The U.S. Can Fix Its COVID Testing Failures

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S1: In March, the president went into a lab and said every American who wants a test for the coronavirus can get one. Anybody right now. And yesterday, anybody that needs to get in touch with through there, they have the test and it has to be anybody. Was it true then? It was definitely not true that this is Robinson Mayer, staff writer at The Atlantic. We’re talking in late August. Is it true now?

S2: So it’s interesting now. The country still definitely does not have enough tests. And whenever there’s a surge in cases, then everyone who wants a test is definitively unable to get a test.

S1: Normally, Robinson covers climate change and technology, but like many of us, his attention this spring shifted to one thing the pandemic. He’s written extensively about the testing shortages Americans have faced during this public health crisis.

S2: We saw this in Arizona last month where not only were there not enough tests even to test everyone who was symptomatic, not only were there not enough tests to test everyone who was asymptomatic and might have been exposed, there weren’t enough tests to test doctors who were exposed or doctors who are symptomatic. And what that meant was that health care workers, nurses, doctors who had been exposed to the virus had to just sit at home and wait seven, 10 days for a test to come back while their offices basically were short staffed, you know, in the middle of the biggest public health crisis that Arizona has ever seen. So I think that’s a great microcosm of just how dysfunctional most of these systems are across the country six months after this pandemic began.

S1: Robinson says the United States is still experiencing one of the worst covid outbreaks of anywhere in the world. And much of that is because our communities still haven’t been able to answer one fundamental question who has the virus?

S2: If you are able to test people relatively early and often, then you start to bring down infection levels really quickly. And if you’re able to test people every time they go into a public place with a special kind of rapid test, for instance, every time they go to work or school, then all these concerns we have about spreading become much less of an issue.

S3: I mean, I think if you think about all the discussions we’re having about school reopening now, they would all be simplified if we had some way of just testing every student when they arrived. But right now, we just don’t have sufficient tests, much less the huge number of tests. It would take two to to pull off something like that.

S1: Today on the show, what would it take to have widespread functional testing in the U.S., and have we learned enough about the virus to start testing in a new way? I’m Ray Suarez, filling in for Mary Harris. And you’re listening to what next?

S4: Stick with us.

S1: Early on in the pandemic. The emphasis seemed to be on stopping the spread so many of the public health messages centered around wash your hands, cover your face, keep your distance, then testing came surging in. You know, the president started every briefing by saying we’re leading the world in testing and testing became the the measurement of success. Now that we’re around six million cases, now that there are communities where you’d get, you know, 18 percent infection rates once testing for in the in the armoury of public health. What is it for now?

S2: Testing remains one of the key tools in the public health fight against this virus. And there are two reasons for that. I mean, the first is just at a basic level, it allows us to do the most basic task in disease control, which is figure out who’s sick and keep them away from susceptible people. That’s how you bring down a pandemic. The second reason testing is extremely important for this virus pacifically is that there do seem to be some fraction of people where people are just never symptomatic or they never experience symptoms. They actually may never know they’re sick or they may not experience symptoms any more severe than an allergy or so. So they don’t really think that they’re sick. It seems like those people may potentially be more infectious for longer than people who eventually do develop symptoms. And so we have no way of knowing who those people are and keeping them away from susceptible people, from healthy people without testing. And finally, there is kind of a set of other behaviors about this virus that we’re starting to understand that make testing even more important. The first is that it seems like a relatively small number of people drive a relatively large number of infections. So most people probably infect zero other people. But one out of every 10 cases or one out of every 20 cases infects 20 or 30 other people like this virus is driven by very spiky, super spreading events.

S1: Testing would have allowed us to identify those super spreaders early on in the pandemic. Now, with so much community spread, it’s a little late to expect testing will help us get out in front of the virus.

S2: We definitely started too late. There’s there’s no question about that. There’s another question, though, which is do we even have the right tests now with the right kind of tests? Nearly all the tests we run in this country are called PCR tests. They’re highly sensitive, very accurate molecular tests.

S1: PCR test isn’t the term I’ve used a lot, but it’s the test you’re used to hearing about. It’s the one with the long stick nasal swab where recipients feel like they’ve just gotten poked in the brain.

S2: They need to be run in a lab by trained technicians and they take a few hours to run. And because they have to be run in a special place, there’s logistics and getting a sample from the test site to the lab, it can take in a good world one or two days for results to come back. It can take in a world like ours where the testing system is totally clogged and overwhelmed as much as five to seven days. I mean, Arizona tests for not coming back for 14 days. That is a useless test. There is no reason to do that test because 14 days is the quarantine period for coronavirus in the first place. And so what we need, in addition to those molecular tests, which are extremely useful and extremely effective for medical contexts, are screening tests or diagnostic tests tests that let us test a lot of people very quickly across the population.

S1: How would that work? What would that look like?

S2: So what a program like that would look like? I would say, first of all, the NIH has started to fund kind of breakthrough advanced forms of testing. It’s funding, testing that uses genetic sequencing machines that would let us test at a single facility two hundred fifty thousand three thousand tests a day, which is, to give you a sense, about a third of the country’s total testing capacity right now. What this epidemiologists at Harvard, Michael Maeno, it’s calling for are the development and in fact, the government funded mass destruction of rapid tests test that I should say exists right now, tests that don’t require special machinery. They’re just a paper strip. They work in some ways, like the closest comparison is a pregnancy test. You would spit on them. You basically put it in a cup and wait ten minutes. It would tell you whether you’re infectious right now. It would deliver a result within 15 minutes. And what Michael Minah says is that we should produce these. In the billions at public expense and then just make them freely available to anywhere in the country, and before you go into a public place, before you go into a movie theater or a restaurant or a school or an office, you just have to take one of these tests. And if it’s negative, you’re allowed to proceed in. And if it’s positive, then you then you go home and you wait. He argues that if we had a testing strategy on that scale, we’d be able to bring the virus to heel within three weeks, three weeks.

