Although President Trump claimed yesterday that coronavirus testing is no longer a problem, the fact is that the U.S. is still not testing enough. A recent report from the American Enterprise Institute estimates, based on peak demand of past flu seasons, that we need to conduct at least 750,000 tests a week, and this may be a conservative suggestion. Other groups estimate that we need to test more than 1 million people a week. At the moment we’re testing less than half as many people, and not necessarily where the need is greatest.
Testing can no longer “flatten the curve.” It’s too late for that. But once the rate of infections has been slowed by social (really physical) distancing, only a testing scheme far beyond our current capabilities can prevent another surge in infections. If we are going to get out of lockdown, we need to radically improve our testing protocols and infrastructure. And we need to do it fast.
First in line for routine testing should be health-care workers. They have a much greater risk of exposure. They also have a much greater chance of exposing others should they become infected. It’s important to know whether health-care workers are infected before they show symptoms, so they can stop interacting with patients before they spread the disease.
More broadly, we need to implement a scheme by which anyone who is symptomatic at all gets a test, hopefully in a facility set up for that purpose and away from other people. Anytime someone is identified as infected, that person should immediately be put in quarantine. Hotels could be used to isolate the infected.
Just as important, we need a legion of public-health workers to identify all of the infected person’s close contacts, check them for symptoms, and test them. If any of them are positive, the same procedure needs to be carried out again. This “test and trace” system is an essential part of how some Asian countries have kept their outbreaks in check.
“Connecting diagnostic testing to public-health interventions is a cornerstone of outbreak control,” Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security, told me. “We would like to get to a point where all of the close contacts of someone with COVID-19 are notified so they can remain at home and be monitored for symptoms.”
We don’t currently have the public-health workforce we need for such a system. But a hiring spree won’t be sufficient. The federal and state governments need to give workers license to conduct tests, report results, and impose quarantines without bureaucracy getting in the way.
The federal government needs to come up with a way to pay for this new workforce as well as for the tests it administers. Our health-care system usually depends on insurance to pay for tests because the benefit is thought to be for the individual. Testing and intervention in this scenario is also for the public good, at the order of public-health entities. Neither individuals nor their insurance providers can reasonably be held responsible for payment. The full cost of this endeavor has yet to be calculated. It will not be a small number, though.
Testing also has to get faster. If they wait days for results, infected people might unwittingly spread the disease. The good news is that companies are already developing faster tests. But we’re also going to need new kinds of tests. Right now we depend on a type of testing that looks for RNA from the virus. In the future, we will also need antibody testing, which will allow us to learn who has been infected in the past and recovered. This capability will, in turn, help us learn who might be immune, and therefore able to provide care and necessary services without fear of becoming sick or spreading the disease.
Unless and until a fast, comprehensive testing regime is in place, we cannot end social distancing. If we do, the virus will spread undetected once more, and we’ll have no choice but to engage in severe social distancing yet again. We have to stop playing catch-up and build a comprehensive testing infrastructure now.
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