Back in April, the Rockefeller Foundation released its “National COVID-19 Testing and Tracing Action Plan,” a blueprint for nationwide testing, contact tracing, and analysis intended to help policymakers and researchers in their decision-making. At the time, testing throughout the country was vastly insufficient, and while it has expanded since then, Rockefeller and others say it must grow even further to support reason-based reopenings of communities and businesses. Though it is clearly one of the most fundamental tools in pandemic response, testing remains inadequate and politicized.  

So Rockefeller has circled back to the topic with a recent update of the COVID-19 testing plan, committing millions and calling upon the federal government to develop and implement broader testing and related functions. Central to Rockefeller’s updated plan is expanded screening of asymptomatic people who can still spread the disease, but who are almost never tested currently. Experts have estimated that the true number of infected Americans may be 10 times greater than the number of cases confirmed through tests. So only through screening of asymptomatic people can public officials determine the spread of the virus through the country and thus make informed decisions about school attendance, business activities and the like.

Needed: 30 Million Tests a Week and More

The current estimated 4.5 million tests per week should be increased to 30 million per week by October, said Rajiv Shah, Rockefeller Foundation president. “We know we need testing at that level or more to get on top of the epidemic and bend the curve, and to allow workers to go to work knowing they’re safe. We think it’s not too late for the fall to be worse than the spring.”

In addition to large-scale screening, the new report calls for a government plan for contact tracing, improved data collection, and a nationwide communications effort on public safety. With so much disagreement on COVID-19 response around the country, convincing people to practice even a few basic safety measures on a national scale could have a significant impact on the spread of the virus. This has been demonstrated around the world, where many countries have tamped down the epidemic even as the U.S. has seen a sharp growth in infections, illnesses and deaths.

"Instead of ricocheting between an unsustainable shutdown and a dangerous, uncertain return to normalcy, the United States must mount a sustainable strategy with better tests and contact tracing, and stay the course for as long as it takes to develop a vaccine or cure,” the report says. “Any plan to do so must win the faith of private and public sector leaders across the country, and of individual Americans that they and their loved ones will be safer when we begin to return to daily life.”

There’s much more in the Rockefeller report—including recommendations to develop protocols for contact tracing, and for screening in schools, universities, workplaces, nursing homes, vulnerable communities, and more. And it calls for much faster turnaround in the return of test results, from as many as 14 days currently to one or two days—or even same-day results.

The foundation says the measures will require an additional $75 billion in government funding. And while that may sound like a lot of money, it’s nothing compared to the impact of the pandemic, said New York University economist and Nobel prizewinner Paul Romer, who contributed to the Rockefeller report: “The economic consequences of the country’s lost output is orders of magnitude larger.”

Building Support for a National Plan

According to Shah, the Rockefeller recommendations for testing and other measures have wide agreement across epidemiologists, biotech industry leaders, scientists and experts in testing, and former government healthcare leaders from both parties.

“The public is still not united in its response to the lethal virus, with large numbers refusing to take precautionary steps and dubious over the need for more testing,” the report says. “We can reverse this trend, and prevail over COVID-19, only with a clear, concerted, national plan for testing, tracing and communications. Leaving the fight up to a patchwork of individual states, cities, businesses and school systems will not work.”

Since mid-March, Rockefeller has committed $100 million to support COVID-19 response efforts in the U.S. and other places in need around the world; $15 million of that went to the national action plan and the Testing Solutions Group (a coalition of Rockefeller and other funders, public health officials from Oregon, several cities and two tribes, with a dozen more members set to join) and technical experts.

Until such time as a vaccine or effective treatments for COVID-19 are developed, testing is crucial—the key to answering basic questions not only about the spread of the virus, but also about its health impacts and true fatality rate. It’s hard to believe that the federal government hasn’t been on this issue from day one of the pandemic, but that’s where we are now. More public health funders should join Rockefeller in its advocacy for an appropriate government plan for testing and studying the disease.

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