The nation is at a pivotal moment in the fight against the pandemic. Vaccines are finally starting to roll out, but the virus is spreading faster than ever — and killing thousands of Americans daily. And it will be months before enough people get inoculated to stop it.
That means it's critical to continue the measures that can limit the toll: mask-wearing, hunkering down, hand-washing, testing and contact tracing.
"Vaccines will not obviate the need for testing any time soon," says Dr. Ashish Jha, the dean of the Brown School of Public Health. "It doesn't mean we can let our guard down. The virus will not be gone."
So where do things stand with testing in the U.S.?
A new analysis that researchers at Brown and Harvard universities conducted for NPR finds that the country may finally be close to doing enough testing to identify most people reporting symptoms and at least two of their close contacts.
The amount needed for that is 2 million a day by Jan. 1. The U.S. is currently conducting nearly 1.9 million tests daily.
Testing simply those who are sick and two of their contacts is a bare minimum to respond to current outbreaks, Jha explains.
The analysis finds that the U.S. should be doing about three times more than that — or nearly 6 million daily tests — to stop outbreaks from growing and protect the most vulnerable. This approach would proactively screen key groups of asymptomatic people, including college students and school teachers, for example.
"There's no doubt that we've made progress," says Jha. "But testing in this country is still really inadequate."
Even that progress is spotty around the country. Only 12 states plus Washington, D.C., are conducting enough testing to reach the bulk of symptomatic people, according to the analysis. Those states are: Alaska, California, Connecticut, Illinois, Maine, Michigan, Montana, New Jersey, New Mexico, New York, Oregon and Vermont.
Another nine are very close, and the remaining 29 states fall short.
"A lot of states have invested a lot of resources into trying to do more testing, and we're seeing payoffs and we're seeing some states are able to do that basic level of testing," Jha says. "That is progress."
But even 2 million tests a day is really far from what's needed to actually slow raging outbreaks and prevent them from springing back up again, Jha explains.
The minimum targets for testing symptomatic people are based on modeling growth of current outbreaks. It assumes a modest two contacts per infection get tested, because of the difficulties many states report conducting contact tracing. Since as many as 1 out of 2 infections are spread by people without symptoms, more ambitious testing efforts are needed for communities to screen high-risk, asymptomatic people.
"Just focusing on testing people who have symptoms or their close contacts is really not enough. That has been the Achilles' heel of our entire disease outbreak control," Jha says. "We've never really had a strategy for identifying people with asymptomatic infection."
To capture those cases, Jha and his collaborators propose that communities should be testing, at a minimum: 20% of students and teachers in K-12 schools weekly; college and university students, prisoners and guards, health care workers and first responders weekly; and nursing home residents and staff twice weekly.
"What we need is a jump-start of our testing if we want to actually move to an offensive strategy around active screening of our asymptomatic individuals," says Dr. Thomas Tsai, an assistant professor in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health, who helped conduct the testing analysis.
"It would mean that students can return to school safely. Nursing home residents and family members know that their loved ones in nursing homes and the people who work [there] can do so safely," he says.
In spite of the optimistic vaccine news, Tsai says this type of coordinated and proactive coronavirus screening is still critical to stopping the pandemic in the U.S. It will "buy time for the vaccine to be rolled out," he says.
"Testing is just as important as before vaccines," Tsai says. "The vaccine isn't an either/or strategy. Vaccines are part of the toolkit along with continued testing and masking and social distancing. In fact, it's even more important now that all of these strategies are working together to suppress the virus."
The researchers hope the incoming Biden administration will provide the federal leadership needed for a more coordinated national response to provide more testing. The proposed 6 million tests a day would probably require $10 billion to $20 billion for at least three months, the group estimates.
"It will take a real effort from the federal government, but it's not going to break the bank," Jha says.
Some other researchers say the estimate that about 2 million tests are needed as a bare minimum today may be an underestimate.
Jennifer Nuzzo, a senior scholar at the Johns Hopkins Bloomberg School of Public Health Center for Health Security, notes that the percentage of people testing positive has been increasing, suggesting that far too few people are being tested, to capture the actual infections in the community.
"We probably need to at least double the amount of testing we're doing," Nuzzo says.
Unfortunately, the increase in testing appears to have stagnated, Nuzzo notes.
