Millions of swabs pledged by U.S.
In report, testing left to the states
WASHINGTON — In a report to Congress, the Trump administration is pledging to buy 100 million swabs by the year’s end and distribute them to states to help expand the nation’s capacity to test for the coronavirus.
But the report, delivered on the Sunday deadline Congress set for a national testing strategy for the coronavirus, doubles down on the administration’s stance that individual states, not the federal government, should bear primary responsibility for carrying out diagnostic tests to help curb the pandemic.
The report comes as a White House goal set two weeks ago to test residents and workers at nursing homes has yet to be met.
The Washington Post obtained the 81-page document, called Covid-19 Strategic Testing Plan, from an individual on Capitol Hill who was not authorized to disclose it. Federal health officials did not release it publicly, submitting it to four congressional committees as required by law.
The plan, sought by public health experts and congressional Democrats since the virus began circulating in the United States in late February, arrived as the nation’s coronavirus cases exceeded 1.6 million and deaths closed in on
100,000 — both the highest in the world.
Public health authorities emphasize that diagnostic testing to identify who is infected, along with antibody testing to determine who might have immunity, are crucial tools to slow the spread of the highly infectious virus and to develop strategies to make it safe for states and communities to reopen. Without a nationwide strategy, states have developed their own approaches, creating a patchwork, with some parts of the country doing far more testing than others.
The administration’s testing plan says every state should aim to test at least 2% of its population in May and June. The document, however, lists the testing targets each state reported to federal officials for May, totaling 12.9 million tests nationwide, rather than laying out goals the federal government is calling on each state to meet.
“With support from the federal government to ensure states are meeting goals, the state plans for testing will advance the safe opening of America,” the document says.
And in keeping with the portrayal by President Donald Trump and others in his administration that the pandemic is under control, the document says that epidemiologists and public health organizations have said that if 10% of tests are positive for the virus over the course of a week, that is “enough to assure broad coverage of the population.” It says 41 states already have achieved that goal.
LAWMAKERS WEIGH IN
In a joint statement Monday, House Speaker Nancy Pelosi, D-Calif.; Senate Minority Leader Charles Schumer, D-N.Y.; chairman of the House Energy and Commerce Committee Frank Pallone, D-N.J., ; and Sen. Patty Murray of Washington, the ranking Democrat on the Senate’s health committee, said the Trump administration was not taking responsibility for ramping up national testing capacity.
“This disappointing report confirms that President Trump’s national testing strategy is to deny the truth that there aren’t enough tests and supplies, reject responsibility and dump the burden onto the states,” the lawmakers said. “In this document, the Trump administration again attempts to paint a rosy picture about testing while experts continue to warn the country is far short of what we need.”
Experts also took issue with the report’s assertion that continuing to test only about 300,000 people a day, by targeting only those likely to be positive, would be enough to contain the outbreak.
“On the face of it, the idea that 300,000 tests a day is enough for America is absurd,” said Dr. Ashish Jha, director of the Harvard Global Health Institute.
The availability of tests and test kits has been a critical problem with the administration’s pandemic response since the beginning. Testing began late because of problems in the central lab at the Centers for Disease Control and Prevention, which was at first the only source of a diagnostic test. Even when academic and commercial labs began developing their tests, government bureaucracy delayed their use. And the supply of testing materials has been a recurrent problem, though the White House consistently says there are ample tests.
The number of tests nationwide has hovered lately around 400,000 a day, according to the Covid Tracking Project, which compiles and publishes state testing data. That is hundreds of thousands a day fewer than various research models say is necessary.
The new report, prepared by the Department of Health and Human Services, elaborates on a blueprint the White House released last month for increasing the nation’s capacity for coronavirus testing. That 11-page document, released April 27, also placed responsibility primarily on states, saying the federal government’s role would be to “provide strategic direction and technical assistance,” while regulating tests and testing equipment. The government would “act as supplier of last resort,” it said.
The blueprint said it was up to each state to devise a testing plan, determine where people could get tested, and monitor and seek to contain outbreaks. The private sector also had a role, developing new tests, getting them approved by federal regulators, and speeding up production of the tests and needed materials — all features of the strategy Health and Human Services submitted to Congress on Sunday, as well.
Upon its release, the blueprint was immediately derided as inadequate by leading public health officials and other experts. The president issued it hours after a bipartisan group of 16 prominent former federal officials and academics — all with health care expertise — sent a letter to lawmakers urging them to devote significantly more money to expand testing, as well as do more public health tracing to identity the contacts of infected people and isolate them.
Under a $484 billion coronavirus relief package that Congress adopted in late April, lawmakers devoted $25 billion for testing. The law says each state must submit to Health and Human Services a detailed coronavirus testing plan for the rest of this year. It also requires the department to submit a national testing strategy to the four congressional committees — including plans to increase the amount of testing available and to curb disparities among different communities. The deadline for both was Sunday.
NURSING HOME TESTING
Meanwhile, a review by The Associated Press found that at least half of the states have not met White House’s 14-day deadline set May 11 that every nursing home resident and staff member be tested for the coronavirus.
Many states said the logistics, costs and manpower needs are too great to test all residents and staff in a two-week window. Some say they need another week or so, while others say they need much more time. California, the most populous state, said it is still working to release a plan that would ensure testing capacity for all residents and staff at skilled nursing facilities statewide.
And still other states are questioning whether testing every nursing home resident and staff, regardless of any other factors, is a good use of time and money.
“At this time it would be fairly useless to do that,” said Nebraska Chief Medical Officer Dr. Gary Anthone, adding that the state would have to repeat the tests almost daily to get more than a snapshot in time, and the state doesn’t have the capacity when there are others who need to be tested.
Anthone said the state was going to stick with the CDC’s guidelines, which call for testing individually when nursing home residents show symptoms or collectively if there is a new confirmed case of covid-19 in a home.
White House adviser Dr. Deborah Birx acknowledged Friday that the two-week recommendation was a challenge but said it was needed because of the particular vulnerability of nursing homes.
“We should never be discouraged by those who can’t get it done,” she said. “We should be encouraged by those who have shown us that it can be done.”
Nursing homes residents, who are typically older and often have underlying medical conditions, have been particularly hard hit by the virus. More than 36,000 residents and staff have died from outbreaks at the nation’s nursing homes and long-term care facilities, according to an AP tally. That is more than a third of all deaths in the U.S. that have been attributed to the virus. Information for this article was contributed by Amy Goldstein of
The Washington Post; by Apoorva Mandavilli and Catie Edmondson of The New York Times; and by Alan Suderman and staff members of The Associated Press.