The Trump administration official overseeing the nationwide strategy for COVID-19 diagnostic testing is pushing back on the idea that more widespread and frequent testing of asymptomatic individuals is needed, arguing that focusing on the sick and vulnerable is already leading to an improvement in caseloads.
As some state and federal leaders push for schools and businesses to reopen, some public health experts say widespread testing using diagnostics that are cheaper and potentially less accurate is the best way to ensure that cases are caught before more people are infected.
The logic behind the approach is that these tests can be processed more quickly, and anyone with a positive result would need to follow up with a more accurate test to confirm an infection. Under such a system, you would guard against false negatives by having people tested every few days.
But Brett Giroir, the assistant secretary for health at the Department of Health and Human Services, called it a “false narrative” that there is a need for millions of tests every day. He argued that widespread, frequent testing like that could result in delays of processing tests for people who are actually symptomatic. He also said it could instill a false sense of security in those who test negative if they use the result as an excuse to abandon public health measures like wearings masks or social distancing.
“You beat the virus by smart policies supplemented by strategic testing,” he said on a call with reporters Thursday. “You do not beat the virus by shotgun testing everybody, all the time.”
The federal government is being urged to adopt the more widespread approach by academics like Michael Mina, an epidemiology professor at the Harvard T.H. Chan School of Public Health.
Mina argues that the Food and Drug Administration should authorize cheap paper-strip tests that can be used at home, similar to a pregnancy test, and that consumers should test themselves at least every other day. If people who test positive stay home, he says, it could limit the spread of the virus that causes COVID-19.
The approach has gained traction as commercial labs have struggled to quickly process more accurate tests conducted with a nasal swab sample. While there is still anecdotal evidence of long wait times, Giroir said Thursday that half the tests in the country are being done in hospitals and other congregate settings at the point of care, with processing times of 24 hours or less. At the largest private lab companies, LabCorp and Quest Diagnostics, he said processing times are now 1-2 days and 2-3 days, respectively.
Some public health experts are concerned the more widespread approach has limitations. The idea of ubiquitous testing is “being pushed without really thinking through the operational consequences,” said Jennifer Nuzzo, an epidemiologist with the Johns Hopkins Center for Health Security.
She expressed concern that these kinds of tests would put unsustainable demands on test component supply chains that are already under strain because of the pandemic. She is also concerned that the tests, which are more likely to have false positive or false negative results, could result in people like essential workers staying home when they don’t have to.
“You’re potentially making consequential decisions on the individual level based on test results that are difficult to interpret,” she said Tuesday on a call with reporters hosted by the Association of State and Territorial Health Officials.
Cyrus Shahpar, director of a team focused on epidemic prevention at Resolve to Save Lives, a nonprofit focused on global health, noted that if testing occurred in non-traditional settings it could be harder to get a picture of how much testing is actually happening.
“If we don’t know about tests outside of a certain system, or if we know less about those tests because they are different, it just leaves bigger gaps in information when it comes to testing,” he said Wednesday on a call with reporters organized by COVID Exit Strategy, a group tracking state progress in COVID-19 cases.
Giroir said the administration is focused on increasing rapid, point-of-care testing in settings like hospitals and nursing homes and that a baseline of around 2 percent of state populations should be regularly tested for surveillance purposes.
His comments came as the amount of testing being conducted in most states appears to be declining. While Giroir argued that the current amount of testing is appropriate, Shahpar and the COVID Exit Strategy group say the amount of testing should be based on the rate of new cases occurring in each state. By that measure, the group estimates, only 10 states and the District of Columbia are testing an adequate number of people.
Still, both COVID Exit Strategy and the COVID Tracking Project estimate that the number of new cases and the number of people hospitalized with COVID-19 have been declining nationwide in the past two weeks, including in the states hit by significant spikes earlier in the summer.
Between Aug. 1 and Aug. 12, the number of new daily cases nationwide dropped from around 61,000 to 56,000, and the number of people currently hospitalized dropped from around 54,500 to 48,000.
The number of new deaths from COVID-19 remains high, but Giroir called that a “lagging indicator,” saying it would decrease in the coming weeks following the downward trend in cases and hospitalizations.