"The rate at which we have increased testing in the last month is much slower compared to the previous month and yet we have more infections now than we've ever had," Nuzzo says.
Jha, Tsai and others hope the increasing availability of antigen tests could quickly increase the nation's testing capabilities and hope the targets in the new analysis will spur policymakers to make that happen.
Nuzzo hopes so too.
"Testing is slowing in the United States. We're hearing reports of shortages once again and test turnaround time increasing. All of the warning signs are there that now is the time to take this problem seriously and fix this problem for good," Nuzzo says.
DAVID GREENE, HOST:
NPR has new data this morning. It reveals that some states finally are catching up on COVID testing. And that is crucially important at a time when the virus is spreading faster than ever, also killing record numbers of people. We've been tracking the data in partnership with Harvard and Brown Universities. And NPR's Rob Stein is here to tell us about it. Rob, good morning.
ROB STEIN, BYLINE: Good morning, David.
GREENE: So how much better have these testing levels gotten in the U.S.?
STEIN: You know, things have gotten way better. There are lots more tests out there these days. You know, people can even test themselves at home now. More than 234 million tests have now been done. And the U.S. is doing about 2 million tests a day now, so big improvements.
GREENE: I mean, early on, you were talking about the standards we needed to sort of meet for the amount of testing. Is this enough now, can we say?
STEIN: So according to the new analysis this team at Harvard and Brown just did for NPR, the U.S. is finally just about hitting the target for the very basic amount of tested needed nationally. That's testing everyone who has symptoms and at least two of their contacts. That would be about 2 million tests a day. But there are two big caveats about that. No. 1, there's still a lot of variation around the country. According to this analysis, 12 states plus the District of Columbia are finally doing enough of that kind of testing. They are Alaska, California, Connecticut, Illinois, Maine, Michigan, Montana, New Jersey, New Mexico, New York, Oregon and Vermont. And about another nine are very close.
GREENE: OK. You definitely listed far fewer than 50 states there. It sounds like...
GREENE: ...There is a lot of variation.
STEIN: Yeah, yeah. So the remaining 29 states aren't even close. And this second big caveat - this is a big one - is that 2 million tests a day is far below what's really needed, and that's to test lots of people without symptoms because, you know, they're a huge reason the virus is spreading so fast. I talked about this with Dr. Ashish Jha. He's the dean of the Brown School of Public Health.
ASHISH JHA: We know that about half the spread happens from people who have no symptoms at all. And that has been the Achilles' heel of our entire disease outbreak control is that we've really never had a strategy for how to identify asymptomatic people.
GREENE: So how much more testing do we need to spot people who don't have symptoms, Rob?
STEIN: So according to this analysis, the U.S. would need at least 6 million tests a day at a very bare minimum. That would test 20% of students and teachers in K-12 every week. Test college students, prisoners and guards, health care workers and first responders weekly, and nursing home residents and staff twice a week. Here's what Dr. Thomas Tsai from Harvard says this could mean.
THOMAS TSAI: It means that students can return to school safely, nursing home residents and family members know that their loved ones in nursing homes and the people who work in nursing homes can do so safely - reducing transmissions in prisons, providing enough testing so health care workers don't have to go to work and wonder if they have COVID or not.
STEIN: Now, the country would need even more than that to really be able to safely get life back to normal. But this would at least be a start and help as more and more people get vaccinated and testing ramps up even more.
GREENE: So how realistic, though, is that, that that might happen?
STEIN: Well, you know, the incoming Biden administration is talking about launching a new nationally coordinated strategy to boost testing. And, you know, there are lots of cheap, new, fast tests that are becoming available. So you know, it is within reach. Jennifer Nuzzo at Johns Hopkins says that's especially important because right now the opposite is actually happening with testing.
JENNIFER NUZZO: Testing is slowing in the United States. We're hearing reports of shortages once again and test turnaround time increasing. I mean, all of the warning signs are there that this is something - you know, now is the time to take this seriously and to fix this problem for good.
STEIN: Yeah. So the question is whether Congress will come up with the billions of dollars needed to ramp up testing to help blunt the toll of what could be a very grim winter we're going into right now.
GREENE: All right. NPR health correspondent Rob Stein. Rob, thanks so much.
STEIN: You bet, David. Transcript provided by NPR, Copyright NPR.