If successful, Biden’s approach would turn the testing system into a tool capable of reducing infections, rather than merely documenting the pandemic’s toll. The Trump administration has largely shifted responsibility for testing onto states and commercial labs — supporting the development of new types of tests but shying away from a coordinated federal strategy to screen the public.
Public health experts say a new approach to testing is sorely needed, a year after the virus first emerged. The United States recorded more than 1.1 million new cases in the last week, increasing by 26 percent over the previous week — while the number of tests run grew by just 10 percent, to 11 million. Labs are beginning to struggle with the growing demand. One major provider, Quest Diagnostics, warned this week that its turnaround times for test results were slowing and the situation was unlikely to change for “the foreseeable future.”
The current testing system is not set up to identify people who are infected but don’t have symptoms, said Eric Goosby, an infectious disease expert at the University of California, San Francisco, and a Biden adviser. “Until we do that, we’re going to chase this thing.”
Medical staff from the Ohio National Guard work at a Covid-19 testing site at PrimaryOne Health in Columbus, Ohio. | Joshua A. Bickel /The Columbus Dispatch via AP
But the ongoing surge in cases could also make it difficult for the Biden team to make quick changes to the country’s testing apparatus. An urgent need to ensure the sick are tested quickly could slow the drive for rapid testing to identify asymptomatic cases, for example. And strengthening the supply chain will take time, because manufacturers may need to set up new production lines.
The team’s work has also been disrupted by President Donald Trump’s refusal to concede the election and allow the president-elect’s advisers to begin transition discussions at federal health agencies.
“The Biden administration has a huge task ahead. They have to put the train back on the rails while hurtling down the track,” said Scott Becker, CEO of the Association of Public Health Laboratories.
The president-elect’s transition website lays out a number of steps aimed at making testing more plentiful and accessible, and strengthening now-fragmented state contact-tracing programs.
Proposals include establishing a “Pandemic Testing Board” to increase production and distribution of tests and creating a 100,000 person U.S. Public Health Jobs Corp to help with contact tracing. The plan also suggests doubling the number of drive-through testing sites across the country and investing in the development of new types of Covid-19 tests, such as at-home tests.
New York University epidemiologist Celine Gounder, a Biden adviser, told POLITICO the transition team wants to be able to surge testing and other pandemic response bandwidth to areas of the country experiencing acute Covid-19 spread.
“We are very much in the mindset of a dimmer switch, instead of an on and off, where you’re able to dial things down based on local data and do things in the most geographic way possible,” Gounder said.
Eileen O’Connor, senior vice president at The Rockefeller Foundation, said the organization has briefed the Biden team on its work with the federal government to expand and implement widespread testing. Rockefeller is pushing the incoming administration to immediately use the Defense Production Act to increase the availability of testing materials like pipette tips, which have been in short supply.
“We work with both the federal agencies and experts across the country to help those on the ground resolve these issues, but they would more effectively and quickly resolved with a more robust federal response,” O’Connor said.
In September, Rockefeller estimated that 200 million tests a month are needed to safely reopen schools and nursing homes. But the figure was based on infection rates that were far lower than what the U.S. is currently experiencing. Some Biden advisers appear open to such a major increase in testing, which they argue is necessary to help bring the pandemic under control.
“Sports teams have shown us this,” Goosby said. “The sports teams that did once-a-week testing strategies broke more often with outbreaks than those who [tested] twice a week.”
Screening people more frequently increases the chance of identifying those who are infected earlier in the course of their disease, and reducing the risk they’ll pass on the virus, he added.
But Becker said the Biden team’s progress on testing will be limited by how difficult it will be to increase access to testing supplies. “Decisions have been made over the last 10 months that make turning this ship quickly a difficult task,” he said.
And some of the strategies Biden’s team is exploring — like using the Defense Production Act — could run into industry opposition. “We believe DPA should be used carefully and only in a manner that will incentivize the diagnostics industry to continue the tremendous work they are already doing to meet the needs of this crisis,” said Scott Whitaker, the CEO of medical device industry group AdvaMed.
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