A further massive increase in the availability of tests for the coronavirus could functionally end the pandemic and return life to normal, many public health experts and economists say. The Trump administration’s coronavirus testing czar, though, rejects the idea.
“You never have enough tests because it’s not one and done,” said Peter Pitts, the former Food and Drug Administration associate commissioner and president and co-founder of the think tank, the Center for Medicine in the Public Interest. “It’s not as though I get tested on the list, I’ll never need to be tested again. People will need to be tested many times.”
In the view of many public health experts, widespread testing for both symptomatic and asymptomatic people would allow many people to return to their pre-pandemic lives. Today, in contrast, the Centers for Disease Control and Prevention recommends that testing should only be used for people who have symptoms or were exposed to the virus or for public surveillance. The approach has limited the spread of the disease. But outside experts argue that the administration should prioritize the development and distribution of cheap, easy-to-use tests so that people could test themselves regularly. Doing so would allow the vast majority of people to go about their lives without fear of spreading the disease, they say.
But the top administration testing official, Adm. Brett Giroir, told reporters last week that testing “everyone all the time” is not necessary.
Giroir said that the United States is already doing enough testing to stop the spread of the coronavirus by focusing on people who are already showing signs of exposure, adding that “it is just a false narrative … that we need millions of tests every day.”
“We are doing the appropriate amount of testing now to reduce the spread, flatten the curve, save lives,” Giroir said. “You beat the virus by smart policies supplemented by strategic testing. You do not beat the virus by shotgun testing everyone all the time.”
The U.S. did ramp up testing massively over the course of the pandemic. When the pandemic began, getting a test was nearly impossible without a physician’s order. The number of diagnostic tests performed each day since July 25 has ranged from 479,000 to 881,000, according to the COVID Tracking Project. The U.S. has performed more than 68 million tests since March.
Yet the number of tests performed daily since last week alone has dropped, from 880,729 tests performed Aug. 13 to 642,814 performed on Tuesday. Recent declines in rates of tests administered in hot spot states, such as Florida and Texas, have created doubt that the number of new daily COVID-19 cases reported is accurate. The U.S. has not fully realized the goal of making testing widely available, Pitts said, and “a higher number [of tests] is always better.”
The next step would be a leap, from testing to allow people to confirm whether they have the virus to testing to allow people to go about their lives as normal, regardless if they’ve been exposed.
Dr. Laurence Kotlikoff, a one-time economic adviser to Ronald Reagan and former presidential candidate, outlined a plan in April for large group testing procedures to allow authorities to isolate cases and permit others to go back to work. He told the Washington Examiner recently that millions of more tests are needed per month not only to reach every person once but also to give people access to more than one test to confirm more than once that they are not infected.
“There should be a Manhattan Project underway right now for both group testing and for rapid home testing,” Kotlikoff said, adding that Giroir does not understand that repeat testing is the only way to eliminate risks of false negatives and successfully contain the virus.
Paul Romer, a Nobel laureate in economics and former World Bank chief economist, has also argued that widespread testing across large groups until a vaccine becomes available is the best way to limit viral transmission and allow people to return to work.
Dr. Ashish Jha, director of the Harvard Global Health Institute, has also said that testing large groups of people at a time is the best way to monitor progress the U.S. is making in eliminating community transmission. Otherwise, daily reported cases may not reflect the actual case count.
“Yes, that is millions of tests a day. Many millions,” Jha said. “Yes, our nation needs that level of testing. No, we don’t have it. Yes, we can do it if we actually put all of our time, effort, and some real resources behind it.”
The FDA has granted authorization to many different coronavirus test kits in an effort to make them more widely available. Most recently, the FDA granted emergency use authorization to a test developed by researchers at the Yale School of Public Health last weekend. The test, called SalivaDirect, is a less invasive test than nasal swabs that require chemical reagents and allows saliva samples to be collected in any sterile container. Researchers at Yale determined the test is “highly sensitive” and produces results just as accurate as nose swab tests. Labs would be able to run nearly 100 samples in a matter of hours to decrease “testing times and costs, to make testing widely accessible.”
Many biotech companies are developing rapid tests, but the FDA’s lengthy approval process may prove an impediment to introducing them to the public. Tests may have to go through the same approval process as point-of-care tests taken at a hospital or clinic, which must achieve 80% accuracy for approval. In addition to delays caused by the long approval process, there is the possibility that a test that is not 80% accurate never becomes available because the FDA will not approve.
Giroir, however, said the U.S. has already sufficiently boosted test capacity to reduce the spread of the virus. He pointed out to reporters that the rate of tests coming back positive has fallen to about 7%. If the U.S. were not doing an appropriate number of tests per month, he said, the positivity rate would be much higher.
President Trump himself has dismissed the value of testing, entertaining the idea that less testing would mean fewer confirmed cases and less fear of the pandemic. Most recently, he said on Tuesday, “Tell the Dems that we have more Cases because we do FAR more Testing than any other Country!”
The ideal test positive rate is 3%, according to the Harvard Global Health Institute, which would be the key indicator of progress toward viral containment and suppression. The positivity rate has plummeted since the pandemic began, from about 20% in April to less than 7% in the past week. Coronavirus cases keep climbing, though, by about 50,000 cases or more each day since the beginning of July.
In total, more than 5.48 million coronavirus infections have been confirmed in the U.S., and more than 171,800 people have died.