S1: That estimate is debated among epidemiologists and economists. But what’s not debated is that the federal government needs to invest a lot more in these rapid tests because no private company can produce them on such a massive scale.

S2: You know, the government has powers to compel basically the manufacturing of materials for national security or the public good. It did this during the Korean War. There did this during World War Two. Of course, there are laws on the books that allow the government to do this. A big one is the Defense Production Act, which the Trump administration has only invoked once in the spring to make more respirators. What we haven’t seen, kind of in a broad sense, though, is the massive expenditure of billions of dollars to to make testing a widespread common, cheap, easy and accurate part of American life, the only place the government does seem willing to spend billions and billions of dollars finding a vaccine.

S1: Robinson says the US has spent about eight billion dollars on vaccine development.

S2: There is no equivalent of that on testing. All that we’ve spent basically on new experimental testing development is two hundred fifty million dollars. We really only seen that money spent on vaccines. And and I think there needs to be a similar effort for test Robinson.

S1: One thing we know about the rapid tests is that they are less sensitive, less accurate there. I think it’s fair to say a cruder measure. Why are they still a useful tool?

S2: Yeah, absolutely, so I think those questions around accuracy are exactly why they stayed off the market so far. The FDA doesn’t allow any test. It’s not 80 percent is sensitives. Basically, 80 percent is accurate at catching positive cases as that high end best in class PCR molecular diagnostic technique is the FDA doesn’t allow tests like that on the market. And so that’s why we haven’t seen them. I think they’re still a useful tool, first of all, because even if they’re only somewhat as accurate, they will still catch a lot of infections and they’ll catch people with the highest viral load. I mean, if you think about it, it makes sense. I think that if you have a lot of virus in your system, then a slightly less sensitive test is more likely to give you a positive than if you only have a little bit of virus in your system. So they’ll catch a lot of both the catch, a lot of infections, kind of first off that. But they know what we know is that they are almost answering a different question than other kinds of COVA tests. What it’s really looking for is infectiousness. And so instead of these PCR tests that are looking for infections, the way to think about these less sensitive tests is that they’re they’re contagiousness tests. They don’t answer. Am I infected with sars-cov-2? The answer? Am I do I have so much sars-cov-2 in my system that I’m contagious right now?

S1: But long and short, you get useful information out of them.

S2: You do get useful information and you actually get a kind of information that you can get from the from the clinical molecular PCR test that that we use in the majority right now.

S1: These rapid tests, though, they’re not perfect.

S2: One concern I had about these tests, honestly, is that because they are not as sensitive as these high end PCR tests, there are going to be news stories that say, oh, well, they’re not as accurate. They missed they missed 20 percent of cases that these PCR tests don’t. But I am slightly worried that if these tests were to roll out and then there’d be news stories about how they are not as accurate or something, that people would not trust the results of these tests and then would then opt out of taking them or or not take the results seriously.

S1: Now, let’s think for a minute about widespread, almost ubiquitous testing. We you and I live in a country where millions of people are refusing to wear a mask when it was offered as a cheap, easy, low threshold way to just stop making other people sick. We live in a country where, depending on the poll, anywhere from thirty five to 50 percent of people say they won’t take a vaccine once one is developed. Are we really going to have people patiently waiting outside the front door of restaurants to voluntarily give a saliva sample in a country where that many people believe those things?

S2: I think it’s a great question. There’s a few ways I would look at this. I mean, I think the first is that in many states of this, the country already of this test exists today. I am not sure. And it existed in such quantities that we were able to, for instance, give a rapid test to everyone who wanted to eat indoors. I’m not sure it would be voluntary. I think many states would immediately say, well, you just have to take one of these before you go eat, before you go into a store. And I don’t see a reason that wouldn’t be within the legal power of the states to say that. I think the second thing is that if these tests existed at the scale that that Michael Mina and others are talking about would be a huge a huge triumph of the Trump administration. Right now, everyone who meets the president gets actually a rapid covid test. And so it’s something the president is quite familiar with. It’s a system that exists and benefits him right now. And I mean, I think it would be quite in his interests and indeed, his administration would spend a lot of money getting these tests out. The last thing I’d say is just no public health intervention has one hundred percent uptake. There are going to be people who doubt masks. There’s going to be people who doubt the efficacy of this and saying, who is this social distancing? And so I think in this case, we should not let the perfect or the imagined and perfect the enemy of the good here. I think if this technology was available, it would it might not do everything that we want it to do in a perfect world with one hundred percent of people pick it up. But it would save a lot of lives. And it would it would allow. A lot of public places to reopen. They can’t reopen right now.

S1: Rubinson Meyer has been covering the coronavirus pandemic for The Atlantic magazine, thanks a lot. Absolutely. Thank you. I have this suppo. And that’s the show What Next is produced by Mary Wilson, Danielle Hewitt and Jason de Leon with help this week from Daniel Avis. The What Next team also has a new crew member on board. Welcome to the team, Elana Schwartz. I’m Ray Suarez, filling in this week for Mary Harris. Thanks for listening. I’ll be back tomorrow with more. What next?