Even as Donald Trump has delineated his plan to relax social distancing, the United States remains very much in the dark about who has the coronavirus and who does not.
We have a shortage of COVID-19 tests, and we simultaneously have the highest number of confirmed cases in the world. Consequently, not every American who wants a test can get one. Not every health-care worker can get one. Not even every patient entering a hospital can get one. Because of the shortages, we are rationing tests, and medical facilities and public-health officials are prioritizing the sickest patients for them.
If the goal is to restart the American economy, the United States isn’t performing anywhere near enough tests. Worse still, we are testing the wrong people. To safely reopen closed businesses and revive American social life, we need to perform many more tests—and focus them on the people most likely to spread COVID-19, not sick patients.
COVID-19 testing has been an unmitigated failure in this country. This month, according to the COVID Tracking Project, a data initiative launched by The Atlantic in March, the number of tests performed in the United States has plateaued at about 130,000 to 160,000 a day. Rather than growing rapidly—as all experts think is absolutely necessary—the daily number of tests administered in some jurisdictions has even decreased. In New York, for instance, 10,241 tests were performed on April 6, but supply limits forced a huge drop a few days later to 25 total tests. Quest Diagnostics, one of the two biggest firms that run tests, just furloughed 9 percent of its workforce. In addition, Deborah Birx, the White House coronavirus-response coordinator, said during a briefing last week that, of 1 million test kits distributed for use in Abbott Laboratories’ high-throughput testing machines, only 88,000 had been used; news reports suggest that shortages of supplies and personnel were to blame.* Testing bottlenecks such as these are major obstacles to getting Americans out of their homes and back on the job.
How many tests do we need in order to safely relax social-distancing measures, reopen nonessential businesses and schools, and allow large gatherings? According to the Morgan Stanley analyst Matthew Harrison and the Harvard professor Ashish Jha, we should be conducting a minimum of 500,000 tests a day. One of the authors of this article, Paul Romer, has called for the capacity to run 20 million to 30 million tests a day. Even this has been criticized as insufficient for the task of identifying enough of the asymptomatic spreaders to keep the pandemic in check.
Current guidelines from the Centers for Disease Control and Prevention give priority first to hospitalized patients and symptomatic health-care workers, then to high-risk patients, specifically those over 65 and those suffering from other serious health conditions, with COVID-19 symptoms. Under this system, asymptomatic individuals are not tested, even if they had contact with people who tested positive.
This is an enormous mistake. If we want to control the spread of COVID-19, the United States must adopt a new testing policy that prioritizes people who, although asymptomatic, may have the virus and infect many others.
We should target four groups. First, all health-care workers and other first responders who directly interact with many people. Second, workers who maintain our supply chains and crucial infrastructure, including grocery-store workers, police officers, public-transit workers, and sanitation personnel. The next group would be potential “super-spreaders”—asymptomatic individuals who could come into contact with many people. This third group would include people in large families and those who must interact with many vulnerable people, such as employees of long-term-care facilities. The fourth group would include all those who are planning to return to the workplace. These are precisely the individuals without symptoms whom the CDC recommends against testing.
Not testing suspected COVID-19 patients will not harm those patients. Because we do not have any treatment targeted for the new coronavirus, confirming an infection generally does not change the way a patient’s symptoms are treated. Patients suspected of having COVID-19 should be presumed to be infected and receive care accordingly. Symptomatic patients should be tested only in the rare case where a positive test would meaningfully change what type of care is delivered.
Culled from Flipboard