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Saturday, August 15, 2020

‘We’re Clearly Not Doing Enough’: Drop in Testing Hampers Coronavirus Response - The New York Times

"For the first time during the pandemic, the United States saw a downward trend in the number of coronavirus tests conducted each day.
A testing site in Los Angeles on Thursday. The number of tests being conducted daily in the area is down from earlier peaks this summer.
A testing site in Los Angeles on Thursday. The number of tests being conducted daily in the area is down from earlier peaks this summer.
For months, public health experts and federal officials have said that significantly expanding the number of coronavirus tests administered in the United States is essential to reining in the pandemic. By some estimates, several million people might need to be tested each day, including many people who don’t feel sick.
But the country remains far short of that benchmark and, for the first time, the number of known tests conducted each day has fallen.
Reported daily tests trended downward for much of the last two weeks, essentially stalling the nation’s testing response. Some 733,000 people have been tested each day this month on average, down from nearly 750,000 in July, according to the COVID Tracking Project. The seven-day test average dropped to 709,000 on Monday, the lowest in nearly a month, before ticking upward again at week’s end.
The troubling trend comes after months of steady increases in testing, and may in part reflect that fewer people are seeking out tests as known cases have leveled off at more than 50,000 per day, after surging even higher this summer. But the plateau in testing may also reflect people’s frustration at the prospect of long lines and delays in getting results — as well as another fundamental problem: The nation has yet to build a robust system to test vast portions of the population, not just those seeking tests.
Six months into the pandemic, testing remains a major obstacle in America’s efforts to stop the coronavirus. Some of the supply shortages that caused problems earlier have eased, but even after improvements, test results in some cases are still not being returned within a day or two, hindering efforts to quickly isolate patients and trace their contacts. Now, the number of tests being given has slowed just as the nation braces for the possibility of another surge as schools reopen and cooler weather drives people indoors.
“We’re clearly not doing enough,” said Dr. Mark McClellan, the director of the Duke-Margolis Center for Health Policy and the commissioner of the Food and Drug Administration under former President George W. Bush.
Credit...Shannon Stapleton/Reuters
The downward trend may turn out to be only a short-term setback: The nation reported more than 800,000 tests on Thursday and Friday. There are also limitations to the data, which is largely drawn from state health departments, some of which have recently struggled with backlogs and other issues. It may not include tests done in labs not certified by the federal government.
But according to the figures available, tests were declining in 20 states this week, and data collected by the Department of Health and Human Services showed a similar overall trend nationally.
Without a vaccine or a highly successful treatment, widespread testing is seen as a cornerstone for fighting a pandemic in which as many as 40 percent of infected people do not show symptoms and may unknowingly spread the virus. Testing a lot of people is crucial to seeing where the virus is going and identifying hot spots before they get out of hand. Experts see extensive testing as a key part of safely reopening schools, businesses and sports.
The nation’s testing capacity has expanded from where it was only a few months ago, but public health experts believe it must grow far more to bring the virus under control.
The Harvard Global Health Institute has suggested the country needs at least 1 million tests per day to slow the spread of the virus, and as many as 4 million per day to get ahead of the virus and stop new cases. Some experts view that goal as too ambitious, and others say the benchmark should focus not on a particular number of tests but on the percent of people testing positive.
Yet there is broad consensus that the current level of testing is inadequate and that any decrease in testing is a worrisome move in the wrong direction.
“There is a reasonable disagreement about what that number ought to be, but all of them are way ahead of where we are right now,” said Dr. Ashish Jha, director of the Harvard Global Health Institute. “There is no expert that I know of that thinks that our testing infrastructure right now meets the needs of the American people.”
Adm. Brett P. Giroir, the assistant secretary for health and the Trump administration’s virus testing czar, said that conducting millions of tests per day was not realistic and defended the current testing levels as adequate. The administration has asked states to test at least 2 percent of their populations each month, or the equivalent of about 220,000 people per day nationally, which Admiral Giroir said would be enough to identify rising hot spots.
“We are doing the appropriate amount of testing now to reduce the spread, flatten the curve, save lives,” he said this week.
He said the government was already testing large numbers of asymptomatic people, and he described an effort to strategically deploy tests, including to those who are hospitalized and in nursing homes. “You do not beat the virus by shotgun testing everyone all the time,” Admiral Giroir said, adding: “Don’t get hung up on a number.”
For much of the spring and summer, the number of daily tests steadily increased. The United States averaged about 172,000 tests per day in April, before ramping up to an average of 510,000 in June and nearly 750,000 in July.
The recent dip in testing is likely a result of several factors, epidemiologists said.
