The Trump administration’s new testing strategy, released Sunday to Congress, holds individual states responsible for planning and carrying out all coronavirus testing, while planning to provide some supplies needed for the tests.
The proposal also says existing testing capacity, if properly targeted, is sufficient to contain the outbreak. But epidemiologists say that amount of testing is orders of magnitude lower than many of them believe the country needs.
The report cements a stance that has frustrated governors in both parties, following the administration’s announcement last month that the federal government should be considered “the supplier of last resort” and that states should develop their own testing plans.
“For months, it was a tennis game, it was going back and forth between the feds and the states, and it’s now landed with the states,” said Scott Becker, executive director of the Association of Public Health Laboratories.
Mr. Becker noted that the federal government plans to distribute some testing supplies, including swabs and viral transport media, and to store test kits in the strategic national stockpile. “That’s actually quite significant,” he said. “That’s a positive step.”
The Department of Health and Human Services prepared the strategy, which meets requirements under the Paycheck Protection Program and Health Care Enhancement Act, signed into law by President Trump on April 24, that federal agencies come up with a strategic testing plan within 30 days. It was reported earlier by The Washington Post.
Mr. Becker, public health experts and Democratic leaders panned the proposal, saying the strategy runs the risk of states competing with one another and may create deep inequities among them.
The strategy mirrors a divide that has played out in Congress for months. As they negotiated the virus relief bill in March, Democratic lawmakers pushed to require the administration to submit this national testing plan to Congress. Republicans resisted, saying those decisions belonged to each state.
Mr. Becker and others said it’s reasonable to expect states to implement some aspects of the testing, such as designating test sites. But acquiring tests involves reliance on national and international supply chains — which are challenging for many states to navigate.
“That’s our biggest question, that’s our biggest concern, is the robustness of the supply chain, which is critical,” Mr. Becker said. “You can’t leave it up to the states to do it for themselves. This is not the Hunger Games.”
In a joint statement on Monday, Speaker Nancy Pelosi; Senator Chuck Schumer, the Democratic leader; Representative Frank Pallone, Democratic chairman of the House Energy and Commerce Committee; and Senator Patty Murray, the ranking Democrat on the Senate’s health committee, said the Trump administration was not taking responsibility for ramping up national testing capacity.
“This disappointing report confirms that President Trump’s national testing strategy is to deny the truth that there aren’t enough tests and supplies, reject responsibility and dump the burden onto the states,” the lawmakers said. “In this document, the Trump administration again attempts to paint a rosy picture about testing while experts continue to warn the country is far short of what we need.”
Experts also took issue with the report’s assertion that continuing to test only about 300,000 people a day, by targeting only those likely to be positive, would be enough to contain the outbreak.
“On the face of it, the idea that 300,000 tests a day is enough for America is absurd,” said Dr. Ashish Jha, director of the Harvard Global Health Institute.
He offered a quick rundown of the numbers to illustrate the estimate’s inadequacy. Most hospitals nationwide now test everyone who is admitted for any reason, roughly 100,000 tests each day, fearing that they may be asymptomatic and yet still spreading the virus. Testing the 1.6 million residents of nursing homes — known to be at high risk of coronavirus infection — and workers every two weeks would require 150,000 more tests each day. Add high-risk places like meatpacking plants that need regular testing, and the numbers rapidly build.
“Without having tested a single person for symptoms of Covid, we would quickly exhaust our entire national supply of testing if all we have is 300,000 tests per day,” he said.
The H.H.S. report noted that an analysis by the Safra Center at Harvard estimated the need at more than three million tests per day. But the federal report said that estimate was based on faulty assumptions.
The Safra authors who crafted the estimate said that the federal report had cherry-picked one simple example from their analysis without considering other evidence.
Frequently Asked Questions and Advice
Updated May 26, 2020
How can I protect myself while flying?
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
What are the symptoms of coronavirus?
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
How many people have lost their jobs due to coronavirus in the U.S.?
Over 38 million people have filed for unemployment since March. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.
Is ‘Covid toe’ a symptom of the disease?
There is an uptick in people reporting symptoms of chilblains, which are painful red or purple lesions that typically appear in the winter on fingers or toes. The lesions are emerging as yet another symptom of infection with the new coronavirus. Chilblains are caused by inflammation in small blood vessels in reaction to cold or damp conditions, but they are usually common in the coldest winter months. Federal health officials do not include toe lesions in the list of coronavirus symptoms, but some dermatologists are pushing for a change, saying so-called Covid toe should be sufficient grounds for testing.
Can I go to the park?
Yes, but make sure you keep six feet of distance between you and people who don’t live in your home. Even if you just hang out in a park, rather than go for a jog or a walk, getting some fresh air, and hopefully sunshine, is a good idea.
How do I take my temperature?
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
Should I wear a mask?
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
What should I do if I feel sick?
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
How do I get tested?
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
How can I help?
Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities.
“We ran multiple models, all of which pointed to the same order of magnitude,” said Danielle Allen, director of the Safra Center. “They’ve selected one non-primary model in an appendix and selectively adjusted assumptions to generate a different number.”
Dr. Allen said millions of daily tests would be required to have 4 percent of people test positive with the coronavirus — the level they say is needed to halt the spread of the virus. The administration’s target, 10 percent, would allow only for mitigation.
“There is not a single country that I’m aware of that achieved disease suppression with a positivity rate of 10 percent,” she said.
And 300,000 daily tests would be insufficient even for mitigation, Dr. Jha said, estimating that would require at least 900,000 tests per day.
The proposal also leaves it to states to plan for contact tracing and isolation, rapidly identify new clusters of coronavirus infection and adopt new technologies. It says the federal government is “supporting and encouraging” states to rely heavily on guidance from the Centers for Disease Control and Prevention.
However, the C.D.C. has been slow to release guidance for states during this outbreak, Dr. Jha said. And the agency fumbled its role in testing strategy, most recently with last week’s dust-up over the mixing of test results for active infection with serology. “This is not C.D.C.’s shining moment,” he said.
Federal virus relief legislation required states to release their individual testing plans last week, but they requested an extension to later this week. If elements of those state plans prove promising, Mr. Becker said, the federal strategy could be revised or merged with them.