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1. TESTING
Widespread testing can yank away the curtain that
hides SARS-CoV-2, revealing where there are clus-
ters of people who are infected by the virus but
not showing symptoms, and thus aren’t aware they
might be spreading it to others. That, in turn, will
lead to more targeted efforts to isolate anyone who
is infectious. And, if all the people who came in
contact with an infected person were also tested, it
would help local health authorities trace how the
virus is moving through a community. It’s basic,
boots-on-the-ground disease control.
The U.S., however, stumbled on testing in the
early days of the pandemic, and those failures led
to a dramatic surge in cases that climbed more
quickly than in other countries. Thanks to a com-
bination of contamination issues that delayed the
original test from the CDC, and regulatory require-
ments that prevented commercial and academic
labs from immediately developing their own as-
says, “It’s still the case that testing isn’t nearly as
readily available as it needs to be,” says Frieden.
As of this writing, just over 1 million tests for
COVID-19 are performed in the U.S. each week,
which is woefully inadequate, Fauci says.
Public-health experts estimate that the current
U.S. testing rate has to triple simply to include all
the people who are considered highest priority for
testing, including health care workers and nursing-
home residents. To fold in all of those who should
be tested if gyms and restaurants reopen, the num-
ber of daily tests has to increase by tens of millions.
Ideally, anyone with symptoms like a cough, fever
or shortness of breath should be tested, as should
anyone who is sick and living in a group facility
like a dormitory, along with any patient admitted
to a hospital for any reason. Family members and
others with close contact to someone who tests
positive should also be tested.
Boosting testing volume is about not just manu-
facturing more tests but also ensuring that they’re
relatively easy to take. So at-home testing kits that
are just becoming available—which still require
a doctor’s prescription but won’t require people
to go to a doctor’s office or health facility to pro-
vide a sample—will become more critical as states
gradually reopen. Several companies are also of-
fering COVID-19 tests, approved by the U.S. Food
and Drug Administration (FDA), that don’t require
doctors or patients to sample from deep in the
back of the nose and throat, but instead swab the
inside of the nostrils or provide a small amount of
saliva, making it easier even for non–health pro-
fessionals to provide samples.
While testing capacity in the U.S. is gaining
ground, the road ahead remains long. The health
system has never had to manage testing at the scale
0
MARCH APRIL
10
20M
DAILY TESTS
FOR COVID-19 April 28
202,233JUNE
GOAL
5M/
dayJULY
GOAL
20M/
dayROADBLOCKS TO
TESTING GOALS
Health experts have called for
testing well beyond current
levels. But ramping up capacity
will be a challenge at every step
in the processSTEP 1 A specimen,
such as saliva or a
sample from the nose
or throat, is collected.
Challenge: Supplies such as swabs
and vials are specialized and
regulated. This makes the supply
chain vulnerable to demand surges.
In March, testing was hampered by
a shortage of swabs.STEP 2 The sample
is placed in a solution
and delivered to a
lab technologist.
Challenge: Workforce is already an
issue at many labs. Hiring is difficult,
as only certified technologists
are trained to handle the patient
samples.STEP 4 Machines
detect the presence
of the virus in a
sample.
Challenge: Dozens of test systems
have been FDA-approved, but
many labs lack the up-front capital
to invest in the technology and
scale up.STEP 3 Chemical
liquids called reagents
extract and amplify
the virus’s genetic
material.
Challenge: Labs have faced reagent
shortages, and industry groups
have already noted that a spike in
testing demand has the potential to
exhaust supplies.