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March 24, 2020

The 'double whammy' that's keeping Americans from coronavirus tests

Daily Briefing

    As COVID-19 continues to infect a growing swath of the U.S. population, Americans face a new barrier to getting tested for the new coronavirus.

    Our take: Is drive-thru testing the answer to coronavirus screening?

    Supply shortages are the latest hurdle the United States is facing to scale testing, and they are driving providers to shift their testing strategy toward a narrow focus on health care workers and the severely ill.

    Supply shortage 'double whammy'

    While new entrants rush to set up drive-thru testing sites and more companies gain FDA approval to manufacture tests, a supply shortage "double whammy" is stymying efforts to increase testing access on two fronts:

    1. Test kit materials are in short supply. Suppliers have struggled to keep pace with the soaring demand for materials required to use the test kits. In the past week, critical shortages were reported for specialized nasopharyngeal swabs used to collect samples, chemical reagents used in processing, and transport media. While manufacturers say the shortages will likely be short-lived, the challenge could persist for weeks to months as baseline production catches up with global demand.

    2. Lack of personal protective equipment (PPE) prevents test administration.Even where test kit materials are available, the critical shortage of PPE is preventing health care workers from administering the tests broadly. According to CDC guidelines, health care workers testing patients for COVID-19 “should wear an N-95 or higher-level respirator (or facemask if a respirator is not available), eye protection, gloves, and a gown.” As COVID-19 patients fill an increasing number of hospital beds, health care providers are reserving PPE for the frontline workers treating the severely ill—and even so, they are quickly running out.

    What it means for providers' testing strategy

    In light of these challenges, providers in hard-hit regions on the East and West Coasts are shifting their testing strategies accordingly.  Previous efforts to scale testing aimed to identify and diagnose symptomatic individuals in the population at large.  Yet new guidance from health officials in certain states (including New York and California) suggests conserving tests for health care workers and those displaying signs of severe to critical illness. 

    Ultimately, that means people with more mild symptoms will go undiagnosed and reflects a new goal in the United States:  managing limited resources to minimize the loss of life rather than identifying and isolating less severe cases.  This dynamic is representative of a larger change in the U.S. response to COVID-19—from one of containment to one of mitigation.

    Why it matters

    Despite this shift, ensuring broad access to testing in the U.S. must remain a top priority.  Widespread testing is essential to epidemiological research and therefore containment of future localized COVID-19 outbreaks until a vaccine becomes available. Broad-base testing provides a barometer of emerging COVID-19 hotspots. This understanding is critical to slow the spread of the virus and the surge of patients into our nation’s hospitals.  As such, testing is a vital tool to help alleviate our healthcare providers’ escalating capacity challenge.   

    The question remains: Will manufacturers be able to quickly flex their supply to meet the moment? If so, the U.S. will likely see a movement toward broader testing—finally. 

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