variant.

It is much less deadly than other variants, regardless of vaccination status (a third less deadly than delta, even for the unvaccinated) and is more likely to infect the upper respiratory system than the lungs.

It infects people regardless of vaccination status, but the symptoms are milder with vaccination (50 percent) and boosters (73 percent).

It is most contagious 1-2 days before symptoms and up to 5 days after symptoms.

Infection with omicron reduces susceptibility to infection from delta.

The rapid antigen tests are very poor at detecting symptomatic omicron until 2-3 days into symptoms, which makes these tests poor choices for early diagnosis. They are essentially useless for screening. They also give sick people a false sense of security if they test negative, potentially promoting the spread of omicron across productions.

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The main screening metric for COVID, lab-based PCR testing, is not as reliable as it once was. This is evident in many productions across New York City. I own a testing company, and I’ve seen it in my productions across TV, film and Broadway, regardless of testing situations, labs, locations, etc. Weakly positive results can fluctuate between negative and positive from day to day, but we don’t know why.

Even now, still in the midst of the omicron wave, very few other industries are testing with the frequency of TV, film and Broadway. This means that omicron is being spread outside our productions, but we are catching it through our testing. Take, for instance, a Broadway show. The cast and crew are tested, but the audience isn’t. Grocery stores aren’t testing their staff. Neither are restaurants or retailers. Omicron is so contagious, elevators could even spread it (i.e., even if you ride alone, you could get it if someone who was in the elevator before you had omicron, regardless of whether or not you wear a mask).

Testing was meant to trigger contact tracing within a closed system, but we are no longer working in closed systems. If we have clusters of positive cases on set, we have no way of knowing if they caught COVID on our productions or off. And because there are so many other variables — like vaccination status, recent infection, overlapping illnesses, etc. — COVID compliance teams are struggling with how to handle those who test positive. When cast-/crewmembers report an illness, the COVID teams are almost being asked to practice medicine.

In short, our testing protocols are no longer serving their intended goal: to prevent the spread of COVID in our workplaces. The good news is that maybe, as an industry, we don’t have to take on that burden anymore. For vaccinated and boosted people, there is a very low risk of death or hospitalization from COVID. In those populations, omicron appears to be less dangerous than the normal flu. There are many treatments, including Paxlovid, which is 88 percent effective for treating high-risk people with COVID. Ten million courses will be available by June 2022. In my experience, although cast and crew are concerned about passing COVID on to vulnerable or unvaccinated people, they are less worried about getting sick from COVID themselves. They are more worried about losing their jobs and having to shut down. All this testing is creating a pandemic of anxiety that is detrimental to our industries and our mental health. And the worst part is that it’s not even preventing the spread of COVID.

As a physician, it is heartbreaking to see testing resources being used in this way when the majority of people in the city/state/country don’t have this kind of access. For some, their very lives depend on testing. There are immunocompromised parents, patients waiting for organ transplants, health care workers exposed to high viral loads of COVID every day, just to name a few. These people have to wait days for results, if they can get tested at all.

In summary, I recommend the RTW guidelines be amended to remove mandatory COVID testing starting immediately. The tests have simply become unreliable and unhelpful, and contact tracing has become nearly impossible. Instead, productions should adhere to the government guidelines that apply to their location. Paid sick leave should remain in place, regardless of cause (since there are many other causes of illness, like influenza, rotavirus, etc.) Sick cast/crew should stay home and seek medical care. They should follow their physician’s recommendation regarding returning to work. At-home testing can be offered to those who are sick (the government is now providing tests for free) and, if someone tests positive, they should follow CDC, local and state guidelines. Everyone should continue to be encouraged to get vaccinated and boosted, which is a much better way of preventing hospitalization and death than testing. Those with fragile immune systems should be more vigilant and work carefully with their doctors. Masking, sanitation, ventilation and handwashing help prevent many illnesses, not just COVID, and should continue to be practiced in line with local, state and national guidelines.

We are no longer working at a time when there are no vaccines or treatments for COVID. Everything has come full circle. COVID is here to stay. As an industry, we need to learn how to live with COVID, instead of trying to eradicate it.

Linda Dahl is an ear, nose and throat physician who has been in practice for over 18 years with patients mostly drawn from the TV, film and Broadway industries. Since August 2020, she has also run COVID compliance teams for film, television and Broadway productions both on the ground as a CCO/HSS (COVID compliance officer/health and safety supervisor) and remotely as a medical advisor. In December 2020, she also founded a COVID testing company. None of the productions she has worked on have been shut down due to COVID. She previously wrote a story for The Hollywood Reporter in April 2021 about becoming an on-set COVID compliance officer.