It may, in part, reflect an improved outlook from earlier this summer, when parts of the Sunbelt were seeing alarming outbreaks. The number of people hospitalized with the virus each day across the country has decreased to around 45,000, down from earlier peaks of around 59,000 in April and July. And the percent of people testing positive over all is hovering at about 7 percent, down from 8.5 percent in July.
“It’s an indication to me there are not as many people getting sick,” said Nelson Wolff, the county judge in Bexar County, Texas, where a site that provides free tests for people reporting symptoms had seen a decline in demand.
But experts fear the slowing of tests may also reveal a sense of “pandemic fatigue” — people who want or need to be tested but may choose not to, discouraged by stories of others waiting hours in line and waiting as long as two weeks for a result.
Even if fewer people are volunteering to be tested, most experts believe testing should still be going up over all, particularly in regions where the portion of people testing positive is high. A community may be considered to have controlled virus spread if it is testing widely and the percent of people testing positive over a two-week period is less than 5 percent, according to the World Health Organization.
Yet testing has been dropping in a number of states with positivity rates in double digits, including Mississippi, Nevada and South Carolina.
The situation has been particularly acute in Texas, where the number of reported daily tests fell to as low as 35,000, down from a high of 67,000 in late July. The drop came as the state’s percent of positive tests rose to as high as 24 percent earlier this week.
Gov. Greg Abbott said the state deployed a team to investigate why the positivity rate had risen so sharply. He said on Thursday that the state had more testing capacity than was being used and that he was sending thousands more tests to Houston.
In Travis County, which includes Austin, the health authority, Dr. Mark Escott, told local officials of a drop in demand. “This is not because tests are not available,” he said. “It is because less individuals are signing up.”
That dilemma reveals perhaps the biggest challenge going forward.
The country has so far relied heavily on laboratory tests, which are accurate but can take hours or days for results and are best suited for people who believe they may have been exposed to the virus.
To scale up testing to a level that could keep the virus in check, experts say, the United States will need to expand other types of testing, like antigen tests, which are less accurate but can provide results in as little as 15 minutes, and other new technologies, like tests that could be done at home.
Such an approach would reduce the strain on laboratories, reserving those tests for people who need them most, while allowing the country to simultaneously screen large numbers of asymptomatic people at schools, nursing homes, offices and neighborhoods.
By some estimates, as much as $75 billion in additional federal funding may be needed. The Trump administration agreed to allocate an additional $16 billion for states to conduct testing and contact tracing, as part of a proposal Republicans unveiled late last month. But negotiations over a new coronavirus relief bill have resulted in a standoff between the White House and Democratic leaders in Congress, and only Congress can approve new aid. Lawmakers have left Washington until early September, all but guaranteeing they will not approve more funds for testing until next month.
The country is also still waiting on a larger market of tests.
The Food and Drug Administration has approved just two companies to sell antigen tests. One of the companies, the Quidel Corporation, says it is making 1 million tests per week. The other, Becton, Dickinson & Company, said it is ramping up testing, with the aim of manufacturing 10 million tests by the end of September.
Other tests are still in development. For example, a saliva test, which has been tested on N.B.A. players and staff, is awaiting emergency approval by the F.D.A.
“We are at an inflection point,” said Dr. Jonathan Quick, who is managing the pandemic response at the Rockefeller Foundation, which has said the nation needs to carry out about 4 million tests a day by the fall. “That is a paradigm shift.”
The Trump administration has at times provided inconsistent messages on testing. President Trump said in June that testing leads to more cases, which “makes us looks bad” but is “good to have.” He repeated the idea in an interview with Axios in late July, saying, “There are those that say you can test too much.”
Members of his administration have repeatedly stressed the importance of testing. The nation’s top infectious disease expert, Dr. Anthony S. Fauci, has said more testing of asymptomatic people is needed. “We’re going to be doing more testing, not less,” he told Congress in June.
Other top officials have also talked about expanding testing. Dr. Deborah L. Birx, the Trump administration’s coronavirus coordinator, has said that pooling tests together to assess multiple samples at once could expand capacity to as many as 5 million tests per day.
The Department of Health and Human Services said in a report to Congress that its aim was for the country to have the capacity to perform 40 million to 50 million tests each month by September, an average of about 1.3 million to 1.6 million tests a day.
Admiral Giroir, the testing chief, said the country was on pace to surpass that number by the fall, with the majority being new tests to screen people. But he said the figure was only a goal for capacity, and that fewer tests might ultimately be carried out.
Mitch Smith and Emily Cochrane contributed reporting."
‘We’re Clearly Not Doing Enough’: Drop in Testing Hampers Coronavirus Response - The New York Times

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