As I’ve argued frequently here, the first and most important part of that strategy is a tool of disease control powerful enough to replace collective stay-at-home orders. That tool is testing, contact tracing and supported isolation used at scale. It requires about 5 million tests a day for full incorporation of the workforce into a stable regime. President Trump endorsed that target last Wednesday. This is an ambitious goal, and it is good to set our sights this high. We are can-do America, and we can do it.
The second piece of the strategy is a clear vision of what is needed by essential workers, in particular. The economy has not been closed for as much as 40 percent of the workforce. These essential employees are health-care workers; public safety officers, such as police and fire personnel, and guards in our jails and prisons; staff in nursing home facilities; transportation workers; and Navy sailors. They are workers in the food supply chain from meatpacking to agriculture. They are grocery store workers. The virus has been spreading widely among them. They make up a significant share of our casualties.
Here, too, the White House knows what is needed. The nation’s essential workforce includes the president and the vice president. We can look at the protocols used for them. When Vice President Pence was asked about not wearing a mask at the Mayo Clinic, the explanation given was that he and the president are tested weekly, and those who interact with them are tested before meetings. This has given both men a sufficiently sturdy sense of their own safety that they feel confident traveling and even interacting in high-exposure contexts without a mask. While we can’t test all essential workers on a weekly basis — the volume of tests required would be too great — we can make testing broadly available to essential workers and supplement it with contact tracing (and mask-wearing) — to achieve a similar level of safety for them. Pence’s subsequent acknowledgement that he should have worn a mask at the Mayo Clinic underscores the value of masks.
Changes in guidance from the Centers for Disease Control and Prevention reflect that more ambitious stance on testing. The guidance given on March 24 designated testing of asymptomatic individuals as “not a priority.” But an estimated 25 percent of infectious carriers are asymptomatic. We cannot control the disease if we do not test asymptomatic people.
In the most recent guidance, released Sunday, first priority goes to hospitalized patients, first responders with symptoms and residents in congregate-living contexts, with symptoms. But a second priority category includes asymptomatic individuals from groups experiencing disparate impacts of the disease and “persons without symptoms who are prioritized by health departments or clinicians, for any reason, including but not limited to: public health monitoring, sentinel surveillance, or screening of other asymptomatic individuals according to state and local plans.”
The last phrase, referring to screening of “asymptomatic individuals according to state and local plans,” supports broad testing of contacts of covid-19-positive individuals and essential workers, even when they have mild symptoms or no symptoms at all. The strategy within the White House is a good example of the kind of hyper-local plan the CDC now enables. So take note, states and municipalities: Just as the White House has done, it’s time to draft your plans.
The final piece of the strategy is the supply chain. We currently test about 250,000 people a day but could squeeze up to 1 million a day out of the current testing infrastructure. The administration is working toward that target, hence the Defense Department’s recent mega-order of 20 million swabs a month, doubling swab production. Also, as the White House testing blueprint points out, several innovation pathways could deliver multiple millions. University research labs are developing non-proprietary protocols for increasing the output of standard polymerase chain reaction (PCR) tests for covid-19; examples include the Broad Institute in Massachusetts and the University of Washington. Other labs — for instance, a firm called Ginkgo Bioworks, in collaboration with researchers at UCLA and MIT — are developing sample collection and processing protocols that could repurpose next-generation genome-sequencing machines to run a million covid-19 tests a day. Combined with recent breakthroughs on saliva tests that simplify the testing process by removing the need for swabs, personal protective equipment and transport of biohazardous samples, we have the tools we need for testing millions per day. Congress should quickly fund a DARPA-style review process to identify which projects can demonstrate capacity for quality at scale.
Every one of us who can help bring that innovation supply chain into existence ought to be devoting every ounce of energy we have to doing so. It is the key to a safe reopening in which we get to stay open, without repeated applications of broad stay-at-home rules. This is public health that saves lives and livelihoods.
We’re on our way, America, but we’ll need every ounce of will and ingenuity.
An earlier version of this column misspelled the name of Ginkgo Bioworks. This version has been updated.