The plan offers little in the way of actual assurances to the states while insisting that most of the work of scaling up testing will be left to them. It calls on states to develop their own plans and identify hurdles on their own. It says nothing specific about what steps — if any — the federal government will take to increase the number of tests, instead passing the buck to others. The federal government, the plan says, is merely a “supplier of last resort.”
In fact, it’s not clear if the plan will significantly increase testing. In unveiling the plan on Monday, administration officials promised the US will reach at least 8 million tests a month by the end of May. That’s roughly 260,000 tests a day — barely more than the 220,000 a day that the US already averaged over the past week, based on the Covid Tracking Project, which is compiling testing numbers for every state.
Experts say far more testing is needed. On the low end, they’ve called for at least 500,000 tests a day. At the high end, some have called for as many as tens of millions of tests a day, which they say would let public health officials truly track and subsequently contain the full outbreak without as much social distancing.
This much testing is, however, expensive. Paul Romer, a Nobel Prize-winning economist, has projected that the US needs more than 20 million tests each day, effectively letting the country test each person in the country every two weeks. He estimated that would cost $100 billion — which may sound like a lot, but it pales in comparison to the cost of keeping the economy shut down.
But the only way that level of investment in testing will happen, particularly as cities and states deal with tight budgets, is if the federal government gets more involved. Congress already allocated $25 billion to testing and contact tracing in a recent bill, which will start to chip away at the gaps but falls short of Romer’s proposal.
The current testing gaps come down to supply. The White House has said that the US currently has the machines to conduct more than 2 million tests a day. But a shortfall of supplies for tests — due to a lack of swabs for collecting samples and reagents for the tests themselves — has kept the US from reaching anywhere close to that number.
This is a giant obstacle to safely reopening the economy. Every major plan to combat the pandemic and pull back social distancing relies on testing to fully understand the extent of the outbreak and keep it in check. Without that, the only options are more social distancing, with the economic harm that entails, or letting the pandemic run its course — at the cost of potentially hundreds of thousands or millions of lives.
The White House, however, has offered no concrete answers on what the country will do next to fix this problem.
What Trump’s testing plan calls for
The overview largely provides a summary of the situation so far, detailing how the federal government has waived regulations, provided some supplies to states, and partnered with private businesses to scale up testing. But it leaves out the failures — particularly how the Centers for Disease Control and Prevention botched its original test and took weeks to fix the mistake, as well as how the Food and Drug Administration moved slowly to let private labs conduct tests.
Trump insisted in his press conference on Monday that the US is “lapping the world on testing,” but the data simply doesn’t reflect that. When accounting for population, the US testing rate is a little more than half of Italy’s, one of the countries hit hardest by the pandemic. It’s about two-thirds of Germany’s, which has been widely praised for its quick response to the crisis.
Moving forward, the blueprint explains what should be expected from the federal government, the local, tribal, and state governments, and the private sector.
The short of it: The plan downplays the role of the federal government and calls on cities, states, tribal governments, and the private sector to do much more. The federal role in the blueprint amounts to little more than providing some guidance and technical assistance here and there. The role for everyone else is sweeping — establish plans, identify problems, and implement solutions. There are few specifics for how exactly any of this can and will get done.
According to Trump’s White House, the federal government’s role is to provide general guidelines and “strategic direction and technical assistance,” including on testing supplies and capacity. It will ease regulations, partnering with the private sector when needed, and accelerate research. If problems with the supply chain persist, it will “act as supplier of last resort.”
Local, tribal, and state governments, meanwhile, have to actually develop and implement testing plans — including maximizing the use of testing platforms and venues, figuring out how to “identify and overcome barriers to efficient testing,” and developing broader monitoring and rapid response programs. And the private sector will be responsible for accelerating the production of tests and the supplies needed for them.
It’s, in other words, a largely local and state-driven approach.
That’s in many ways the opposite of what Trump’s Democratic critics have suggested. Former Vice President Joe Biden, the presumed Democratic nominee for president, has called for a “Pandemic Testing Board” that would mirror federal oversight of defense production during World War II. “This isn’t rocket science,” Biden said in a statement. “It just takes investment and execution — both of which have been gravely lacking.”
Trump’s plan is also at odds with what many experts are calling for. In a letter released this week, Scott Gottlieb, who previously served as Trump’s FDA commissioner, and former public health officials from both political parties called on the federal government to take charge not just on testing but community monitoring and surveillance for the coronavirus. “This is fundamental to our ability to begin to reopen our economy while continuing to safeguard American lives,” the ex-officials wrote.
More could be coming. Under a recently enacted law, Congress allocated $25 billion for testing and required the Department of Health and Human Services to develop a “strategic testing plan” that will, among other things, boost testing capacity. What that looks like, and how it differs from the White House’s new set of guidelines, remains to be seen.
America needs way more testing
The reality is America simply needs way more testing.
The US has scaled up testing since the start of the pandemic. At the beginning of April, the number of tests averaged around 150,000 a day. That was up to around 220,000 during the week of April 21.
But that falls short of the 500,000 to tens of millions of tests a day that experts have called for.
Testing gives officials the means to isolate sick people, track and quarantine the people whom those verified to be sick came into close contact with (a.k.a. contact tracing), and deploy community-wide efforts if a new cluster of cases is otherwise too large and out of control.
Other countries, like South Korea and Germany, have paired high levels of testing with aggressive contact tracing to control their outbreaks. A report from the Johns Hopkins Center for Health Security and Association of State and Territorial Health estimated the US will need to hire 100,000 contact tracers — far above what states and federal officials have so far said they’re hiring. A phone app could help cut down on the need for quite as many tracers, but it’s unclear if Americans have the appetite for an app that will effectively track their every move.
This will, again, require a significant federal investment — to the tune of tens of billions more dollars. States and cities, cash-strapped due to the economic downturn, simply don’t have the financial means to act on their own. They also have little influence over how, for example, to fix supply shortages that are originating in other cities and states.
Trump’s testing overview and blueprint simply don’t provide assurances on these fronts. Instead of calling for a bigger investment and strong federal leadership, it leaves a bulk of the work to states, calling on them to set up their own plans and identify and fix their own problems. The federal government, with its “guidelines,” “strategic direction,” and “technical assistance,” will largely play a supplemental role.