Apr 13, 2020 - Health

Diagnostic testing supply shortages threaten coronavirus response

Caitlin Owens, author of Vitals

Illustration: Aïda Amer/Axios

There’s no clear strategy in place to resolve or prevent the shortages of testing supplies that have threatened the U.S. coronavirus response for more than a month.

Why it matters: We can now run hundreds of thousands of coronavirus tests a week, but it’s still not enough to meet the demand.

  • And experts say that for social distancing measures to be safely lifted, we’ll need to run millions of tests a week — the feasibility of which depends largely on having a resilient supply chain.

Driving the news: Efforts to ramp up manufacturing and importation of masks, gowns, gloves, face shields and ventilators make headlines almost daily. But reagents, swabs, test kits and RNA extraction kits haven’t received the same amount of coordinated attention.

  • “Across the board, labs do not have predictable, consistent access to the test kits and other supplies necessary for expanded testing capacity," said a spokesperson for the American Clinical Laboratory Association.
  • "Any constriction of, or disruption in, the supply chain can suddenly create a bottleneck, which is why we continue to closely monitor the status of all supplies necessary for our labs to expand testing capacity,”

The big picture: To keep the coronavirus outbreak from spiraling out of control, “you literally have two choices: distancing or testing and isolation. They’re the only tools you have,” said Ashish Jha, professor of global health at Harvard T.H. Chan School of Public Health.

  • Because we failed to do widespread testing and isolation before the coronavirus spread widely within the U.S., the majority of the country is now practicing intense social distancing.
  • Once the virus caseload has significantly decreased, we’ll be able to slowly lift some of those measures. But we’ll essentially be back to square one: We’ll need to do more testing and isolation to make sure the virus isn’t spreading to the point where we’ll need to do this level of social distancing again.

By the numbers: That kind of surveillance, once the caseload is down, will likely require 200,000–250,000 tests a day, Jha said.

  • Well over 100,000 tests are being completed daily, with more than 160,000 tests completed on Thursday of last week, according to The COVID Tracking Project. But that’s still not enough.
  • “Not one of the 50 U.S. states currently has surveillance capabilities sufficient to enable case-based interventions at the necessary scale,” former FDA commissioners Mark McClellan and Scott Gottlieb wrote last week in a report on how to contain the virus.

The good news: Ramping up testing to this level isn’t hard, comparatively. We just have to do it, experts say.

  • “Surely, given that we have the entire country shut down, I am confident we can produce the swabs,” Jha said. “It’s not beyond the capacity of our nation to produce millions of swabs a day.”

Yes, but: President Trump has said repeatedly that we now have the best testing system in the world, but the administration has not announced any large-scale push to resolve the supply shortages.

  • When asked last week about Gottlieb’s earlier estimate that 750,000 tests will be needed weekly to reopen the economy, Trump disagreed with the premise.
  • “I don’t like using the word ‘needed’ because I don’t think it’s ‘needed,’ but I think we’re going to try and hit a number like that.”
  • “We want to have it, and we're going to see if we have it,” Trump added. “Do you need it? No. Is it a nice thing to do? Yes.”

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The Department of Health and Human Services moved on Thursday to require that an individual's race, ethnicity, age and sex be submitted to the agency with novel coronavirus test results.

Why it matters: Some cities and states have reported the virus is killing black people at disproportionately high rates. There are gaps in the national picture of how many people of color are affected, since the data has not been a requirement for states to collect or disclose.