The U.S. needs a national Covid-19 testing strategy, not a state-by-state patchwork

Widespread and accessible testing is an essential component of our nation’s response to the Covid-19 pandemic. Yet while testing continues to expand across the U.S., with nearly 90 million tests administered to date, the lack of a national Covid-19 testing strategy is standing in the way of the government’s oft-repeated promise that “anyone who wants a test can get a test.”

The Trump administration’s decision to shift the responsibility for managing Covid-19 testing to the states has led to a patchwork system with critical issues, including supply chain and logistical challenges, lack of reimbursement, and disparities in which populations should be tested. These challenges are the direct result of having states compete with each other for scarce resources versus having a coordinated federal response that directs resources where they are most needed.

Those were some of the findings of a recent study of regional off-site Covid-19 testing centers and public health departments conducted this summer by our two organizations, the Network for Regional Healthcare Improvement and Qualidigm.

Key among the challenges facing these off-site testing centers is the continuing shortage of personal protective equipment (PPE) available to the health care workers who administer the tests.

“We were really struggling to get PPE in and it was a constant shortage,” said Aaron McIntire, deputy fire chief of the Concord, N.H., fire department. “We would just get enough gowns in there and then we would be short on masks and then we would get enough masks and we would be short on gloves. It always seemed like there was one link in the chain that was on a shortage and back order.”

Several sites reported finding creative ways to reuse existing N95 masks, including wearing surgical masks over N95s.

The supply chain was a major factor especially for smaller, regional testing sites. According to Henry Mitchell, the emergency manager for Colorado’s San Miguel County, “The minimums for some of these folks selling PPE is 3 million units. That’s not realistic for a small county.”

Reimbursement is another key issue. Early on, when Covid-19 testing was limited to those displaying symptoms, the federal government assured the public that tests would be free with no copays or out-of-pocket expenses. That hasn’t proven to be the case. While the federal government did direct insurers to waive patient costs for “medically appropriate” tests, many insurers have gotten around that directive by categorizing them as “screening tests.”

Many testing facilities are taking a loss for Covid-19 testing but continue to do it because they see the benefit in their communities. “We are not refusing anyone because of the lack of ability to pay … at this point in time … we are doing this because this is the right thing to do for our community,” said Donna Barron, a registered nurse who is an infection preventionist for Southwestern Vermont Medical Center.

Without clear guidance on who should be tested, many sites are also facing increasing pressure to support back-to-work and back-to-school testing, which is causing an overload in demand.

Calls for the federal government to institute a national testing strategy to address these challenges are increasing as we head into what many believe will be a more deadly than usual flu season.

The Rockefeller Foundation, in coordination with a coalition of private sector and philanthropic groups, issued a National Testing and Tracing Action Plan that calls for increased federal funding of $75 billion, beyond the $25 billion for testing that was included in the Coronavirus Aid, Relief, and Economic Security (CARES) Act passed last spring.

Despite the lack of a national strategy and guidance for Covid-19 testing, communities across the country are identifying innovative strategies to test even the most vulnerable individuals, such as equipping vans with the technology needed to set up clinics in hard-to-reach places. They are also forming new and unexpected partnerships, including engaging places of worship and social justice groups, to build trust among communities less likely to seek testing.

Many leaders, however, fear these solutions are unsustainable given the quickly approaching Dec. 31 deadline for use of current CARES Act funding. For communities to support sustainable and scalable testing practices, it is imperative that the government provides longer-term funding and communicates its intent to leaders well in advance of the funding cliff anticipated at the end of the year when CARES Act funding expires.

These challenges will not disappear once a vaccine is available. In fact, they will become even more persistent without clear national guidance on how to distribute a vaccine, who gets it first, and how to ensure it is reaching all populations.

America should be leading the way in the response to this global pandemic. The time is past due for the federal government to develop and put in place a coordinated national plan for Covid-19 testing for all Americans. A national strategy that also outlines effective quarantine procedures, contact tracing, and treatment for the disease would be even better.

Craig Brammer is president and CEO of the Network for Regional Healthcare Improvement, a national organization of regional health improvement collaboratives and state partners, and president and CEO of the Healthcare Collaborative. Tim Elwell is president and CEO of Qualidigm.

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