Failing the Coronavirus Test

By BY THE EDITORIAL BOARD from NYT Opinion https://ift.tt/2VKEja4

Gov. Andrew Cuomo of New York offered a blunt and troubling summary of America’s coronavirus predicament on Friday. To revive the economy, he said, “You have to develop a testing capacity that does not now exist.”

There are promising signs that the spread of the virus is slowing, at least across large chunks of the United States. But that fragile victory has been won only by placing much of the nation in suspended animation, at great expense.

Widespread testing is critical to allow a sustainable resumption of economic activity.

It isn’t a panacea. Precautions like wearing masks and avoiding large gatherings will help limit the spread of the virus. Even with testing, states need to build systems for tracing the contacts of those who fall ill; people required to stay home need economic support. And a vaccine that is not yet known to exist still offers the best hope for a return to something approximating normal life.

But testing permits the substitution of targeted quarantines for general shutdowns, because it lets public health authorities identify people who fall sick, and in turn those who have been exposed to the virus. It lets people start returning safely to work, to school, to stores.

And, notwithstanding the Trump administration’s boosterish assurances, the United States still lacks the means to perform enough tests.

Over the past week, about 151,000 Americans per day were tested for the coronavirus, according to the Covid Tracking Project. Perhaps even more concerning is that the average volume of daily tests has been at roughly the same level for two weeks.

How much more is needed? To sustain a resumption of activity, estimates range from 500,000 tests per day to five million per day, and beyond. The uncertainties are considerable; what is clear is that the current level is not enough.

To ramp up testing, the United States needs to centralize procurement of the necessary supplies, maximize the use of existing laboratory capacity and encourage innovation.

Doing so will require leadership, and money.

On Tuesday, the Rockefeller Foundation published a useful road map for the United States to reach three million tests per week by late June. The foundation’s expert panel estimates that would be sufficient to test people with coronavirus symptoms, people identified as coming into contact with those who have the virus and people at high risk if they get the virus. That, in turn, would allow for a limited return to normal activity across much of the country.

The core of the foundation’s plan is the conscription of laboratory facilities that currently perform other kinds of tests, including university labs and small private labs. The foundation estimates that two-thirds of the nation’s molecular testing capacity is used for other purposes and could be easily redirected.

The report calls for states to oversee this comprehensive mobilization, but the money would come from the federal government, in the form of a fixed $100 fee for each completed test. It estimates the total cost around $100 billion — a huge bargain compared to the economic toll of continuing or recurring economic shutdowns.

Rockefeller also is proposing to create a nonprofit to place bulk orders for needed supplies, backed by a foundation guarantee of payment.

Labs across the country report that they could conduct more tests but for shortages of critical supplies — swabs to gather nasal samples, containers to transport samples, chemicals to test samples. Moreover, a lack of coordination has forced labs to compete for available supplies, creating huge inefficiencies: Some places have plenty of swabs but not enough containers, or containers but not chemicals. Dr. Nirav Shah, the director of Maine’s Center of Disease Control and Prevention, said he would not disclose what kind of testing equipment the state was buying for fear others would hoard necessary supplies.

Vice President Mike Pence called on governors last week to “simply activate” machines sidelined by shortages. This has the quality of putting a man in shackles and then urging him to run. There is a crying need for coordination.

Finally, the Rockefeller report calls on states to hire at least 100,000 people to perform the work of testing and contact tracing. This, too, most likely requires federal funding — and has the virtue of doubling as a jobs program during this period of extremely high unemployment.

All of this, however, falls well short of what is needed. To maintain a more normal level of economic activity, the Rockefeller report says, the United States needs to aim for the capacity to perform 30 million tests every week by the fall.

Getting there will require innovation. The United States has a strong ecosystem of for-profit companies, university labs and foundations. The government has a critical role to play in validating and disseminating the best ideas.

There are some green shoots. The Food and Drug Administration, leaning on new research performed by UnitedHealth Group and backed by the Gates Foundation, approved changes last week intended to simplify collection and transportation of nasal samples.

Credit...Johnny Milano for The New York Times

But more remains to be done. The government’s decision last month to let labs develop new tests for the coronavirus is producing a wave of new approaches. Last week, for example, scientists at the University of Minnesota unveiled a test that does not require the chemicals used in the most common current tests, a potentially important breakthrough. But the Trump administration’s insistence that states fend for themselves means the government is not trying to identify the best approaches, or to encourage production on a national scale.

A tenfold increase in testing also requires a huge increase in the production of necessary supplies. The White House has demonstrated a clear reluctance to issue orders to companies, preferring to beg for cooperation. On Sunday, after weeks of delay, President Trump finally said he would require Puritan Medical Products, a Maine company, to ramp up production of swabs. More is needed. There is no time for deference in the midst of an emergency. Better to issue the necessary orders and then congratulate companies on compliance.

Mr. Trump and his lieutenants have instead preferred to pretend the challenges do not exist. Brett Giroir, the administration’s testing coordinator, said Friday that the nation needed no more than 4.5 million tests per month to begin reopening the economy — meaning that the present level of testing is enough, if it can be sustained.

This is a claim that state officials and scientific experts regard with incredulity.

Virginia’s governor, Ralph Northam, a Democrat, on Sunday described as “just delusional” the administration’s claims that the nation’s existing testing capacity is sufficient. In Maryland, Gov. Larry Hogan, a Republican, called the claim “absolutely false.”

One marker of the inadequacy of the current level of testing is that the share of positive tests has held steady, at about one in five, even as the total number of tests has expanded. In South Korea, which has used widespread testing to keep the coronavirus under control, establishing a model for other countries, the positive test rate is about 2 percent.

Mr. Trump has proclaimed his absolute authority while nearly in the same breath disclaiming responsibility. “The states have to step up their TESTING!” he tweeted Friday.

What the nation needs is the opposite — a leader who accepts the responsibility to do the utmost, within the limits of his constitutional authority, to increase testing.