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Since the early days of the coronavirus pandemic, the U.S. has struggled to keep up with the level of testing needed to track, let alone contain, the virus.
When the initial phase of infection struck, limited supply meant tests were reserved for only the sickest patients, so mild and asymptomatic cases went undetected. The U.S. has dramatically increased testing capacity since then — from about 100,000 tests a day in March to roughly 800,000 by late July. But even those numbers are proving to be insufficient in some parts of the country.
On top of supply shortages, the recent surge in cases has also led to a new problem. Labs that process tests have been overwhelmed, causing some patients to wait several days — or even weeks — to get their results. Experts say that turnaround time must be reduced to 24 to 48 hours for there to be any hope of bringing the outbreak under control. Test results that take days to be processed are “almost useless,” Colorado Gov. Jared Polis said.
The U.S. is testing more, both in total and per capita, than almost any other nation. But comparing those numbers doesn’t provide a full picture, experts say. The percentage of tests that come back positive is seen as a key indicator of whether an area is doing enough testing. Right now, the positivity rate in most states is well above the recommended threshold. Since the start of the pandemic, the U.S. has conducted about 52 million total tests. A bipartisan group of experts recently released a report arguing that the country needs to be doing 30 million tests a week by October to avoid “impending disaster” if a second wave of infections hits at the same time as cold and flu season.
Why there’s debate
Meeting or coming close to the target of 30 million weekly tests with quick results would take an extraordinary effort, and a variety of experts have proposed ways to achieve that goal.
One of the most important steps toward improving testing will be establishing a coordinated nationwide strategy, many argue. The Trump administration has left testing plans up to states and local governments. As a result, the country has an inefficient patchwork of systems in which supplies and labs are overwhelmed in some parts of the U.S., while resources elsewhere go unused. Some have called for the federal government to end its hands-off approach and take command of testing logistics. Others suggest regional compacts between groups of states could be a better plan.
On top of logistical support, states need Congress to allocate billions of dollars to shore up their testing budgets, some argue. Shifting the burden of processing away from overloaded national corporations and into smaller local labs, as New York has successfully done, could also help prevent roadblocks.
Others say the U.S. needs to embrace different testing methods that require less time and fewer resources to perform. A popular suggestion is pool testing, in which the mixed samples from many people are all tested at once. A negative pool test can eliminate the need for dozens of individual tests. After a positive result, everyone in the pool would take a standard test.
Another potential option is at-home tests that can provide a result within minutes, similar to a pregnancy test. Several companies are developing products that would be affordable, easy to use and easy to produce at scale if they make it to market. Research suggests that at-home tests, which use saliva rather than a nasal swab, are likely to be less accurate than current testing methods. Most experts see them as a supplement, rather than a replacement, for existing tests.
The next stimulus bill approved by Congress will likely include billions of dollars in extra funding for testing. House Democrats included $75 billion for testing and contact tracing in the package they passed in May. The recently unveiled proposal from Senate Republicans allocates $16 billion for testing.
The Food and Drug Administration recently approved the use of pool testing for the first time, though they limited the initial groups to just four samples at a time. FDA approval could also be a major hurdle for at-home tests if they prove to be significantly less accurate than nasal swab tests. However, small-scale clinical trials of two at-home tests under development have shown accuracy levels as high as 97 percent.
Accurate at-home tests could be a game changer
“The hope has been that an easy-to-use, easy-to-manufacture at-home COVID test as affordable and accessible as a pregnancy test could dramatically change the course of the pandemic for the entire world. Or at least help stave off disaster in the country that has nearly 2 million more coronavirus cases than any other nation on the planet.” — Olivia Messer, Daily Beast
States need to work together to build effective testing plans
“Interstate compacts are valuable tools for addressing problems that are complex, require scale to solve and also require state leadership because of on-the-ground variation. They are tools for empowering states. Congress should use its upcoming legislative session to turn the tide once and for all in our fight against covid-19 by investing in interstate compacts that have the single mandate to fully activate our testing supply chain.” — Danielle Allen, Washington Post
Pooled testing could help the economy safely reopen
“Pooled testing may be particularly useful for testing groups at lower risk of disease. Employers, college campuses or professional sports teams eager to identify infected individuals before an outbreak starts could use pooled testing to screen large numbers of people regularly, without using up testing supplies needed for people with symptoms or known exposure to the virus.” — Quoctrung Bui, Sarah Kliff and Margot Sanger-Katz, New York Times
The virus is too widespread for pool testing to work
“I think we’d be in pool testing hell because you would have so many positives showing up. Pool testing I think is not going to be helpful until we get to the point where the virus load is way down.” — Former HHS Secretary Kathleen Sebelius to Politico
The U.S. needs a coordinated nationwide testing system
“We basically need a Manhattan Project for testing. A nationwide, systematic strategy with a clear agency lead is desperately needed. But it’s not happening and I think we all fear significant access issues and supply-chain disruptions in the near future.” — Emergency response expert Lauren Sauer to Atlantic
The federal government must take responsibility for solving the testing mess
“Will companies sort this out on their own? No, because they’re competing against one another. Can states help? No, they’re competing against one another, too. That leaves the federal government as the logical referee.” — Timothy L. O'Brien, Bloomberg
Every lab in the country that has the capabilities should be utilized
“We also need to enlist or draft more companies into the testing process. Biotech companies, academic facilities and smaller labs, many of which have the necessary expertise at hand, could be steered into this, but they need clear, direct orders from Washington to do so.” — Andy Serwer with Max Zahn, Yahoo Finance
States can’t fix their broken testing systems without a lot more money from Congress
“The signal difference between federal and state leadership is that the former can print money and the latter cannot. If states are to step up, they will need resources: money from Congress without executive branch holdup, coordination and mutual aid from one another, and cooperation and expertise from the public itself.” — Margaret Bourdeaux, Beth Cameron and Jonathan Zittrain, New York Times
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