According to the Covid Tracking Project, we saw 152,000 tests on Tuesday. The numbers are slowly edging upward, but are mostly plateauing. Numerous states and hospital professionals have sounded the alarm about the federal government’s failure to marshal private-sector resources to deliver the supplies needed to seriously scale up.
And that’s not all: Another major issue is contact tracing, the painstaking push to identify people who have come into contact with someone who is known to be infected. Experts fear that the states, which are escalating their contact tracing efforts, are doing so in a haphazard way with far too few personnel.
Dr. Tom Frieden, a former director of the Centers for Disease Control and Prevention and a former New York City health commissioner, has been advising world governments on how to scale up testing regimes.
I spoke to Frieden about what’s needed in the United States. An edited and condensed version of our conversation follows.
Greg Sargent: What would a robust federal testing regime really entail?
Tom Frieden: The volume of testing we’re doing now is far lower than what we need to be doing. It has scaled up some, but we need to be doing at least three times more per day to meet the bare minimum of the highest priority testing.
What is the highest priority testing?
You would want to test every person admitted to hospitals, every person in a nursing home, homeless shelter, or other congregate facility exhibiting symptoms.
You test every single person admitted to a hospital?
At a minimum, those who have suspected covid. But if you really want to keep hospitals safe, you would test all those admitted. Everyone with pneumonia in America should get tested.
At this point, do we have even a general sense of what percentage of people with covid-like symptoms admitted to hospitals are being tested?
No. This is the kind of data we should be seeing, but aren’t. The most important indicator isn’t how many tests we’re doing per day, or even how many tests per 1,000 of the population we’re doing per day. The most important is: Are we testing the highest priority people?
There are more people who have symptoms of covid every day than there are tests. So we can’t even test everyone with symptoms of covid.
Everyone who has tested positive should ideally be tested again at the end of hospitalization or isolation. Every contact with symptoms, and potentially those without, should ideally be tested.
Testing is just one of four crucial components of boxing in covid-19. Without isolation, contact tracing, and quarantining of contacts, testing itself won’t make much difference.
About contact tracing — what do we need in a serious national response?
We need national guidance and policy. We need a pattern for how it gets done. We need many people to do it, led by public health and supported by health-care and social-service agencies.
The act of contact tracing is a highly specialized skill. It requires people skills, communication skills, knowledge of confidentiality and medical issues. It needs to be done expertly in order to have good results.
It’s hard to get one’s head around how big this response needs to be.
Look at Wuhan. It has 11 million people. It has 9,000 contact tracers, and they’re doing 50,000 tests a day. And it has almost no cases.
If we had the kind of contact-tracer-to-population ratio that Wuhan has, that would be 300,000 contact tracers.
On tests, with 400,000 to 500,000 a day, we’d be able to reach the priority population. By priority, I mean the people for whom testing might save their lives and help stop spread.
On supply chains, what would it look like if we had a fully engaged federal government?
Other countries around the world have basically planned, taken over production, made sure it gets done, repurposed factories. A war-footing approach.
The broader issue here is that the way to respond to an emergency like this is to use a structured incident management system. You have an incident manager. You have task forces reporting to the incident manager. The incident manager reports to the head of the country or city or state or province. This is the best practice for how to manage emergencies.
Countries do this all over the world. It seems to still be lacking in the United States.
How would you overlay [federal coordination of] testing and contact tracing on to the states?
Production coordination has to be done on a national level. Then the states have to implement the testing. If you’re going to get the military or businesses to work in concert producing the whole supply chain of tests, that has to be done with national coordination.
Once there are enough tests, it’s up to the states, the health departments and hospitals to make sure they get used correctly.
Contact tracing is a little different. The boots on the ground are going to have to be at the state and local levels. That’s going to require a great deal of training and creativity and coordination by a lot of different entities.
It’s mind-bogglingly huge, what we need.
It’s huge, but our ability to restart our economy and save lives depends on it. So we need to get past “this is bigger than anything we’ve done,” and say, “alright, it’s going to take awhile, but it’s something we have to try.”
South Africa — they’ve got 25,000 people doing this. Liberia has 6,000 doing it.
Contact tracing. And following cases. We have let our public-health infrastructure decay.
What are the consequences going to be if we continue on our current course?
If we can’t box it in by testing, isolating, contact tracing and quarantining, there is a much higher risk that the virus will explode again, resulting in avoidable infections of health-care workers, an overload of our health-care system, and increased deaths.
Our ability to get to the new normal depends to a great extent on our ability to test, isolate, contact trace, and quarantine.