One point I try to make on the Twitter machine and on this crappy blog is that we need to bring testing to people. It’s not enough to have the ability to conduct X number of tests, if that capacity is never actually used to test the people we need to test (boldface mine):
To get out of this pandemic, we need fast, easy coronavirus testing that’s accessible to everyone. From the way people often talk, you might think we need a technological breakthrough to achieve this. In fact, we don’t have a technological problem; we’ve got an implementation problem. We could have the testing capacity we need within weeks. The reason we don’t is not simply that our national leadership is unfit but also that our health-care system is dysfunctional…
To fix testing, we have to accelerate two lines of operation: test collection and test processing. The primary challenge of test collection—sticking a fifty-cent swab in someone’s nose—is last-mile logistics, which can be more intricate than most realize. You’ve got to manage people flow; it can be a challenge just to find locations where potentially infectious people can turn up without infecting others. Then there’s the flow of supplies, which involves having adequate quantities of the swabs and tubes that your particular lab requires, plus the personal protective equipment required for the staff. There’s the information flow—gathering and linking a patient’s information, the provider information, and the bar code on the specimen tube in a way that the laboratory can deal with. And there’s the financial flow—figuring out the billing system required to get reimbursed by the correct payer, which, for a particular person, could be Medicare or Medicaid, a private insurer, an employer, the state, the patient herself, or any number of other sources. Running a test-collection operation can be a nightmare for scores of reasons. You have to navigate supply shortages, neighborhoods that object to having lines of cars turn up at a pharmacy or clinic parking lot, business-insurance plans that may not cover you if you provide testing, and building owners with liability concerns. You may be unable to use your label printer and computer system if there’s no Wi-Fi in the parking-lot drive-up location you’ve picked…
Yet we have other laboratories with large amounts of untapped processing capacity ready to provide next-day results. In July, for instance, I visited the Broad Institute, a large academic laboratory affiliated with M.I.T. and Harvard, in Cambridge, Massachusetts, which has provided coronavirus testing for area hospitals, clinics, and others. As Sheila Dodge, the senior director of Broad Genomics, explained as she walked me through its molecular-testing operation, they had the capacity to process up to thirty-five thousand tests per day. With a few weeks’ notice, they could expand that to a hundred thousand a day—more than fifteen per cent of the nation’s current capacity. But, when I visited, they were receiving just a few thousand test specimens per day. I saw an entire room of machines standing by, mostly idle.
It’s the same story elsewhere. I spoke to leaders at the University of Minnesota’s Genomics Center, who reported that they have unused capacity to deliver up to twenty-five thousand tests a day. And there are numerous other university-based and independent molecular-diagnostics laboratories with the ability to expand the country’s testing capacity. Several companies—including Guardant Health and Helix, in California; Kailos Genetics, in Alabama; and Ginkgo Bioworks, in Boston—are rolling out advanced molecular-testing techniques that could enable them to collectively process hundreds of thousands of tests a day. Whereas the usual charge for test processing is a hundred dollars or more, most of these labs are willing to charge much less—from fifty dollars to as little as twenty dollars. What’s missing is the logistics operation to connect their supply of tests to the people who need them and to the entities that pay for them.
On a local level, what I find frustrating in D.C. is that we really could have enough tests and be able to deploy them to people. It would not be hard to generate thousands of tests for D.C. But when I look at the data for D.C., we’re only testing ~1,000 D.C. residents every day (D.C. also tests about an equal number of out-of-state residents). It wouldn’t be hard to get rapid turnaround time for thousands of tests. But D.C. also has another advantage: geography. That is, D.C. is small. You don’t have to drive for four hours to reach someone. If we lowered prevalence a bit more, we could bring tests to people–I mean that literally. Maybe not all contacts, but we could do a lot more testing–and do it faster.
But right now, we’re not connecting the testing with people who should be tested, and we’re not giving them (and the health department) that information quickly. It doesn’t have to be like this.
Anger is still the appropriate emotion.