‘This Is Not the Hunger Games’: National Testing Strategy Draws Concerns

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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.

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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.

ImageHouse Speaker Nancy Pelosi at a news conference on Capitol Hill in Washington last week.
Credit…Anna Moneymaker/The New York Times

“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.

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“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.

Governors have bristled at claims from the administration that the supply of tests was adequate, routinely asking for more federal assistance. Some states have ultimately decided to negotiate directly with suppliers to obtain test kits.

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.

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