[guest post by Dana]

On the heels of President Trump’s new guidelines to “opening up America,” medical experts are pointing out that increased testing needs to happen in order to get back to business as usual:

Testing for the coronavirus would have to be at least doubled or tripled from its current levels to allow for even a partial reopening of America’s economy, public health experts say, but it is unclear how soon such an ambitious goal could be reached amid persistent shortages of testing supplies and a lack of coordination from the Trump administration.

Without diagnostic testing on a massive scale, federal and state officials and private companies will lack a clear picture of who has been infected, who can safely return to work, how the virus is spreading and when stay-at-home orders can be eased, public health experts say.

“We are an order of magnitude off right now from where we should be,” said Dylan George, an expert in infectious disease modeling who advised the administration of President Barack Obama in combating the Ebola epidemic. “Testing is the perpetual problem here.”

Current rate of testing in the U.S. is about 1%, per Dr. Dan Hanfling, who worked in the National Healthcare Preparedness Program during the Obama and Trump administrations. He considers this an indicator that we are nowhere we need to be with testing if want to get back to business as usual.

Dr. Tom Moore, an infectious disease specialist, also cautioned about the need for more testing:

To avoid a second wave of viral spread you have to do what South Korea and other countries, including Germany, have done. You have to have testing in place, and aggressive testing. We don’t have to test everybody, but we definitely need to test a significant portion of the community.

This is a Herculean task. I don’t know how it’s going to be solved in the immediate future, but it needs to be.

Dr. Scott Gottlieb, physician and public health expert who served as President Donald Trump’s first FDA commissioner, was asked in a recent interview, what it would take to see social distancing end and life return to “normal:

We’re doing a lot to increase testing capacity, but we’re going to hit an upper limit. Getting from 100,000 tests to a million tests is going to be a lot easier than getting from a million tests to 1.5 million tests. The reason is that what we’ve done so far is take platforms and labs that already existed and made them available for coronavirus testing. That’s why we’ve been able to increase testing. By the end of this week, we’ll probably be at a million tests a week in terms of capacity. Next week, we’ll build on that.

But getting to the point where you have a 2-3 million test capacity per week — which is probably where you need to be initially as you do this transition — is going to be very hard. We’ve tapped out the available platforms and now we’re dependent upon creating new platforms and new supply chains to fuel those platforms. We’re approaching an upper limit in spare capacity. The question is how fast can Abbott and other companies build new testing platforms? And how fast can LabCorp and Quest scale up new labs that didn’t exist before? That’s a harder exercise.

When will we get there? I don’t think we’re gonna get there by May. I think that we’re still going to be under-testing relative to what is optimal from a public health standpoint. I think we have the ability to get there by September…

Further, the Association of American Medical Colleges wrote to Dr. Birx, White House Coronvirus Task Force Coordinator, reiterating the need for a sufficient amount of available equipment to maximize diagnostic testing:

…The promise of these tests is that labs that already own the relevant machines can start running the tests quickly, provided that the machines are in working order and that the labs have the proper reagents, transport media, and specialized equipment for the specific test; adequate training of technicians to run the complex test; and sufficient swabs and personal protective equipment (PPE) for collecting the specimens without endangering the health of the health care provider. As we have come to learn over the past several weeks, despite the best efforts of all parties, not one of these components is readily available in sufficient quantities to each and every lab that needs them. Widespread but uneven shortages in one or more of the essential components for testing have resulted in a situation where few labs are able to maximize the testing capacity of any one machine, platform, or test.

Ongoing shortages of testing equipment continue to hamper increased testing efforts, resulting backlogs of testing. Lab around the country are now having to get creative to find work arounds because of supply chain issues.

–Dana