Without testing data, the U.S. response to the coronavirus will continue to fall short.
Countries like Australia, South Korea, Germany, Singapore, and Taiwan managed to contain the coronavirus early and are working hard to keep it suppressed as they reopen their economies. But, writes Eric C. Schneider, MD in The New England Journal of Medicine, the U.S. response to COVID-19 has been “ineffectual.”
The key reason for our failure? Lack of testing.
“U.S. testing to identify people infected with SARS-CoV-2 has been slow to start and to this day has not sufficiently ramped up,” writes Schneider. “Without testing, the response will continue to fall short. “
Early in the pandemic, shortages of test materials forced us to adopt a narrow strategy of testing hospitalized patients and preventing health care workers from transmitting COVID-19. Only now are state officials and business leaders recognizing that “testing, contact tracing, and isolation of people who test positive will be essential to successfully reopening economies,” writes Schneider.
You can’t just offer more tests, he maintains. “If enough tests were available, we would still need to answer a fundamental question: What decisions are the results meant to inform?”
Testing has many purposes beyond diagnosis and protection of health care workers, writes Schneider. It is needed to manage all aspects of a pandemic, including:
- Developing forecasting models that can reveal future outbreaks and demands for care.
- Developing safe drugs and vaccines.
- Evaluating the effectiveness of nonpharmacologic interventions (NPI) like stay-at-home orders.
“Modeling is difficult, and a paucity of the facts required to inform models is problematic,” Schneider writes. “Modelers make up for missing facts by including assumptions.”
Because we’ve relied too heavily on these assumptions, our current models don’t correspond to the “unfolding reality” of the pandemic, he writes. Yet, “surprisingly little energy has been dedicated to an important fix: replacing models’ assumptions with verifiable facts.”
“That the United States is failing such a simple test of its capacity to protect public health is shocking,” concludes Schneider. “Reopening state economies without the precision provided by analysis of rigorously reported testing data seems a peculiarly American form of madness.”