We Can Stay Open with a State Driven Testing Strategy for COVID19

Open? Shut? Be it a business or school, neither can answer whether they will be "Open" or "Shut" with certainty.

Waiting for a national COVID-19 testing strategy is not working. Instead, we should build around successful local testing models. The NBA by far has the best approach, but not all of us can afford to live in a bubble. Seattle & King County have a great model for others to affordably replicate. It involves repeated testing and vigorous reporting to an electronic database. The results can be mapped which allows healthcare officials to track the virus back to its source and contain it until the threat to public health is over.

While the uncomfortable nasal swab is the gold standard of testing, it is too slow and requires both expensive equipment and specialized staff to work the machines and process the data. According to the New York Times, these tests can cost anywhere between $250 and $1000 per test after all components are calculated.

To make matters worse, The Hill reported that the Government Accountability Office (GAO) found that states are still facing shortages of protective equipment and testing supplies because of high global demand and the limited production of those items within the U.S, despite “numerous, significant efforts” taken by the federal government.

“Delays in processing test results have multiple serious consequences, including delays in isolating those who test positive and tracing their contacts in a timely manner, which can in turn exacerbate outbreaks by allowing the virus to spread undetected.” (See GAO report).

The Hill goes on to report that the Trump administration has largely deferred the COVID-19 response to the states, but it tries to mitigate supply chain shortages and sends shipments of masks, tests and other gear to help with the response.

With this in mind, States ought to use their power to solve the testing crisis. They have the right to authorize new types of #COVID19 tests to enter the marketplace. This is the only effective way to deal with current supply shortages.

So what are our options on testing?

There are three types of tests available for COVID-19: polymerase chain reaction (PCR) (a.k.a. the nasal swab), antigen, and antibody (serology) testing. PCR and antigen tests detect whether a person is currently infected, and serology detects whether a person has an active infection or had an infection in the past.

We know the PCR test is the best and we have already witnessed its limited capacity in providing timely results due to various factors. The antigen and antibody tests offer promising alternatives for us to get back on track. The antigen test can quickly tell who has an infection or who is contagious. New advancements enable the antibody test to do the same by showing who had the virus and at what stage – asymptomatic or symptomatic. The serology tests are by far the most useful in helping public health leaders know (i) what percentage of the population had COVID-19 and (ii) determine who can donate blood to help make a vaccine.

The Food and Drug Administration administers a process to grant rapid antigen and antibody tests an Emergency Use Authorization (EUA) to help fight COVID-19. The FDA rightfully became cautious on some of these devices and has either revoked EUA’s for poor performance or has taken longer to process EUA requests given staff shortages in reviewing applications.

This is where States can step in.

States can and should take the lead to "test" rapid COVID tests and help the FDA determine how best to design and implement a national testing strategy. By testing more rapid tests, States can literally end the uncertainty around "Open" or "Shut" and kick-start building back better. With States authorizing rapid tests, they can mitigate supply shortages and measure performance in concert with Federal and County Health Departments. More data on the effectiveness on rapid tests will lead to improved reliability of testing and strengthen capabilities to predict/trace the virus. Access to more types of rapid tests will ultimately lower the cost of testing to benefit more people. The bottom line is more accessible, affordable testing is the only way to confidently open our schools and businesses in the face of COVID.

“We don’t have anything tomorrow, other than shutting down the economy and keeping schools closed,” said Michael Mina, an epidemiologist at Harvard T.H. Chan School of Public Health and Brigham and Women’s Hospital.

According to the Coronavirus Resource Center, COVID-19 has claimed 200,541 lives in the United States and 967,035 worldwide since January 2020.

The restaurant industry once forecast $899 billion in sales for 2020, but lost 6 million out 6.4 million jobs once the pandemic struck in March – wiping away 35 years of gains. The National Restaurant Association found that during the same time period professional and business services (-2.2 million), retail trade (-2.2 million), health care and social assistance (-2.2 million), manufacturing (-1.4 million), construction (-1.0 million) and accommodations (-900,000) were among the other industries to register significant employment declines.

Without cheap and frequent testing, we will remain paralyzed by the pandemic – stuck between "Open and Shut."

The social and economic disasters do not need to be the only stories told of the pandemic. Another story of States stepping up to fill the gap can be written. In many cases, it has already been done and more collaboration between States and Federal agencies will only help defeat COVID-19.

We can start this new chapter by moving forward with State driven testing strategies using rapid tests. This will stop outbreaks before they start and give rise to a national standard to help America "Stay Open" and "Shut Down the Coronavirus!"