It’s Not Too Late (to have a National Testing Strategy)

I was fixing a fence with my granddaddy one morning when I was 12, and a guy in a loaded grain truck pulled up seeking directions to the mill. My granddaddy looked at the farm stenciled on the door and said with a quick smile “if that was where I started, I sure wouldn’t have come this way if that was where I wanted to go.”

Alas, you can only start from where you find yourself. We find ourselves as a nation failing miserably at addressing the COVID-19 pandemic, especially with respect to amassing evidence of how to deal with the disease. One problem is not having a national testing strategy, backed up by funding, and based in science.

The Margolis Center for Health Policy at Duke has developed a legislative and regulatory plan for such a strategy.

The plan calls for $75 billion in funding to allow rapid, accurate, less costly, and more effective testing, contact tracing, isolation, and containment enabled by the following:

  • Developing Smarter Testing: Fund an additional $300 million in research and development to accelerate and expand access to rapid, accurate point-of-care testing and easy sample collection. Provide additional review resources to the Food and Drug Administration (FDA) to speed authorization pathways for rapid turn-around screening tests for asymptomatic individuals, and to improve data and assessments on test performance in real-world conditions. Support a regulatory pathway to open up unused capacity to run laboratory “PCR”-based pooled screening tests at academic and research labs.
  • Increasing Testing Capacity: Provide $45 billion to create a robust national testing capacity, including Federal provision of screening test platforms and grants to states and local governments to secure testing access for at-risk populations, including public schools and colleges, nursing homes, essential workers, and others at elevated risk. Provide Federal guidance on effective screening protocols for high-risk and vulnerable populations and on contracting models to support effective and inexpensive screening.
  • Widening the Supply Chain: Direct the Department of Health and Human Services (HHS) to address critical testing supply chain shortages and report on progress, with $6 billion to fund advance purchase contracts or support use of the Defense Production Act (DPA) for testing equipment, infrastructure, and related supplies.
  • Tracing and Isolating: Provide $24 billion to support state and local governments to implement additional contact tracing, provide local isolation for those who cannot do so at home, and support infected workers who lose pay in isolation, similar to support for jury duty service.
  • Reporting: Standardize and publish key information on testing and community risk by state and region stratified by age, sex, race and ethnicity, so that local epidemic response decisions (e.g., testing, contact tracing closures) can respond effectively to shifts in the pandemic.
  • Communicating: Implement a cohesive public communications strategy at the Federal level to keep all Americans informed about testing opportunities, turn-around times for results, contact tracing, and support for preventing spread.

It is still not too late.

About Don Taylor
Professor of Public Policy (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute), and Chair of the Academic Council at Duke University . I am one of the founding faculty of the Margolis Center for Health Policy. My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

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