Illustration: Sarah Grillo/Axios

Coronavirus testing capacity is still lagging far enough behind demand that the U.S. continues to only test the sickest patients — a bad omen for future efforts to return to normal life.

Why it matters: Diagnostic testing is the cornerstone of any containment strategy. To even begin talking about resuming social and economic activity, we would have to get testing right first.

The big picture: Testing failures allowed the coronavirus outbreak to spread in the U.S. without detection, almost certainly making it worse than it would have been otherwise.

  • And if we fail to create a stronger testing infrastructure before Americans ease back into public life, history could easily repeat itself.

Driving the news: The Trump administration said yesterday that at least 1.79 million tests have been completed.

  • More than 665,500 samples were tested last week, according to an HHS spokesperson.
  • "HHS and FEMA are coordinating with manufacturers and laboratories to provide the necessary resources and support for continued expansion of our testing capacity," the spokesperson added.

At the same time, tests are still generally being saved for those who need them the most, namely the sickest patients and health care workers — indicating a shortage.

  • For people who do get tested, the wait for results is often several days.

Between the lines: The problem boils down to overwhelming demand and testing supply shortages, the New York Times reports.

  • Private labs have swarmed the market, and some — like LabCorp and Quest — are running thousands of tests a day.
  • But Quest's test backlog is still 80,000, and LabCorp says it's caught up but still requires a four- to five-day turnaround time.
  • Shortages of key testing materials like swabs, reagents and test kits limit how many tests can be done.
  • LabCorp "is now able to perform about 35,000–40,000 tests per day and expects capacity to increase assuming supplies are available," the company says on its website.

What's next: The goal of social distancing is to drastically reduce the number of confirmed cases, by limiting people's interactions with one another. But once we've done that, testing is crucial for identifying new outbreaks and determining who has already been infected before they spread the virus further.

  • To successfully transition our national strategy into this case-based intervention phase, we need to be able to complete at least 750,000 tests per week, according to a report by former FDA Commissioners Scott Gottlieb and Mark McClellan, John Hopkins' Caitlin Rivers and Crystal Watson, and Tempus' Lauren Silvas.
  • Global demand for testing supplies isn't likely to decrease anytime soon.

The bottom line: It's hard to see the country being able to shut down twice. That means we only have one more shot at getting this right, and the clock is ticking.

Go deeper

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Coronavirus dashboard

Illustration: Sarah Grillo/Axios

  1. Global: Total confirmed cases as of 3 a.m. ET: 19,648,084 — Total deaths: 727,024 — Total recoveries — 11,941,723Map.
  2. U.S.: Total confirmed cases as of 3 a.m. ET: 4,998,105 — Total deaths: 162,425 — Total recoveries: 1,643,118 — Total tests: 61,080,587Map.
  3. Politics: Trump signs 4 executive actions on coronavirus aid — Democrats, and some Republicans, criticize the move
  4. Public health: Fauci says chances are "not great" that COVID-19 vaccine will be 98% effective — 1 in 3 Americans would decline COVID-19 vaccine.
  5. Science: Indoor air is the next coronavirus frontline.
  6. Schools: How back-to-school is playing out in the South as coronavirus rages on — Princeton, Johns Hopkins, Howard to hold fall classes online.
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Brazil coronavirus death toll tops 100,000 and case numbers surpass 3 million

Brazilian President Jair Bolsonaro posted a photo of himself to Facebook congratulating his soccer team, Palmeiras, for winning the state title Saturday, moments after the health ministry confirmed the national COVID-19 death toll had surpassed 100,000.

Why it matters: Brazil is only the second country to confirm more than 100,000 deaths from the coronavirus. On Sunday morning, it became the second country to surpass 3 million cases, per Johns Hopkins. Only the U.S. has reported more. Bolsonaro has yet to address the milestones. He has previously tested positive for COVID-19 three times, but he's downplayed the impact of the virus, which has crippled Brazil's economy.

Editor's note: This article has been updated with the latest coronavirus case numbers and more context.

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Republicans and Democrats react to Trump's coronavirus aid action

President Trump speaks to workers at a manufacturing facility in Clyde, Ohio, on Thursday. Photo: Scott Olson/Getty Images

Some Republicans joined Democrats in criticizing President Trump Saturday night for taking executive action on coronavirus aid, with Democratic leaders demanding the GOP return to negotiations after stimulus package talks broke down a day earlier.

Why it matters: Trump could face legal challenges on his ability to act without congressional approval, where the constitutional power lies on federal spending. Sen. Ben Sasse (R-Neb.) was the most vocal Republican critic, saying in a statement: "The pen-and-phone theory of executive lawmaking is unconstitutional slop."