Finding out if someone has COVID-19 is fundamental to controlling the spread of the virus, and to allowing a safe return to some level of normalcy before an effective vaccine is developed and distributed widely — whenever that may be.

Yet more than six months since the first case was confirmed in the U.S., with the virus circulating nearly as widely as ever and an expected fall surge on the way, testing is wildly insufficient, and there remains no national strategy to change that.

One solution is the creation of a new kind of test that sacrifices some accuracy for speed and ease of use. But in order for it to work, the Trump administration has to do something it has not for the entirety of the pandemic — prioritize widespread testing.

In the first few months of the pandemic, testing capacity in the U.S. could not keep up with demand. That slowly changed as states, laboratories and health care providers stepped in to fill the void left by a vacant federal government led by a president who is, against all expert opinion and common sense, opposed to the very concept of testing.

But as states began to resume activities, cases of the virus spiked again, and again testing capacity has been overwhelmed. With a backlog at the labs that process tests, people are now waiting up to two weeks for results, making them functionally useless.

In Maine, state officials, health care providers and private business have worked to increase capacity, and cases have remained low, isolating the state from some of the testing shortfalls, though there are still limitations here.

The long waits, both for administering the test and getting the results, are keeping people from even trying, the Associated Press reported last week. As a result, the number of tests per day dropped 3.6% in two weeks, even as cases ticked upward.

The lack of testing means many cases are being missed, allowing the virus to circulate unchecked and turn into more cases. In just one example, it means tourists coming to Maine can’t find out if they are infected first, which is both keeping healthy people away and opening the way for sick visitors to come here.

And that’s before schools reopen across the country. To do so safely, there will have to be fast, comprehensive testing of an entire population anytime a person at a school gets sick.

Right now, the country is not ready.

The new kind of test could help. Tests now work by detecting the virus’ genetic code, a process that requires bulky, expensive equipment mostly found in labs and supplies that are now hard to find, causing delays in results.

Experts now are pushing for the development of antigen tests, which look for proteins created by the virus. Even with 50% accuracy, such a test would uncover far more cases than the lab tests just through wider use.

The Food and Drug Administration, however, has only approved two such tests, both of which require an invasive nasal swab.

Harvard University researchers have a better way. They propose a $1 saliva-based antigen test that could be distributed to all Americans, working like an at-home pregnancy test, perhaps even taken daily where appropriate.

The FDA says it wants tests with accuracy of at least 80%. But those more accurate tests are worthless if they take two weeks, or even a few days, to get a result.

For the challenge we have ahead, fast, cheap, numerous tests will be helpful. The country cannot afford to look back in a few months and wonder — again — where all the tests are.

 


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