Why Our COVID-19 Testing Strategy is Still Failing Us — And How to Fix It
President Donald Trump’s advisors have touted him as “the most tested man in the world” for COVID-19. And every single person who attended the Rose Garden Supreme Court nomination celebration — widely believed to be a super-spreader event — was tested, too.
Whether testing succeeded in limiting the virus’ spread at the Rose Garden event is unclear. But what is abundantly clear is that our testing strategy is still failing.
It’s failing for three important reasons — we are testing too late and too narrowly, the technology we are using to test is not accurate enough, and testing has largely been viewed as a stepchild, lagging behind vaccines in investment, commitment and clarity of policy.
Of course, Mr. Trump’s consistent disdain for masks, general disregard for social distancing and, frankly science, contribute significantly to the fact that our government is going into quarantine. Still, we must get this right — to contain COVID-19, fight future pandemics and mitigate the threat of debilitating bioterrorism.
Here, are three ways to advance a smart testing approach.
Moving from Point-of-Care to Point-of-Exposure
Despite growing recognition that mass scale testing is required to contain the pandemic, we are still limited by capacity in many places. Put simply, we are not testing enough people with the frequency necessary to control the outbreak. Nor have we developed a thoughtful approach to testing the environment to detect where the virus propagates.
We must change our approach from testing at point of care to testing at point of exposure, or even potential exposure. This strategy calls for robust individualized testing combined with real-time environmental testing and surveillance.
We must move testing away from centralized testing centers, an approach with significant lag from sample collection to reported results, and into the hands of individuals, where actionable results can be achieved in minutes vs. days. This will require development of tests that are both simple to use and smart. Every home should have a test that quickly informs its residents of infection.
Beyond diagnosing infection, we must be able to detect pathogens in the environment in real time. We know that testing sewage can help us identify COVID-19 infections in communities and a number of efforts to do so are under way. What if we could put a sensor in a toilet to detect infectious diseases in the home? Or swipe a table in a hotel room and instantly detect COVID-19? What happens when an individual decides to become a bioterrorist by unleashing their own infection to cause others harm? Could we test schools, concert venues and subways, smartly, efficiently and cheaply?
By testing at point of potential exposure, we become proactive, rather than reactive.
Yes, It IS a Technology Problem
Vice President Biden has promised to “develop and deploy rapid tests with results available immediately,” but that is impossible to do today with any level of sufficient accuracy. The current technology underlying the vast majority of tests for infectious diseases — as well as most of those in development — simply cannot do what we need it to do, and our ability to tackle this pandemic and others to come is significantly constrained by its limits.
The standard gold standard molecular methods used in typical diagnostic tests today require expensive equipment run by specially trained personnel at centralized laboratories. And there are still false negatives and positives. As importantly, it’s time-consuming, costly and laborious. This is due primarily to the fact that these tests rely on technology and chemistry that has remained largely static and not significantly advanced since the 1990s.
We have settled on the idea that a greater capacity of less accurate tests can better contain the pandemic than more accurate tests that cannot be widely deployed and quickly analyzed. At best, this is a stopgap. And it is a false choice for the future. Inaccuracies breed a false sense of confidence, endangering health and threatening the economy.
Industry, supported by government, must develop new technologies that are fast, highly scalable, portable, cheap and highly precise. Ideally, they would be capable of detecting not just COVID-19, but what strain, or whether instead you have the flu. We must have tests that can outsmart viruses by detecting when they mutate.
We are on the cusp of a technology revolution with humble efforts driving a new era of innovation that will modernize molecular testing. With the right focus, we can bring testing and surveillance to the modern era where it is possible to have simple, fast and portable testing deployed globally. This is not a time for iterative solutions, but bold ideas and significant investments.
The Case for Re-prioritizing Testing
To be perfectly clear, coronavirus testing should be the cornerstone of our strategy to contain the pandemic, not an afterthought. The government has poured more than $8 billion into vaccine development, yet testing has remained the overlooked stepchild. That has begun to change, certainly. The National Institutes of Health has doled out $248 million in grants to companies developing new COVID-19 tests. But this is far from sufficient, far too late and primarily supports incremental development of existing technologies vs. futuristic, riskier yet disruptive approaches.
Importantly, our testing strategy should pay special accordance to underserved communities and communities of color that have been disproportionately harmed by the pandemic. Underpinning a successful testing strategy must be the ultimate goal of improving public health collectively as well as individually. We must understand where the infection is, what is the infection, a person’s risk factors for contracting and spreading it, and ultimately what therapy should be used to treat the individual. This will require not just fundamental advances in technology but a vast information system for collecting and analyzing data.
Only with a coherent strategy and corresponding investment by government, industry and academia will we be capable of containing this pandemic. Perhaps as importantly, we must see this as an opportunity to prepare for the next pandemic — and the very real threat of bioterrorism.