Test everyone now to help end the COVID pandemic
Experts know testing is a cornerstone of our COVID-19 response. President Donald Trump knows this, too. That’s why everyone he sees in the White House is tested regularly. We can’t beat COVID without testing.
Despite its importance, as a country we consider testing a temporary fix, just a bridge to a treatment or especially a vaccine. We seem prepared to wait months or even years for a vaccine to surface. But there is so much we do not yet know. A potential vaccine could have intolerable side effects, result in only temporary immunity or face low uptake among many Americans. Such great uncertainty calls for more reliable, immediate solutions. While hoping for the best, we must prepare for the worst.
What is the path forward? Is there a solution – not a giant leap, but rather a tried and true approach – that could help end the pandemic sooner than we think?
Yes, and the answer is simple: testing. Scalable, cheap and accurate testing. Testing every person in the country quickly and affordably, and again as needed based on risk and exposure, could identify and isolate cases, track spread of the virus and help reduce further transmission.
This isn’t a matter of whether, but when. All signs indicate it’s feasible. Indeed, America’s testing capacity has dramatically improved since the pandemic started. But in order to reach the level of testing needed, we must act quickly and take key steps outlined below.
There is no time to wait for a vaccine. Testing is a more immediate and cost-effective solution than vaccines. Developing and administering a vaccine will be at least a $50 billion investment. Each vaccine, if comparable with other respiratory diseases, could cost hundreds of dollars.
A $20 test, however, even if given to every American multiple times, would be a fraction of the cost and could be directly paid for by the federal government at less than 1% of the cost of the Coronavirus Aid, Relief, and Economic Security Act.
Testing is more accessible, too. While vulnerable populations, such as people experiencing homelessness and undocumented immigrants, would merit special attention, testing more easily enables equitable access compared with a vaccine that may be prohibitively expensive and have loopholes to administration. A cheap, easy-to-collect and rapidly scalable test could reach every single person in the country in the near future.
An effective and efficient testing regime requires leadership from the federal government: investment and incentives to drive low-cost testing development and evaluation, coordination of the supply chain, and confident payment schemes that make this a sustainable proposition for providers to participate.
We also need funding for state public health departments, which have been decimated over the past decade.
In the absence of leadership at the federal level, neither vaccination nor testing programs can achieve their goal of eradicating COVID-19.
Four steps to make testing a reality
Here’s how we can make this happen: h Use saliva testing to collect samples. It’s simpler and more convenient than nasal swabs and facilitates an eventual transition to self-collection for at-home testing. A saliva-based collection device is already available commercially for at-home use (with Food and Drug Administration approval), and saliva testing has shown promise in outperforming conventional, nasal-based sampling methods. We need to boost our investment in the rapid development and scaling of saliva testing.
h Develop pooled testing for scale. Pooled, lab-based polymerase chain reaction testing is another brick in an affordable and scalable road to rapid testing capability. In fact, the federal government is seriously considering it to increase our testing capacity – and while further evaluation is ongoing, all evidence suggests it will be available soon. Employers, universities and health departments can use pooled testing to test large groups at limited cost. In order for that to happen, we need federal leadership to fund and oversee validation efforts, which must run concurrent to pharmaceutical innovation since private markets may otherwise undersupply.
h Ensure vulnerable populations can be tested and isolated. To address socioeconomic and racial inequities in testing access, we need communitybased testing initiatives run by trusted community members who rely on neither personal finances nor access to transportation. Examples include mobile vans and pop-up clinics. Isolation must also be possible, or our testing efforts will be futile. Cities have used vacant hotels as isolation sites, and similar innovations will be needed moving forward. Continued reforms to broaden telehealth access can also close existing gaps for rural communities.
h Partner with the private sector. The public sector cannot do this work alone. Public-private partnerships, like the Greater Seattle Coronavirus Assessment Network and the YALE-NBA partnership, can accelerate test development and improve access to testing.
Taking the above steps can help us return to normal. Getting students back to school is one example. Universities could test every student over three consecutive days before starting school and then weekly for the rest of the semester. If someone develops symptoms or tests positive, they will isolate. If others were exposed, they could be tested more frequently. Safely reopening schools is one of many scenarios made possible by increased testing.
To be clear, this would complement, not replace, social distancing and mask wearing. Cheap and easy testing would dramatically reduce COVID-19 transmission and deaths, and better prepare us for future such pandemics. Vaccine development can continue in parallel. Our nation deserves to get back to normal as soon as feasible. We shouldn’t be a gambler at a casino, betting everything on one number. Lives aren’t chips.
Sudhakar V. Nuti is an internal medicine/primary care resident doctor at Massachusetts General Hospital in Boston. Samuel R. Turner is a junior at Yale University. Howard P. Forman is a professor of public health and management at Yale.