Illustration: Sarah Grillo/Axios

Testing is once again becoming a critical weakness in the America's response to the coronavirus pandemic, and experts say we may need to revive tighter standards about who can get a test.

Why it matters: Although testing has gotten a lot better over the course of the pandemic, the pandemic has gotten worse, and that means the U.S. needs to prioritize its resources — which might mean that frequent testing solely to help open businesses or schools just isn't feasible.

Where it stands: The U.S. is conducting more than 800,000 tests per day, on average — an enormous leap from the severe testing shortages the country experienced in the spring. But it's still not enough to keep up with demand.

  • Getting the results of a test often takes take longer than a week, and sometimes almost two weeks, which makes them a lot less helpful. The longer it takes to identify positive cases, the more time the virus has to spread.
  • "That dramatic scale up is unprecedented, but demand has also been unprecedented," said Julie Khani, president of the American Clinical Laboratory Association.

The big picture: Two factors are driving demand for tests higher than the system can handle: the high U.S. caseload; and precautionary testing tied to reopening.

  • Reducing turnaround times will require doing fewer tests, "and that's in some ways taking a step backward," said Johns Hopkins' Caitlin Rivers. But "there is a need to identify, 'Who really does need a test? And for whom should that be high quality?'"

What they're saying: "I'm not sure we have a shortage of testing in this country, per se. I think what we have is a shortage of smart testing," the University of Minnesota's Michael Osterholm said.

  • "We have many examples of well people being tested throughout the country that are not contacts, they just want to know," he said.
  • In a white paper published earlier this year, Osterholm and his colleagues wrote that most workplace or school-based testing is a low priority.
  • There also needs to be more rigor about the timing of tests for people who might have been exposed to the virus, to avoid wasteful testing.

Between the lines: That may dash the hopes of using frequent testing as a tool to resume work, travel or other elements of pre-pandemic life, at least for now.

  • Even as capacity continues to grow, including through new tests coming onto the market, it's hard to imagine a world where every sports team, business and university is able to regularly test asymptomatic people indefinitely.

The other side: Given how easily people can spread the virus before they begin to feel sick, testing still needs to be available to a lot of people who aren't symptomatic or don't know for sure that they were exposed to the virus.

  • "It's a better conversation to be had about how [we can] increase resources instead of how [we can] decrease testing," said Saskia Popescu, an epidemiologist at the University of Arizona.

Supply-chain issues make it hard to scale up testing supply, though.

  • Rivers and her colleagues this week called for the federal government to do an end-to-end analysis to identify bottlenecks in the testing supply chain, as part of a reset of the U.S. coronavirus response.
  • "We need basically an infusion of resources for the lab side," Popescu said. "We need not just the actual resources like reagents and swabs, but also we need people — for them to not only do the tests, but then also communicate them."

The bottom line: Ultimately, the best way to reduce pressure on our testing infrastructure would be to reduce the number of cases, which reduces the number of people at risk of infection.

  • "Testing is not a replacement for wearing a mask," Khani said.

Go deeper

State coronavirus testing plans fall short of demand

Data: Department of Health and Human Services via Harvard Global Health Institute; Note: New York City's plan is included in New York state; Cartogram: Andrew Witherspoon/Axios

The U.S. plans to test around 600,000 people for the coronavirus every day this month, according to plans that states submitted to the Department of Health and Human Services.

Yes, but: That's likely a drop in testing, compared to July, and it's not enough to meet national demand. By December, states said they plan to ramp up to around a collective 850,000 people tested a day — which also likely will not be enough.

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Georgia Gov. Brian Kemp on Monday said the responsibility should be on schools to enforce a mandate on face coverings, the Atlanta-Journal Constitution reports.

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Coronavirus dashboard

Illustration: Annelise Capossela/Axios

  1. Global: Total confirmed cases as of 3 p.m. ET: 20,158,258 — Total deaths: 738,063 — Total recoveries: 12,388,686Map.
  2. U.S.: Total confirmed cases as of 3 p.m. ET: 5,116,791 — Total deaths: 164,137 — Total recoveries: 1,670,755 — Total tests: 62,513,174Map.
  3. States: Florida reports another daily record for deaths State testing plans fall short of demand.
  4. Axios-Ipsos poll: 1 in 2 has a personal connection to COVID-19.
  5. Business: Moderna reveals it may not hold patent rights for vaccine.
  6. 🏈 Sports: Big Ten scraps fall football season due to coronavirus.