U.S. needs 193 million Covid-19 tests per month to reopen schools and keep up with pandemic, new report says

The U.S. may need up to 193 million coronavirus tests each month in order to safely reopen schools and fortify nursing homes, according to a new report published Wednesday. Current testing capacity in the U.S. is about 21 million tests per month, according to the Covid Tracking Project.

The report is the first testing protocol from the Rockefeller Foundation, which has already issued several testing-related reports and is working with 10 governors to buy and distribute 5 million Covid-19 tests. Written by a team of health policy experts, including a former FDA commissioner, it is aimed at giving states and communities specific guidance on how frequently they should be testing people.

The report’s testing guidelines focus heavily on keeping the coronavirus outbreak under control at schools — at least 175 million of the monthly testing capacity would focus on teachers and students. Much of that would service areas with high coronavirus caseloads that nevertheless open schools, where the report’s authors recommend twice-per-week testing for all students and teachers. Another 18 million or so tests per month would be aimed at testing in nursing homes, where the population is most vulnerable.

The report doesn’t get into specific numbers required for other populations, but Mara Aspinall — one of the co-authors of the report and a managing director of BlueStone Venture Partners — suggested that would be included in future protocols.

Experts have already warned that reopening schools could cause Covid-19 cases to surge again. In some areas, case numbers are already rising. The report suggests that a dramatic escalation of testing could help counteract some of those trends.

“It’s the kind of risk-based, scientifically based protocols that we would urge that the CDC actually carry forward,” said Jono Quick, the foundation’s managing director of pandemic response, preparedness, and prevention.

The report is broadly critical of the Trump administration’s testing practices, and says that the actions so far “do not yet amount to a national testing strategy.” Confusing guidelines and a lack of a coordinated federal response may have hampered the response to the pandemic, the report concludes.

“There is an urgent need for federal action to provide more clarity about testing protocols and testing needs,” it states. “The United States is at a critical point in the pandemic, facing many more months of the severe health and economic disruptions that go along with significant infection spread throughout the country – but now with the potential to avoid that outcome through the effective use of innovative, large-scale testing.”

Federal health officials have pushed back on the idea that there is no testing strategy. Assistant HHS Secretary Brett Giroir told reporters in August that he was “going to start being personally insulted” by questions that suggested the U.S. did not have a national testing plan. “We’ve had a national strategy for months,” he said, citing a report delivered to Congress in May, which emphasized state-level responses.

Most of the tests would not be the most accurate type of test used to diagnose Covid-19; instead, the report suggests screening tests that are potentially less accurate but can deliver results far faster. 

“Frequency makes up for a world of sins,” said David Paltiel, a professor at the Yale School of Public Health who has modeled the effect of testing at colleges and universities and was not associated with the report. “You’d much prefer to use a cheap and less than perfectly specific test if you can use it more frequently.”

“What I really like about this is that it is saying smart things about different types of testing that are for different purposes,” said William Hanage, an epidemiologist at Harvard’s T.H. Chan School of Public Health who was also not associated with the report. “You want a very good diagnostic test which is going to be used in a hospital setting. That’s not necessarily the same as something that you might want to do in a school.”

Wednesday’s report also took aim at a controversial set of Centers for Disease Control and Prevention testing guidelines issued in late August, which stated that asymptomatic contacts of people diagnosed with Covid-19 may not need to be tested.

“We continue to have great respect for the CDC as our leading public health organization, but we don’t agree with the decision of not testing people who have been identified as significant contacts. We just don’t agree with that,” Quick said.

Though the U.S. doesn’t currently have the capacity to achieve the testing the report recommends, Aspinall said it’s not a pipe dream. If manufacturing capacity increases as expected — and if more tests receive emergency use authorizations from the Food and Drug Administration — more than 198 million tests could be produced in January 2021, she said. “It would meet the vast majority of the demand,” Aspinall said.

Quick also praised the federal government for moving quickly to procure new tests, like it did last week when it bought 150 million tests from Abbott, a major diagnostics company.

“The moves around the procurement of the [tests] — all of that is clearly signaling a recognition of the necessity of screening tests. You’re not buying those for diagnostic purposes,” Quick said. “I think the trajectory is going in the right direction.”

Quick said the foundation would be partnering with “four or five” cities to test the protocols suggested in Wednesday’s report.

However, Hanage cautioned that testing programs work best when they aren’t limited to one school or one town — and that putting any recommendations into practice may be more difficult than anticipated.

“For all that we talk about these clever things, we haven’t been able to do the basics right in a lot of places. Given that that’s the case, we need to bear that in mind when evaluating stuff like this,” he said. “Having said that, things like this should serve to remind us that another way is possible.”