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

23 hours ago - Health

U.S. reports over 55,000 new coronavirus cases

Flags on the Washington National Mall on Sept. 22, each representing 1,000 people killed from the virus. Photo: Chen Mengtong/China News Service via Getty Images

The United States reported 55,054 new coronavirus cases on Friday, according to Johns Hopkins University data.

Why it matters: It was the highest single-day increase since August 14, when the country reported 64,350 new cases over a 24-hour span, and suggests that the U.S. has yet to contain the spread of the virus.

Updated 53 mins ago - Politics & Policy

Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Global: Total confirmed cases as of 10 a.m. ET: 32,881,747 — Total deaths: 994,821 — Total recoveries: 22,758,171Map.
  2. U.S.: Total confirmed cases as of 10 a.m. ET: 7,079,909 — Total deaths: 204,503 — Total recoveries: 2,750,459 — Total tests: 100,492,536Map.
  3. States: New York daily cases top 1,000 for first time since June — U.S. reports over 55,000 new coronavirus cases.
  4. Health: The long-term pain of the mental health pandemicFewer than 10% of Americans have coronavirus antibodies.
  5. Business: Millions start new businesses in time of coronavirus.
  6. Education: Summer college enrollment offers a glimpse of COVID-19's effect.
Updated 8 hours ago - Health

World coronavirus updates

Expand chart
Data: The Center for Systems Science and Engineering at Johns Hopkins; Map: Axios Visuals

France's second wave "is arriving faster than we thought" as coronavirus cases surge, the head of the National Council of the Order of Doctors said Sunday, per AFP.

The big picture: France's health service confirmed 14,412 new cases Saturday, less than the record 16,000 reported Thursday and Friday. "But over the last seven days, 4,102 people have been hospitalized, 763 of whom are being treated in intensive care," AFP notes.

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