South Florida Sun-Sentinel (Sunday)
Pivot to end COVID-19, cure lockdowns urgent
WithCOVID-19 cases, hospitalizations and deaths climbing, policymakers understandablywant a response that protects lives and livelihoods. Many have resorted to an old playbook of blunt mandates, including late-night curfews, travel restrictions, aswell as school and business closures. And whilewewait at home, our leaders have pinned hopes on a vaccine that remains months away frombeing widely available.
Unfortunately, these are public health tools predicated on the assumption that it is impossible to knowwhohas the virus. Therefore, wemust treat everyone as infected.
However, this doesn’t need to be theway. The technology exists to equip everyone with knowledge of theirCOVID-positive status using self-administered rapid tests. In fact, theTrump administration recently purchased 150 million rapid tests to distribute to those most in need.
But this is nowhere near enough to collapse the outbreak’s spread. Thatwould take, according toHarvard epidemiologistDr. Michael Mina, half the population testing themselves with a rapid test every four days.
That requires more tests— a lot more — to transform the response to the virus. PaulRomer, aNobel laureate in economics, argueswe need to test 50 million people per day, an investment he estimates could cost of $45 billion over the course of three months. This is a snowflake in a storm compared to what has been spent to date in the response and the lives lost already.
Such a modelwould followthat being used by the NFL, which administers tests to players and other essential employees daily and requires a negative test before entering aNFLfacility, along with other mitigation measures including social distancing.
This approachwould also meet Americans where they are: fatigued fromboth the virus and the response and resistant to additionalmandates. Itwould empower us to knowour ownstatus and be reasonably sure others knowtheirs. Massive distribution of rapid self-tests for use in homes, schools, offices and other public places would replace ignorance with knowledge.
What’s in theway? Regulatory barriers, direct funding and leadership.
Realizing the promise of these tests must begin with theDepartment ofHealth and HumanServices adjusting its regulatory posture. For example, one of the cheapest, most effective rapid tests— delivering results for $5 in 15 minutes— can give results at home, butHHShasn’t cleared it for home use— not even under the supervision of a medical provider via telehealth. Instead, users have to mail it into a lab, whenwhat’s needed to keep pace with the disease are tests with near-instant results that can be done by anyone. This restriction could be understandable if the test is difficult to perform, but it’s not.
Additionally, Congress should immediately provide resources thatwould commit HHSto prepurchasing rapid tests over the next two years. Even if a vaccine is quickly produced and distributed, it is unlikely to reach healthy populations until 2022. During that time, additional rapid testing will be needed to ensure that the virus is contained and that schools and businesses can safely open and remain open.
Andwhile testing capacity is ramping up, theCDCneeds to provide better, clear guidance aboutwhoshould get testedwhen. The CDC’s guidance remains conflicting and contradictory, with differentweb pages recommending different things.
JoeBiden has called for implementing widespread testing; DonaldTrump should join him in that call. We have no time towaste. Aswe have entered a season of rising cases, we have already reached unprecedented caseload levels.
Policies currently in place leave us no way to determine, on a rapid and widespread basis, whomay have the infection and may be spreading it to others. And in response, people are either increasingly resistant to being told what to do and taking no precautions, or returning to their bunkers towait.
These are times that require our leaders to ask hard questions, make difficult choices and pivot quickly as newtools become available and newinformation comes in. It’s time for our leaders to look seriously at ramping up access to rapid self-testing, and do what it takes to advance it.