Home Health Why the U.S. still hasn't solved its testing crisis

Why the U.S. still hasn't solved its testing crisis

Testing alone isn’t enough

Testing can identify people who are sick, but by itself it’s not enough to break chains of infection. That requires tracing the contacts of people who are ill so they can be tested and quarantined to avoid further spread of the virus.

But even as the U.S. scales up testing to record levels, the country is woefully behind on contact tracing. The federal government has largely left that task up to understaffed and underfunded state and local health departments that are unable to keep up with the caseload.

Experts and government officials warned months ago that the country would need a minimum of 100,000 contact tracers to reopen safely. But states are working with only one-third that number, a shortfall that has helped fuel the recent spike in cases.

Rather than establish a national strategy for contact tracing, the Trump administration has given feedback on state plans and admonished the public to maintain physical distancing and practice robust hand-washing.

Alaska’s chief medical officer, Anne Zink, told lawmakers and reporters Thursday that her small staff at the state’s Department of Health is starting to be overwhelmed.

“For the majority of this pandemic, 96 percent of our patients were contacted within two hours of being positive. That’s quickly eroding,” she said at a roundtable held by Sen. Bill Cassidy (R-La.). “Our cases are increasing, our public health staff is exhausted, and people are having bigger and bigger group gatherings. It used to be to get four or five contacts, and now you have 50 or 100 or ‘I don’t want to talk to you on the phone.’ And so the ability to trace is becoming incredibly challenging.”

Racial disparities persist

More than 20 million people in the United States live in coronavirus “testing deserts” — and people of color are disproportionately represented in those counties without testing sites, the Surgo Foundation reported this week.

“If you’re a Black person living in rural America, you’re nearly three times as likely to be living in a testing desert where deaths are rising, compared to any average rural American,” said Dr. Sema Sgaier, the group’s executive director.

The pandemic quickly exposed deep racial disparities in Americans’ overall health and access to coronavirus testing and care. Congress has pushed the Trump administration to do more to track and address the virus’ disproportionate impact on communities of color.

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The Centers for Disease Control and Prevention has established a partnership with Morehouse College, a historically Black institution, to work on a national infrastructure to track how the pandemic is affecting racial minority groups — and to help serve them better. The administration has also worked to set up testing sites at pharmacies and federally qualified health centers that serve “high social vulnerability communities.”

But lawmakers and advocacy groups say the administration’s efforts are late and inadequate.

CDC Director Robert Redfield was forced to apologize to Congress earlier this month for not providing complete information on racial disparities in the pandemic as required by law. The administration released a report last week showing the Black people contracted Covid-19 nearly three times as often as white people, and were hospitalized four times more than white people. Hispanic and Asian people were also more likely to become infected and hospitalized than white people.

“The administration failed to plan in a comprehensive way for nationwide challenges like scaling up testing and contact tracing, and ignored — and exacerbated — existing health disparities that left Black, Latino, and Tribal communities to face the worst of this crisis,” said Sen. Patty Murray (D-Wash.)

Testing is still decentralized

The Trump administration has shied away from developing a national testing strategy, although it has helped route supplies to labs and connect hospitals to labs with spare capacity.

But Democrats and public health experts say the United States needs a nationwide plan — including stronger federal efforts to secure key supplies.

“The Trump administration really just wants to turn the page from Covid-19 even though we’re seeing skyrocketing numbers across the nation,” said House Energy & Commerce Chair Frank Pallone (D-N.J.). “This crisis demands a national testing plan, and it’s extremely frustrating to watch the administration continue to kick the responsibility to the states.”

Ahead of the July 4 holiday weekend, health officials and experts pleaded with Americans to slow the spread of the virus by practicing social distancing and wearing a mask in public. Several states — including Texas, Florida and California — have paused reopening efforts and ordered bars to close as case numbers spike. Texas Gov. Greg Abbott issued an executive order Thursday that mandates mask wearing in most public settings.

“Especially this weekend, we should be meeting or engaging in outdoor activities while maintaining physical distancing of at least six feet,” said Joshua Barocas, assistant professor of medicine at the Boston University School of Medicine. “I would urge people to stay home if they’re even feeling the slightest bit unwell.”

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