johnson130_ John ParaskevasNewsday RM vis Getty Images_covid testing John Paraskevas/Newsday RM via Getty Images

How to Close America’s COVID-19 Testing Deficit

The US is facing a major health and economic catastrophe for one simple reason: its existing COVID-19 testing infrastructure has broken down. There is still time to build a new system that enables policymakers and the public to understand where outbreaks are occurring and where they are likely to occur next.

WASHINGTON, DC – To track the presence of SARS-CoV-2, the virus that causes COVID-19, the United States is relying heavily on polymerase chain reaction (PCR) live virus testing at massive scale. In the most common version of this approach, samples – nasal swabs or saliva – are sent to relatively large labs, with the goal of returning results within 24-48 hours. Unfortunately, while some priority tests receive speedy turnaround, it now typically takes 7-22 days to get results across most of the country. For a fast-moving virus like SARS-CoV-2, which can progress from infection to final outcome (death or recovery) in as little as eight days, long delays mean that PCR virus testing is a waste of time and money. By the time you know the result, it is too late to do anything different.

For “surveillance testing,” an essential part of preventing outbreaks, two highly unequal worlds are emerging. Big companies and universities will pay top dollar to test all their people at high frequency (once or twice a week, with quick results), while everyone else will effectively not be tested (because results obtained after more than three days are of negligible value). This arrangement is not only hugely unfair (in ways that will become increasingly visible); it will also contribute to repeated resurgence of the disease in the coming months.

Quickly detecting COVID outbreaks is currently the main available tool for keeping people safe and retaining any reasonable level of economic activity (and jobs). More than 750,000 people, on average, are currently tested for live virus every day in the US. But this is far from enough in a country of around 330 million people, with a workforce of around 165 million, roughly 57 million schoolchildren, and another 20 million trying to attend some form of college.

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