Testing deal promoted by White House failing to fix lack of Covid-19 screening strategy

A deal for 150 million rapid coronavirus tests the White House promoted last month as a potential game-changer in battling the pandemic fails to fix the lack of an overarching strategy for a new phase of testing the nation needs to embrace, multiple health experts and state and local officials say.

The Trump administration’s purchase of the new Abbott Laboratories antigen tests, which can detect the virus in 15 minutes, was hailed by White House press secretary Kayleigh McEnany as a major development that would help Americans get back to work and school.
But without detailed federal guidance, states and cities remain divided, and some of them stifled, on how to best to use those types of rapid tests and others for the testing technique known as “screening.”
Screening involves routinely testing people whether or not they have symptoms. Because an estimated 40% of coronavirus infections are asymptomatic, according to the Centers for Disease Control and Prevention, the idea is to focus on groups, such as those in nursing homes, schools or higher-risk workplaces, and use point-of-care tests or other techniques to test everyone in those groups and isolate the infected. Epidemiologists say communities should implement screening to limit outbreaks.
New Orleans Health Director Dr. Jennifer Avegno said she has been working with local officials on a plan that would allow for routine testing of teachers in her city, but without overarching federal guidance, she said, “It’s been very challenging as a local health leader to communicate what we believe to be best practices.”
Fewer than 25 million tests are now reported monthly but a basic screening strategy will require as many as 200 million each month — far more than the 150 million Abbott antigen tests purchased by the government, according to a report by the Duke-Margolis Center for Health Policy, with the Rockefeller Foundation and others.

“What we don’t have is a national strategy that we’re actually implementing to get those asymptomatic screening tests to everybody who most needs them right now to reopen schools safely, to reopen the economy as effectively as possible,” said Dr. Mark McClellan, a former commissioner of the Food and Drug Administration under President George W. Bush and the Duke-Margolis Center director.
President Donald Trump has questioned the need for broad coronavirus testing, tweeted in June that more coronavirus tests can make the country “look bad” and suggested that he instructed his administration to slow down coronavirus testing. On Tuesday, he claimed “herd mentality” could help the disease dissipate, even though many medical experts argue that a herd-immunity approach could lead to millions of deaths.
Admiral Brett Giroir, who oversees federal coronavirus testing efforts, said last Thursday he has “never been told to slow down testing” and said that he supports asymptomatic screening efforts.
A spokesperson for the Department of Health and Human Services, Mia Heck, said in a statement that the administration is continuing to aggressively invest in point-of-care testing, that allotments of the Abbot antigen tests to states will begin this month, and that “the public can expect additional guidance on screening to be forthcoming.”
Heck added that the federal government awarded about $10 billion to states, territories and local governments to support their testing plans, and that those funds are still largely available for states to draw upon.
What the tests are needed for
The calls for a national screening strategy come as the US has been performing an average of nearly 704,000 tests per day since the beginning of August, according to data from the COVID Tracking Project.
That number marks exponential growth since the start of the pandemic. But the nation’s testing infrastructure has primarily been wielded for diagnostic purposes — meaning PCR tests, which are known to be highly accurate, have been used to determine whether individuals who feel sick or think they have been exposed to the virus are actually infected.
A. David Paltiel, a professor at the Yale School of Public Health, argues that in order to use testing as a tool for outbreak control as opposed to individual diagnostic purposes, communities must frequently test groups of people in order to catch asymptomatic spreaders.
In a study that examined the spread of the virus among a hypothetical cohort of students, Paltiel found that screening people every couple of days with a less sensitive test was more effective for controlling an outbreak than using more sensitive tests less frequently.
“The most important variable was frequency … and again, the reason frequency matters so much is because of these silent spreaders,” said Paltiel, who said rapid, point-of-care antigen-based tests could prove more effective for catching asymptomatic cases within groups even though they are less sensitive than lab-based PCR tests because they are faster and cheaper.
While the CDC has issued some guidance on antigen tests and their use in nursing homes, the government has not issued extensive guidance for comprehensive coronavirus screening strategies in general.
Moreover, recent comments and guidance from the Trump administration have created questions and confusion around asymptomatic testing in general.
In August, the CDC issued guidelines that said some people without symptoms may not need to be tested even if they’ve been in close contact with infected people. CDC Director Dr. Robert Redfield said Wednesday that the CDC has never recommended against asymptomatic testing, and he said the CDC is currently working on a clarification document on testing.
But Dr. Scott Atlas, a White House coronavirus adviser, seemed to discourage testing individuals with no coronavirus symptoms at an event in Florida on August 31. “We really have to be careful about testing, and I think the CDC guideline now is very clear that asymptomatic people — that’s not a priority for a test,” he said