The Health 202: Trump's coronavirus testing goal is on the low side of what public health experts recommend

Trump, standing in front of signs declaring “America Leads the World in Testing,” tried to take yet another victory lap yesterday as he announced details of his administration’s plan to expand testing over the next few weeks. He boasted of an “unmatched” and “unrivaled” testing capacity in the United States — a statement that is not fully true and also does not account for the nation’s slowness in ramping up capacity compared with other countries.

“This is a core element of our plan to safely and gradually reopen America,” Trump said. “And we’re opening and we’re starting. And there’s an enthusiasm like I haven’t seen in a long time.”

MSNBC correspondent Garrett Haake:

The goal of testing 428,000 Americans every day — a roughly one-third increase over current daily totals — falls short of what many public health experts say is needed to safely reopen the country. 

The administration is setting its testing goals based on recommendations from the Rockefeller Foundation. Rockefeller said 3 million weekly tests should be a starting point and should be ramped up to at least 30 million tests per week within six months. It’s one of several groups and individual experts to issue specific testing recommendations: 

• Between 350,000 and 700,000 people should be tested every day, according to Resolve to Save Lives, a public health initiative led by former Centers for Disease Control director Tom Frieden.
• Former Food and Drug Administration commissioner Scott Gottlieb has suggested a goal of 3.8 million tests per week — which would total around 540,000 per day.
• Caitlin Rivers, a scholar at the Johns Hopkins Center for Health Security, told Congress that estimates for the weekly number of tests needed range from 3.5 million to tens of millions.
• Researchers at the Harvard Global Health Institute said last week that at least 900,000 tests need to be conducted every day to safely restart the economy — a significant increase from their previous recommendation of 500,000 tests per day. The researchers said they upgraded the figures when it became apparent the outbreak was worse than expected.
• And another group of Harvard researchers, at the university’s Center for Ethics, has set the bar higher, saying 2 million people should be tested every day. By early June, that should ramp up to 5 million per day, they say.

But the Trump administration's goal may be all that can be realistically accomplished right now. 

As The Health 202 detailed a few weeks ago, government and health officials have faced enormous challenges in securing the many supplies needed to collect samples and perform tests. Labs are restricted by the capacity of the instruments they have on hand, and exponentially boosting testing has not been a quick or easy process. 

“While Trump moves to increase testing, the United States continues to be, by far, the world’s coronavirus hot spot,” my colleagues Anne Gearan, Brady Dennis, Philip Rucker and John Wagner report. “There are now 1.34 million confirmed cases, more than the sum of cases in the next six countries — Spain, the United Kingdom, Russia, Italy, France and Germany.”

The Department of Health and Human Services has now secured enough testing supplies for each state to test at least 2 percent of its residents, officials say.

Trump said the federal government will provide states with 12.9 million swabs and around 9 million tubes of chemicals used to transport the swabs — the result of HHS staff working over the past six weeks with manufacturers to help shore up supply chains.

NBC News correspondent Kelly O’Donnell:

“Every single state will be able to test more people per capita in May alone than South Korea has tested in four months since the outbreak began,” Trump said. “This major commitment is possible because of the massive mobilization of American industry.”

Trump’s right about numbers in comparison with South Korea. 

The United States has already tested more people per capita than South Korea — about 27 out of every 1,000 Americans, compared with about 13 per 1,000 South Koreans. 

But the timeline is where the president’s boasting falls short. South Korea ramped up its testing capacity incredibly quickly. As a result, it has seen just 258 deaths, even though it’s about one-sixth the size of the United States.

That’s not at all the case the United States, where there was little progress made throughout the month of April on increasingly daily testing. After an initial ramp-up in March, around 140,000 people were tested in the United States per day. More recently, those figures have hovered between 250,000 and 300,000.

Freelance reporter Andrew Feinberg:

New York Times reporter Sheryl Gay Stolberg:

CNN reporter Daniel Dale:

The Post's Aaron Blake:

“Trump’s comparison of how many tests the United States has conducted relative to South Korea isn’t wrong, but it’s a bit like boasting about how you’ve earned $1 million over 25 years of employment, putting you among the richest Americans alive back in 1830,” my colleague Philip Bump writes. “Good for you, I guess.”

There are far higher levels of per-capita testing in other parts of the world. 

