Will the US Have a National COVID-19 Testing Strategy?

As the coronavirus epidemic worsens, U.S. health experts hope the administration will put in place a comprehensive national testing strategy.

Such a strategy, they say, could systematically check more people for infections and spot surges before they take off. The health experts say it would be an improvement from the current practice, which has professional athletes and students at elite universities getting routine tests while many other Americans stand in line for hours — if they get tested at all.

“We have had no strategy for this virus. Our strategy has been no strategy,” said Dr. Michael Mina, a Harvard University researcher focused on use of testing to track disease.

Some experts say the lack of such a system is one reason for the current national explosion in cases, hospitalizations and deaths.

“If we’d had a more robust approach and testing was scaled up as one of the tools, I think much of this third surge would would have been avoidable,” said Dr. Grant Colfax, director of the San Francisco Department of Public Health.

There are differing opinions on what such a strategy should look like, but many experts say rapid and at-home tests should be used so Americans can check themselves and stay away from others if they test positive.

In the latest phase, Trump officials are sending more than 100 million rapid, point-of-care tests to states. The government said the first shipments went out in early October.

Such tests are considered key to slowing spread, but states have distributed them differently. For example, Alaska is sending tests to oil drilling sites, Colorado to local public health agencies for testing homeless populations, and Mississippi to veterans’ homes.

There’s also no federal standard for reporting test data. Some states report the number of tests administered, while others tally the number of people tested. Some have counted types of tests that others don’t, which can skew results because some tests are better at diagnosing active infections than others.

In July the Rockefeller Foundation called for making cheap tests widely available to better identify people who are infected and don’t know it. That would involve developing and making cheap antigen tests, which provide quick results but are less reliable than genetic tests. Foundation officials hoped the government would push companies to manufacture tests the same way it has pushed vaccine makers to mass produce experimental vaccines.

Some Harvard researchers believe that testing half the population each week would be possible by mailing those tests to millions of U.S. households.

Participation would be voluntary, and positive results would have to be confirmed with genetic tests — the home tests are not considered as sensitive as more established lab-based testing. Even so, it could dramatically expand the amount of infection monitoring going on across the nation, its proponents say.

During an appearance on NBC, Dr. Anthony Fauci of the National Institutes of Health said Americans should have easy tests they can do in their own homes.

Versions of such an approach have been tried in some places, including Slovakia and Minnesota. But some experts note there is little precedent for screening tens of millions of people with cheap, rapid tests — which would generate a significant portion of false results. It’s also unclear whether people who test themselves at home will follow instructions to quarantine.