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To Get Our Economy Moving, Focus On Testing For Coronavirus

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This piece by Dr. Ashish K. Jha, Director of the Harvard Global Health Institute, is absolutely crucial reading, especially by Washington policymakers handling the COVID-19 crisis. It puts forth the steps that must be taken immediately if we are to reopen the economy as soon as possible without a resurgence of this ghastly disease. The key is a rapid ramp-up of testing.

The COVID-19 pandemic is taking an unprecedented toll on Americans and on the country’s daily life. President Trump has said he wants to open up again—we all do.   The real question is how we reopen in a way that lets us stay open. Here’s what it will take.

The single most important tool we’ll need is an extensive testing infrastructure. Right now, we’re testing approximately 150,000 people a day. That’s nowhere near enough. In most states, if you have mild symptoms, you are advised not to get a test but, instead, to self-quarantine at home. This strategy, borne out of a shortage of testing capacity, has meant that we don’t know the true burden of disease, and those quarantining themselves at home are often still spreading it to family members. Furthermore, we now know that a large proportion of people who spread the disease to others have no symptoms at all—and we certainly aren’t testing them. Without adequate testing, we don’t know how many are infected, where the virus is spreading or where the hotspots are. We’re on a battlefield wearing blindfolds.

Sweeping social-distancing measures are required, because we can’t properly identify who is sick or who has already been sick and developed immunity. There’s no option to more specifically target those who are infected. Compare the U.S.’ response to that of South Korea, which not only managed to severely reduce its number of new infections but also do so without any major lockdowns, keeping many offices and restaurants open. From the beginning, South Korea implemented a rigorous testing regimen that included testing not only anyone who showed symptoms but also people who had had contact with infected patients. Because South Korea could develop a clear picture of who was sick and who was healthy, it could target efforts to real hotspots—and let people in other areas continue participating in daily economic and social activities.

While we don’t know the exact number of tests needed to safely reopen most of our economy and society, we know it’s a lot more than what we are doing now. We need enough to test everyone who has symptoms and their contacts, as well as a sample of the people who are asymptomatic to know how much silent disease we are missing. Given that we are largely testing only symptomatic people, we probably need to triple our testing capacity, maybe even more. Testing on this scale—about 500,000 people daily—is well within our capacity, and as the disease burden comes down, so will the number of tests we need to perform. However, there are several important barriers to testing all those who need it, and in reaching for this goal we must remember why we find ourselves behind. First, the Centers for Disease Control & Prevention (CDC) built faulty tests that didn’t work. Next, the Food & Drug Administration’s (FDA) red tape and regulation prevented the private sector from building and expanding its testing capacity. These roadblocks stopped progress toward a robust early testing infrastructure—which could have prevented the national lockdown. But looking ahead, there are reasons for optimism about testing. The FDA has made progress on loosening regulations and is allowing the faster development of tests.  

But there are other challenges that will take more than removing regulatory hurdles. In many parts of the country there are serious shortages of supplies needed to conduct tests: many states don’t have swabs, while others lack enough gloves and masks for workers who administer the tests. In other places there’s a shortage of reagents, substances used to detect the presence of the virus, to run the tests. None of these barriers is insurmountable. We are losing hundreds of billions of dollars in economic activity because we didn’t create a testing infrastructure, an infrastructure that would have cost far less.

President Trump must make testing his number one priority. Too many people are advising him that the testing problems have been fixed. That is wrong; they have not. In the daily White House briefing, we should hear updates on the number of tests performed, the major barriers to scaling up testing and what the White House is doing to remove them. The President and his senior team must personally and fully engage the private sector, harnessing American creativity to expand our testing capacity. In the short run, the federal government could offer financial support or guarantee payment for companies producing tests. Finally, the federal government needs to play a critical role in coordination and distribution. Some states have adequate swabs but not enough reagents. Other states may be missing swabs but have enough reagents. We must find ways to move supplies around so that states get what they need when they need it. Only the federal government can play this coordinating role.

Once we have adequate testing, we need to deploy that testing smartly—again, focusing on three groups: those with symptoms; those who have been in contact with those infected; and a sample of healthy, asymptomatic people. Beyond having enough tests, we’ll need a group of public health workers to track down contacts, make sure people adhere to quarantine and ensure that people who need testing are getting it. This is all within our capacity to do and will cost a fraction of the stimulus bill that Congress just passed.

While the price of social distancing is high, the price of reopening without the right testing infrastructure would be higher. If we open up without being prepared, the number of cases of COVID-19 will spike, hospitals will become overwhelmed, and we will have to shut down again, for even longer. We don’t have to choose that path. Other countries have shown us that it’s possible to fight COVID-19 without a widespread lockdown. But to safely do so, we must catalyze a massive investment in and scale-up of our testing infrastructure—and we must do it now. The health of our society and economy depend on making testing a priority.

—Ashish K. Jha, MD, MPH | Director, Harvard Global Health Institute K. T. Li Professor of Global Health, Harvard T.H. Chan School of Public Health Professor of Medicine, Harvard Medical School

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