Six months into pandemic, U.S. is still struggling
Drop in COVID-19 testing hampers America’s response
For months, public health experts and federal officials have said 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 past 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 sevenday test average dropped to 709,000 on Monday, the lowest in nearly a month, before ticking upward again at week’s end.
The trend comes after months of steady increases in testing, and it 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 higher this summer. But the plateau in testing also may 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.
The downward trend may turn out to be only a shortterm setback: The nation reported more than 800,000 tests 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% of infected people do not show symptoms and thus 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 sporting events.
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.
Adm. Brett Giroir, the assistant secretary for health and the Trump administration’s virus testing czar, said 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% of their populations each month — or the equivalent of about 220,000 people per day nationally — which Adm. 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,” Adm. 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 U.S. 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.
Several factors
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 Sun Belt 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 overall is hovering at about 7%, down from 8.5% 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, the home of San Antonio, 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.
“The good answer would be because we have less COVID, fewer people have symptoms. A bad answer might be that people gave up because it’s taking a long time,” said Dr. Junda Woo, medical director for San Antonio Metro Health. “We have the data, but we don’t have a lot of the answers behind the data.”
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.”
The trend worries health experts who fear Texas risks flying blind into the fall if it doesn’t increase testing. Texas embarked on one of the fastest reopenings in the U.S. in May but retreated weeks later in the face of massive outbreaks, ultimately leading Gov. Greg Abbott to impose a statewide mask order after previously saying he wouldn’t.
Improvement
In recent weeks, things have improved, including a nearly 40% drop in hospitalizations since July’s peak. But deaths remain high, and doctors in some parts say they’re still stretched. Texas is averaging more than 210 reported new deaths a day over the past two weeks, according to The COVID Tracking Project. On Friday, it reported 313 deaths. Overall, the state has recorded more than 9,600 fatalities.
The rolling average of people who test positive for the virus in Texas is stubbornly elevated at 16% — a figure that itself could be a sign of insufficient testing. The Centers for Disease Control and Prevention has said a positivity rate under 10% is an indicator a state has robust testing.
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 expand testing to a level that could keep the virus in check, experts say, the U.S. will need to scale up 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.
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 Corp., says it is making 1 million tests per week. The other, Becton, Dickinson & Co., said it is ramping up testing, with the aim of manufacturing 10 million tests by the end of September.