(Data updates, May 1)

In this post, I list a number of specific applications where tests could save lives and restore confidence. Tests could stop the deaths in nursing homes. They could make it safe for nurses to go back to their jobs. They could make parents feel safe taking their children to the clinic to get a vaccination. Such applications yield an immediate demand for 13.9 million tests per day.

At the current government reimbursement rate of $100 per test, the daily cost of these tests would be $1.39 billion. At this rate, the $11 billion that the Congress allocated to the states to support testing will be exhausted in 8 days.

If We Commit, Our Universities Will Respond

It was a huge step forward when the Congress provided $11 billion to the states to jumpstart spending on tests and another $14 billion to develop better tests.

But $25 billion is not enough. To make everyone feel safe going back to work, we must commit to spending $100 billion per year to purchase about 9 billion tests per year. The quid pro quo for committing to buying this many tests must be that the price per test come down to $10.

As my Roadmap to Responsibly Reopen America, published last week, notes, the way to restore confidence that everyone can safely return to work is to test every American once every two weeks. To supply the number of tests that this will require, we have to mobilize the vast pool of scientists who work university laboratories.

Right now, the government pays $100 per test to the dominant firms in the clinical diagnostics industry. The methods used by these firms lag far behind the extraordinary technologies that university researchers use to read genome of all living organisms.

Using their high throughput systems, university labs could mass produce tests. But they cannot make the investments this will require unless they have a firm commitment from the Federal government that the funds will be there to purchase the tests that these labs scale up and start producing.

What More Tests Would Mean for the Lives of US Citizens

The examples I list below only begin to convey the security that more tests would offer: to those who work in the health care system and to those who rely on it. They only hint at the security tests could offer to emergency medical technicians, police officers, employees in the food supply chain (from the meat packing plant to the grocery store). They only begin to suggest how many lives we could save if we used tests to protect vulnerable groups such as residents of skilled care facilities.

Every month, the depressed state of our economy costs us $500 billion in lost output and lost capacity to produce in the future. Spending $100 billion per year to get back $500 billion per month is the best investment we could ever make.

1. Protect Residents of Skilled Care Facilities: 370 Thousand Tests per Day

• Number: 1.3 million residents

• Initial Frequency: test every week

• Health care workers in these facilities: (See items 2 and 3 below.)

Background

Massachusetts is testing all residents of skilled nursing facilities because test and isolate is the best hope for cutting the high fatality rate from Covid-19 in these facilities.

A report from the New England Journal of Medicine describing events at a skilled care facility in the State of Washington, Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility, explains why testing all residents will save many lives. An infected staff member introduced the virus to the facility in late February. The facility implemented measures to contain the virus–using more personal protective equipment when dealing with residents with symptoms; frequent temperature checks, no more communal activities; restrictions on visits. These measures did not stop the spread. On Mar 13, 23 residents tested positive. Just one week later, another 24 tested positive. By Apr 3, 15 of the 89 residents had died.

In the same issue of the journal, an editorial, Asymptomatic Transmission, the Achilles’ Heel of Current Strategies to Control Covid-19, notes that despite the precautions of the staff, the virus infected and killed so many residents because people who caught the virus started spreading it before they developed symptoms. As a result, the only sure way to limit its spread is to test everyone and isolate any resident or staff member who tests positive.

2. Doctors, Nurses, EMTs, Other Health Care Professionals: 8.7 million per day

• Number: 8.7 million

• Initial Frequency: Every day, at the start of a shift

Background

This article, Prevalence of SARS-CoV-2 infection in previously undiagnosed health care workers at the onset of the U.S. COVID-19 epidemic, reports that 7.3% of the health care workers in an academic medical system, none of whom had any symptoms, tested positive for the virus at a time when the prevalence among the general public was less than 0.5%.

To protect health care workers from infection by asymptomatic colleagues, to protect the public, and to restore the confidence that will be needed for everyone to go see health care professionals and get the care they need, we should start testing everyone who works in health care before they start their shift and keep testing this often until we are sure that the prevalence of infection is close to zero.

3. Health Care Support Occupations

• Number: 6.5 million

• Frequency: 1 per week

Because many (but not all) of the supporting occupations tend to not to be on the front line of patient care and hence are less exposed to infection by patients, it might be reasonable to start by testing them once a week.

4. Patients who Visit a Health Care Provider

• Visits to Doctor’s Office: 2.5 m per day

• Visits to Hospital Outpatient Clinics: 2.3 m per day

To protect health care workers from infected patients and to protect patients from one another, it might be best to test all patients at an offsite location before they go to the clinic or doctor’s office; and to have special isolation areas where that patients who are positive can wait to be seen.

5. Protective Service Occupations (Police, Fire, TSA)

• Number: 1.9 million
• Frequency: 1 per week

Background

There is very little systematic data on rates of infection for these workers. On Apr. 19, the New York Police Department reported that about 11% of its members had tested positive, but given the high prevalence in NYC, it is not clear if this rate of infection is higher than the rate for the general population. The Fire Department of the City of Chicago, reported that it has been testing some of its members. As of Apr 29, 151 from a force of 4627, roughly 3%, have tested positive, but in Chicago, the Fire Department includes EMTs, who are classified under item 2 above and are likely to have a higher infection rate than other members of the Fire Department.)

6. Manufacturing, Food Products

• Number: 802 thousand
• Frequency: 1 per week

Background

On Apr. 28, the union that represents workers at meatpacking plants reported that 20 workers have died from covid-19. If the infection fatality rate is between 0.5% and 1.0%, this implies that between 2-4000 workers have been infected. It also reported that there are about 35,000 workers at the 22 plants that had closed.

7. Members of the Armed Forces

• Number: 1.0 million
• Frequency: 1 per week

Background

On Apr. 22, CNN reported that sailors on 26 US Navy warships are infected with the coronavirus and that 3600 members of the armed services have tested positive.