“The United States as of Sunday had completed nearly 9 million coronavirus tests, according to the Covid Tracking Project,” Anne, Brady, Philip and John report. “While an enormous number, the figure is equivalent to just 2.74 percent of the U.S. population and does not give a full representation of the virus’s reach within American society.” 

As they note: “In tiny Iceland, the figure is an extraordinary 15.4 percent, but that amounts to about 54,000 tests across a population of 352,000 people.” And “major industrialized economies with large outbreaks also have fared better in testing than the United States: Italy has conducted tests equivalent to 4.31 percent of its population, and Germany is at 3.35 percent. The United States also is still behind its northern neighbor, Canada, where its 1.09 million tests are equivalent to 2.95 percent of the county’s population.” 

Trump also got this wrong: The U.S. is nowhere close to having the lowest per capita death rates.

“I think one of the things we’re most proud of is, this just came out — deaths per 100,000 people, death,” the president said. “So deaths per 100,000 people — Germany and the United States are at the lowest rung of that ladder. Meaning low is a positive, not a negative. Germany, the United States are the two best in deaths per 100,000 people, which frankly, to me, that’s perhaps the most important number there is.”

Several European countries do have higher death rates. But the U.S. ranks ninth-highest in deaths out of 140 countries for which information is available, according to data from Johns Hopkins University.

Comparing the U.S. death rate to Germany's death rate is ridiculous, The Post's Aaron Blake writes.

“Germany is one of the envies of the Western world when it comes to its coronavirus response, having ramped up testing very early and then dealing with a far less significant outbreak than its neighbors…Germany has about nine deaths per 100,000 people, as compared with about 24 per 100,000 people in the United States,” he writes.

There are a few positive signs, per FiveThirtyEight founder Nate Silver:

Ahh, oof and ouch

AHH: The Democratic Party is readying new rules to allow for remote voting or a virtual summer convention. 

The party’s rules and bylaws committee is expected to adopt the proposed changes during a virtual meeting today. 

The changes would “allow delegates to participate even if they do not attend the convention in person,” Michael Scherer reports. “No final decision on the convention is expected to be made in coming weeks as organizers await a decision by federal, state and local health officials.”

But adopting the new rules will allow for the possibility of a smaller in-person event that some delegates attend or a virtual event in August. Democrats announced last month that they would reschedule the July event for Aug. 17, a date the committee is also expected to formally accept today. 

If the rules pass the committee, they will be voted on by mail by the full Democratic National Committee in the coming weeks, Michael adds. 

OOF: If the coronavirus persists and becomes an endemic virus similar to influenza, there’s concern there won’t be enough vaccine to meet global demand for a least several years. 

That’s true even with the massive effort to manufacture billions of vaccine doses, Christopher Rowland, Carolyn Y. Johnson and William Wan report.

Scientists say about 70 percent of the world’s population will need to be treated with a vaccine to begin to establish herd immunity.  

“Yet the nationalistic priorities of individual nations could thwart the strategic imperative to tamp down hot spots wherever they are on the planet — including poor countries that cannot afford the vaccine,” they write. “The United States in particular could be left in the cold if vaccines developed here as part of a go-it-alone approach turn out to be less effective than those produced in China or Europe.” 

Public health experts want to avoid a nightmare scenario in which manufacturers sell only to the highest bidder. 

“The global grab for protective equipment and ventilators that left poorer countries empty-handed suggests the competition over vaccines could be at least as fierce,” they write. “Dozens of companies large and small are rushing to develop vaccines using different technologies and approaches. Avalere Health, a pharmaceutical consulting company, is tracking at least 120 vaccine projects sponsored by governments, universities, nonprofit institutes and private companies.”

The supply chain in the United States is nowhere near ready to meet the massive vaccine demand. 

“The nation is already grappling with a shortage of the specialized glass used to make the vials that will store any vaccine,” Politico’s Sarah Owermohle reports. “Producing and distributing hundreds of millions of vaccine doses will also require huge quantities of stoppers — which are made by just a handful of companies — as well as needles and refrigeration units.” 

OUCH: Some countries across Europe are reopening schools, spurring questions about the risks and whether children can be super spreaders of the coronavirus. 

