Trump’s Ambition to Reopen U.S. Hinges on Elusive Testing
President Donald Trump’s push to reopen the world’s largest economy hinges on a breakthrough that has so far eluded him: ratcheting up testing capacity to stave off another wave of coronavirus.
Trump is anxious to end economy-crushing social distancing practices that have curbed the spread of the illness. He declared Monday that he has “total” authority to reopen the country, a claim disputed by legal experts and some lawmakers, while governors on each coast -- most of them Democrats -- formed alliances to chart their own paths.
The president will announce a council of doctors and business people on Tuesday that will advise him on restoring the U.S. economy, which little more than a month ago was his top argument for re-election in November.
But there are ample warning signs that Trump’s haste to move past the coronavirus could lead him into a trap: A premature abandonment of the social-distancing behaviors that the government’s top medical experts say have stabilized the rate of U.S. infections, leading to a new outbreak and further economic damage.
Key to avoiding a second round of infections, death and social distancing is robust testing for the virus, so that public health authorities can quickly identify any new flare-ups and contain them before they spread.
“We have to be able to watch this virus very carefully, so we know if there is evidence the wave may be growing and we can re-establish lock-downs,” Michael Osterholm, director of the Center for Infectious Disease Research and Policy and a professor at the University of Minnesota in Minneapolis, said in an interview last week. “We may have to do that multiple times for the next 20 months and we don’t have a plan right now.”
Trump acknowledged that he worries about having to reimpose economic shutdowns if a second outbreak occurs. “I certainly hope that won’t happen, but it does weigh on my mind,” he said Monday at a White House news conference.
1 Million Per Day
While the U.S. has recently achieved the capacity to test more than 100,000 people a day, the country is still struggling with shortages of testing materials as well as the manpower necessary to administer the tests and process them.
“The key, to me, is testing, and people have to know they are safe and that testing actually works,” New York Governor Andrew Cuomo told NBC on Tuesday morning. “And we don’t have that capacity now, and the states can’t do it on their own. We have to develop that widespread testing capacity.”
Howard Forman, director of the Yale School of Public Health’s health-care management program, said it would require capacity of a million tests per day for the country to be confident the outbreak is contained.
“It’s 100% essential,” he said. “We need to be doing testing on an individual basis to assure the public, send people back to work and prevent people from going to work when they’ve been sick.”
Trump’s testing czar, Admiral Brett Giroir, is confident the country will be in the “ballpark” of testing capacity by next month to accommodate reopening measures. He said in an interview on Saturday that testing is “only a component of when restrictions start to end.”
“We’re very close to completing a plan to open our country even ahead of schedule,” Trump said Monday at the news conference, in which he spent more than a half hour defending himself against criticism of his government’s response to an outbreak has killed more than 21,000 Americans so far.
“Everything we did was right,” he said.
The U.S. must be able to perform four categories of tests, Giroir said -- testing people with symptoms of the illness to confirm they’re infected; testing their close contacts to control the spread of the virus; randomly testing asymptomatic people to head off new outbreaks; and testing for antibodies in healthy people, to identify Americans who have already been infected and recovered.
Rolling lockdowns may have to happen “for the foreseeable future,” until vaccines and therapies are available, Federal Reserve Bank of Minneapolis President Neel Kashkari told NBC on Tuesday. “I wish it were just a light switch,” he said, but it’s looking like a “more gradual return to normal.”
U.S. capacity has improved in recent weeks, with the Food and Drug Administration clearing many more Covid-19 tests and more labs bringing their tests online. Still, access is uneven, and the system has been beset by delays in returning results. Today, labs can only handle a fraction of the tests they will need to process for people to return to work and schools, public health experts say.
One crucial limitation has been the availability of testing supplies, from swabs that take patient samples, to transport media that preserve the specimens, to chemicals called reagents used to process tests. This has restrained the availability of testing across the U.S. and compounded other shortages, including personal protective equipment and hospital beds.
Without sufficient testing, the full extent of the U.S. outbreak remains unknown, even as policy makers gear up for a potential reopening of the American economy in May. Deborah Birx, the State Department immunologist advising the White House, said the administration knows that testing remains insufficient.
“We know that we have to further increase that,” she said Monday.
Giroir said that if the U.S. was only seeing about 10,000 new cases a day, for example -- the current rate is triple or quadruple that number -- health authorities would have to perform at least 300,000 tests a month just to confirm those infections. To contain the disease, another five to 10 additional people should be tested for every positive -- as many as 3 million per month.
The U.S. has tested about 144,000 people per day over the last seven days, according to data compiled by the Covid 19 Tracking Project, which replies on state reports.
But that doesn’t include a wide range of other testing -- asymptomatic people, health workers, law enforcement personnel, or even the ordinary work force as a condition for companies to reopen their workplaces. It doesn’t include contact-trace testing, of people who’ve been in contact with confirmed cases -- on average, 5 per case, or another 1.5 million tests monthly if there are 10,000 new cases daily. And it also doesn’t include antibody testing.
“You’re talking about millions of tests per month -- more than we’re doing now,” Giroir said. The administration believes that is industrially possible, he said.
“We will have enough tests in May to at least be in the ballpark to do that,” he said. “Every day matters. Next week is going to be really different.”
States are preparing their own plans to test aggressively and track the potentially infected with help from nonprofits, universities and the private sector. Giroir acknowledged challenges that have stood in the way of efforts to swiftly ramp up testing.
“One factor that is ultimately going to be a strength and is a strength, but is a nightmare when you’re putting things together nationally, is the diversity of tests, the diversity of reagents that are needed by the tests, the diversity that are used in any given zip code or hospital, and the specific requirements and supply chains for each of that,” he said. “That’s the kind of complexity we’re dealing with.”
Giroir said antibody testing would begin to be available in a matter of weeks. Trump’s current restrictions run through April 30, setting up a decision for May 1.
But the president said Monday he’d like to start reopening the country ahead of schedule.
©2020 Bloomberg L.P.