Should U.S. officials, for instance, use new testing capacity to save what’s left of the school year? Or should testing be used to salvage parts of the devastated economy? Or to tamp down emerging hot spots? Should the federal government focus on producing more molecular lab tests — which are more accurate but slower — or hundreds of millions of cheaper, but less accurate, antigen tests?
The debate has increased in recent weeks as infections have spiked and as hopes have risen that a more science-driven Biden administration will enable the country to tackle long-standing testing woes.
This week, the Rockefeller Foundation unveiled a 33-page report arguing that the U.S. government’s top priority should be using the expanded testing capacity on schools. The report calls for allocating $42.5 billion to create 300 million tests a month for students and staff — enabling the country’s 100,000 public schools to reopen and stay open until the end of the school year.
Just hours before the release of the report, more than 50 leading infectious-disease experts sent Congress a letter arguing for another strategy focused on fighting the virus with inexpensive, rapid tests. Their plan calls for $10 billion in federal funds to implement a year-long effort to screen large segments of the U.S. population. The screening would serve as a way to drive down transmission until vaccinations are widespread.
“It’s clear we need a plan. Trying to keep hospitals from collapsing isn’t a goal or plan, it’s crisis management. We just keep lurching from one crisis to another,” said Michael T. Osterholm, a member of President-elect Joe Biden’s covid-19 advisory board and director of the University of Minnesota’s Center for Infectious Disease Research and Policy. “It’s going to be months before we see the impact of vaccines. And in the meantime, things are going to get even worse than they are now.”
Experts have described testing as the original sin among America’s many failures to respond to the pandemic — starting with flawed test kits shipped out by the Centers for Disease Control and Prevention that hobbled the country’s initial response and continuing with President Trump’s attempts to curtail testing in hopes it would keep case numbers down.
Nine months later, the country is finally poised to receive an avalanche of testing.
By the end of January, the country probably will be able to conduct more than 70 million tests each week, according to the Rockefeller report. By April, that number is expected to reach 200 million a week. With federal government action — by invoking the Defense Production Act, quickly clearing new tests now waiting authorization or creating more pooled testing labs — that number could jump further, adding an additional 100 million tests a week. In comparison, the country saw roughly 29 million tests a week in September.
“If you think about it, the progress we’ve made is extraordinary. We went from just a few thousand tests to millions,” said Mara Aspinall, a biomedical diagnostics professor at Arizona State University, who prepared that projection.
Aspinall maintains the country’s most comprehensive database on the country’s array of coronavirus tests by talking to manufacturers.
There are three reasons, she said, for the impending testing increase: Tests under development since the beginning of the pandemic are finally entering the market. Investments into expanding manufacturing of existing tests are coming to fruition. And approaches that were merely theoretical months ago — such as rapid tests people can take at home and pooled testing — are becoming a reality.
The Rockefeller Foundation argues that increased capacity is best used to reopen schools.
“Vaccines will not take hold fast enough to salvage schools this spring. And losing another semester will be devastating,” said Rajiv J. Shah, the foundation’s president. Closing schools not only does damage to children and widens inequalities but is throttling the economy by preventing tens of millions of adults from working.
The plan calls for testing all students at least once a week and teacher and staff twice a week. With the youngest children being the least vulnerable to infection, elementary schools would open first in February, then middle schools two weeks later and high schools in March.
To make that possible, the plan calls for a dedicated testing capacity to be set aside for schools, so that they can get results for a massive amount of tests within 24 hours. That would be possible if the federal government helped several laboratories around the country have the ability to process pooled tests — as the Broad Institute has done for schools in Massachusetts.
Also known as batch testing, pool testing combines samples from several people and runs the slower but more accurate molecular test on all the samples at once. By processing entire batches of tests at once, labs are able to cut down on the time and supplies required.
With $100 million in federal funds, as many as 10 such regional labs could be set up for pooled testing within six to eight weeks, the report said.
For much of the year, Michael Mina has been arguing that federal funds would be much better spent on less accurate but much cheaper and faster antigen tests, instead of the slower molecular PCR tests that depend on labs.
“We’ve seen how this virus spreads. The moment you have a delay, even if it’s just a 24- hour wait for results, you’re losing the battle against transmission,” said Mina, an infectious-disease expert at the Harvard T.H. Chan School of Public Health.
Mina helped write the letter sent this week to Congress. It argues for lowering strict federal regulations that are hindering manufacturers from producing rapid coronavirus tests that would be so cheap and widely accessible that people who need them could take them every day.
As an example of overly burdensome regulation, Mina pointed to a rapid antigen test authorized this week called Abbott BinaxNOW. The home test, which originally could have been sold for roughly $5, is now being sold as a $25 test because the authorization agreement requires an online telehealth expert to supervise people taking it by video to make sure they do it correctly.
Mina’s letter calls for $500 million to $1 billion in federal money to rapidly expand manufacturing of rapid tests, which remains relatively small compared with molecular test capacity. The government funding could jump-start that manufacturing through advanced purchasing or grants. The letter also calls for another $5 billion to $10 billion to carry out a nationwide rapid testing campaign in the coming year that would provide twice-a-week testing for all Americans in their homes for six to 12 months.
The Rockefeller Foundation report and the letter to Congress both highlight that decisions need to be made soon and priorities set for the country to overcome enduring failures in testing during the pandemic.
Biden transition officials have given little indication what direction they will take on testing, other than saying they plan to increase testing and follow the science in crafting a pandemic response. They have talked with Mina and experts at Rockefeller in recent weeks, soliciting advice.
Osterholm said Biden’s pandemic task force is weighing such issues seriously, but declined to comment on the ongoing discussions. Osterholm said he has concerns about the accuracy of the rapid antigen tests.
“Testing is a very important part of our response,” he said, but more important than the specifics of any plan is the country’s overriding need for setting goals and a larger national strategy for dealing with the pandemic after almost a year without any such a strategy.
“If you don’t know where you’re going, you can’t figure out the steps that will get you to those goals,” Osterholm said.