The lesson is simple. We ought to have known it for months: There is no stable reopening, no recovered economy, unless we protect life. A surge of investment in public health infrastructure to bring the incidence of covid back to near-zero is the only solution to protecting lives, liberties and livelihoods. We still need a full build-out of a public health infrastructure to deliver TTSI: testing, tracing and supported isolation.
Our supply chain for testing capacity continues to be insufficiently activated. This country has six categories of lab — state public health labs, clinical commercial labs (for instance, Quest Diagnostics and Lab Corp), hospital labs, academic research labs, commercial nonclinical labs (for instance, 23andMe and other labs running genome sequencers), and veterinary labs. To date we have fully activated the first two categories, partially activated the third, and only sporadically activated the fourth through sixth.
As a consequence, test results are being returned on time scales too slow for contact tracing to do any good. The goal is not merely to flatten the curve — to plateau as we did in May — but to break the chain of transmission and get back to near-zero case incidence. This requires that every test result come back in 24 hours — 48 hours tops. After that, it is too late. We may have contact tracers in the field, but if they are acting on results that took six to eight days to return, they cannot catch up with the virus, which moves like lightning.
In June, Quest was returning results in two to three days. Now, because of the dramatic increases in volume, it and others are returning them in four to six days. Although the volume of samples processed has increased, the slower turnaround makes those increases less valuable for disease suppression than the absolute number of tests would suggest. While the nation’s current nominal testing rate is consistently above 500,000 tests a day, and exceeded 800,000 in a single day in early July, the nation’s effective testing rate should be measured via the number of daily tests results that have been returned in 48 hours or less.
There is a solution. Congress could activate and fund regional interstate compacts that would have the express job of investing in the testing capacity we have not yet activated.
Interstate compacts are legally binding agreements between states, territories and/or tribal nations that allow them to take collective action to solve shared problems or enact a common agenda. The Port Authority of New York and New Jersey is such a compact, as is the Emergency Management Assistance Compact, which enables states to deploy personnel across state lines to help in times of crisis, such as wildfires or hurricanes.
Interstate compacts are valuable tools for addressing problems that are complex, require scale to solve and also require state leadership because of on-the-ground variation. They are tools for empowering states. Congress should use its upcoming legislative session to turn the tide once and for all in our fight against covid-19 by investing in interstate compacts that have the single mandate to fully activate our testing supply chain.
Next-generation genome sequencing labs, for instance, could process 1 million samples a day. But no single state needs that many. So long as the market is made by contracts emerging out of needs defined by states, we will not activate this currently latent tranche of the market. But bundled, bulk orders or projected commitments at the regional level would do it. We need to build on the good work that many states have done to date by empowering them to function at a regional level, also.
We don’t really have a choice about whether to try to suppress covid-19. This is a disease that you either get back down to near zero incidence or it spirals out of control, overwhelming hospitals, jeopardizing our economy and scarring our society. Mitigation just isn’t good enough. Suppression is the only path.
Can we do it? People often ask me whether I’m an optimist or a pessimist. My response is that failure is not an option. This makes me a “not-an-optionist.”
Let’s transmute suffering into wisdom and, at last, get the right things done.