Testing struggles emerge as key hurdle to reopening country

The U.S. needs to significantly increase its testing capability for the coronavirus in order to safely start reopening the country, experts say.

If the current approach of telling everyone to stay home is to be lifted, widespread and faster testing will be needed to identify infected people for isolation. Easing stay-at-home orders in the absence of sufficient testing would risk reigniting the outbreak.

Leading estimates have called for between 750,000 and 1 million tests per week. On the surface, the U.S. is getting closer to hitting those numbers, after an extremely slow rollout of tests in the initial weeks of the outbreak.

The country is now conducting more than 100,000 tests a day, according to The COVID Tracking Project.

But with a large backlog of cases, many of those samples are awaiting analysis, with an average of four to five days for several testing methods in use. Getting same-day results is crucial for any effective testing system to help reopen the country, according to experts.

They say blunt social distancing measures need to remain in place until the worst has passed and the number of new cases is declining. At that point, having a system of testing and tracing ready to go will be key.

“We better be careful about declaring victory just because you’ve turned the corner on a curve,” Anthony Fauci, the government’s top infectious disease expert, said Thursday on CNN.  “When we turn the corner and it goes down, we have to have in place the ability to do the kind of containment that’s pristine — namely, you test like crazy, you identify people, you isolate them and you do contact tracing.”

Michael Mina, a professor at Harvard’s T.H. Chan School of Public Health, said improvements in testing would help ease social distancing measures.

“We’re obviously seeing right now that there are other ways to control a virus without testing, but it’s highly detrimental to the economy and to our lifestyles and pulls at the social fabric of society, frankly. So we obviously can’t just keep social distancing,” he said.

But governors across the country are reporting that their states are struggling with testing.

As of Wednesday, the California Department of Public Health said 59,500 test results were pending, compared with results for just 32,944 tests. Gov. Gavin Newsom (D) said it’s an issue affecting other states as well.

“This is a national problem,” Newsom told reporters Thursday. “Just one lab in the United States has over 100-plus thousand backlogged tests. Those large commercial labs are overwhelmed by the demand.”

President Trump, on a call with governors Monday, said he did not think testing was a problem anymore. “I haven’t heard about testing in weeks,” Trump said, according to audio obtained by The New York Times.

Governors pushed back on his remarks.

“Yeah, that’s just not true,” Maryland Gov. Larry Hogan (R) told NPR on Tuesday. “I mean, I know that they’ve taken some steps to create new tests, but they’re not actually produced and distributed out to the states.”

“No state has enough testing,” he added.

Some hard-hit areas have limited testing to people who are hospitalized and front-line health workers. There are also persistent problems with shortages of supplies needed to conduct tests, including reagents, chemicals used to process the tests.

“There are widespread shortages of specimen collection materials, personal protective equipment, test kits and reagents,” said a spokesperson for the American Clinical Laboratory Association. “All of these factors impact the ability of laboratories to push through testing backlogs and steadily increase capacity.”

There are some signs the situation is improving.

Abbott Laboratories announced it had been approved at the end of March for a point-of-care test that can deliver results in as little as five minutes, a development touted by Trump.

Darcy Ross, an Abbott spokeswoman, told The Hill that by the end of Friday, the company will have shipped more than 191,000 of the rapid tests to 21 states.

Experts also point to the importance of a different kind of test, called a serology test, that looks for antibodies in the blood. The analysis can determine if someone has had the virus before, not just whether they have it while being tested. That means the serology test can help identify people who have had the virus but are now immune and who can more fully reenter society.

The Food and Drug Administration approved the first coronavirus serology test on Thursday, from a company called Cellex.

In addition to testing capacity, states will also need enough public health workers to be able to carry out the tracing of infected people and their close contacts.

“We need an army of contact tracers in every community of the U.S.,” Tom Frieden, former head of the Centers for Disease Control and Prevention, said on a call with reporters Wednesday.

Staffing, therefore, could be a problem.

Massachusetts Gov. Charlie Baker (R) is launching one of the country’s most aggressive contact tracing efforts by enlisting more than 1,200 public health college students to help, according to The Boston Globe.

Sen. Chris Murphy (D-Conn.) said Wednesday that he thinks the Trump administration needs to do more to ramp up testing and staffing for contact tracing.

“Other countries taught us we cannot turn the corner on coronavirus [without] a comprehensive system of TESTING, TRACING, and QUARANTINE,” he tweeted. “The Trump Administration has zero plan to stand up that system nationally. That’s frightening and it must change.”

Experts said preparedness needs to be ramped up quickly.

“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,” Aaron Carroll, a professor at Indiana University School of Medicine, wrote in The Atlantic on Tuesday. “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.”