There are drastic new protocols in place for some: class sizes slashed, one-way hallways, staggered breaks, teachers in masks, the New York Times’s Katrin Bennhold reports. One high school in Neustrelitz in Germany is offering students and teachers free tests twice a week. 

Yet in the U.S., schools remain shuttered even as businesses begin to reopen. 

“Restarting schools is at the core of any plan to restart economies globally. If schools do not reopen, parents cannot go back to work,” Katrin writes. “So how Germany and other countries that have led the way on many fronts handle this stage in the pandemic will provide an essential lesson for the rest of the world.” 

Here's an unanswered question: Just how infectious are children?

“Children often do not have symptoms, making it less likely that they are tested and harder to see whether or how they spread the virus,” Katrin writes. “The prospect that schoolchildren, well-documented spreaders of the common flu, might also become super spreaders of the coronavirus, is the central dilemma for countries looking to reopen while avoiding a second wave of deadly infections,” Katrin writes. “It means that school openings could pose real dangers.”

Congress on coronavirus

Top administration officials will testify to the Senate today, from quarantine. 

Anthony Fauci will appear by video before the Senate Health, Education, Labor and Pensions Committee as he remains in a “modified quarantine” after exposure to a White House employee who tested positive for the coronavirus, the New York Times’s Sheryl Gay Stolberg writes.

The nation's top infectious disease expert and a key member of the coronavirus task force plans to warn the Senate that opening up the nation too soon would lead to “needless suffering and death.” 

“The major message that I wish to convey to the Senate HELP committee tomorrow is the danger of trying to open the country prematurely,” Fauci told Sheryl in an email. “If we skip over the checkpoints in the guidelines to: ‘Open America Again,’ then we risk the danger of multiple outbreaks throughout the country. This will not only result in needless suffering and death, but would actually set us back on our quest to return to normal.”

Two other witnesses, Centers for Disease Control and Prevention director Robert Redfield and Food and Drug Administration commissioner Stephen Hahn, are also self-quarantining and will testify by video. Sen. Lamar Alexander (R-Tenn.), will lead the hearing remotely after he, too, entered self-quarantine after an aide tested positive. 

Expect testing to be a top topic.

“Among the topics that senators plan to raise at Tuesday’s hearing are problems in the supply chain for tests, how the federal government makes decisions about testing machines and testing capacity, and workplace safety standards for businesses that choose to reopen,” Seung Min Kim reports. “Democrats also want to question the health officials on what the administration’s metrics and goals are for testing, and why it did not take certain key steps earlier, according to interviews Monday with senators and aides.”

Coronavirus latest

Here are a few more stories to catch up on this morning:

The Trump administration’s response: 

• Trump was all set to visit a Pennsylvania factory that received national attention for its herculean efforts to produce raw personal protective equipment materials to help fight the coronavirus. But plant officials postponed the visit because of concerns about health risks, Carol D. Leonnig reports.
• In an op-ed in The Post, former vice president Joe Biden, the presumptive Democratic presidential nominee, chided Trump for providing coronavirus tests to White House staff while he tells Americans they’re not necessary. “Instead of once again seeking to divide us, Trump should be working to get Americans the same necessary protections he has gotten for himself,” he wrote.

The hardest hit: 

• The novel coronavirus has been particularly devastating to the Navajo Nation. “There’s a lack of running water, medical infrastructure, Internet access, information and adequate housing,” Robert Klemko reports. “And as of Wednesday, as the Navajo tried desperately to take care of themselves, the promised help from the U.S. government had, as usual, not yet arrived.”

In the Washington region:

• Virginia Gov. Ralph Northam (D) said Northern Virginia will be excluded from the initial reopening of the state this week, noting that a large majority of new coronavirus infections were concentrated in the D.C. suburbs, Michael E. Miller, Gregory S. Schneider and Fenit Nirappil report.
• A federal judge ordered the Prince George’s County jail to test more inmates for the coronavirus, Dan Morse and Spencer S. Hsu report, after an inspection found a limited number of tests had been conducted so far.
• D.C. officials unveiled a hospital overflow area constructed in the downtown Walter E. Washington Convention Center. The center can treat nearly 500 covid-19 patients with mild to moderate symptoms, but as the city is not close to needing it, Mayor Muriel E. Bowser (D) called it an “insurance policy,” Fenit writes.

Sugar rush