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Ask the Dow: Coronavirus testing within the U.S. is dropping even because the variety of deaths will increase

U.S. coronavirus testing declines, although infections remain high and fatalities increase more than 1,000 a day. This is a worrying trend that officials attribute primarily to the fact that Americans are discouraged from having to wait hours to get a test and days or weeks to find it from the results.

An analysis by the Associated Press found that the number of tests per day dropped 3.6% to 750,000 in the past two weeks, with the number falling in 22 states. These include places like Alabama, Mississippi, Missouri, and Iowa, where the percentage of positive tests is high and rising, an indicator that the virus is still spreading unchecked.

In the midst of the crisis, some health officials are demanding the introduction of a different type of test that would produce results in a matter of minutes and would be cheap and easy enough for millions of Americans to test themselves – but also less accurately.

"There is a sense of despair that we have to do something else," said Dr. Ashish Jha, director of the Global Health Institute at Harvard.

Extensive testing is considered essential to contain the outbreak as the US approaches a mammoth of 5 million confirmed infections and more than 157,000 deaths from over 700,000 worldwide.

The demand for tests is expected to increase again in the fall, when schools reopen and the flu season begins, which will most likely exceed supply and lead to new delays and bottlenecks.

Part of the decline in testing in recent weeks was expected after backward commercial laboratories urged doctors to focus on their highest-risk patients. However, some health and government officials are seeing growing public frustration and slacking demand.

In Iowa, state officials report less interest in testing despite plentiful supplies. The state's daily test rate peaked in mid-July, but has dropped 40% in the past two weeks.

"We have the capacity. Iowans just have to test, ”said Governor Kim Reynolds last week.

Jessica Moore, from rural Newberry, South Carolina, said after a private laboratory lost her COVID-19 test results in mid-July, she had to be retested at a state-run popup location.

Moore and her husband arrived at a community center site early Saturday morning, where they waited two hours for their test. Moore watched in the rearview mirror as people pulled up, saw a long line of cars, and then turned and walked away.

"If people have something to do on a Saturday and want to be tested, they won't wait two hours in the South Carolina heat for a test, especially if they're not symptomatic," said Moore.

Before Laura DuBose Schumacher traveled from Florida to Delaware last month, she signed up to drive her husband to an auto test site in Orlando. They were given an hour-long window in which to arrive.

They arrived at the beginning of the window, but after 50 minutes it looked like it was going to take an hour. Others who had been through the line told them that they would receive their results no earlier than five days later, a Monday. They planned to travel the next day, so they gave up.

"Monday would have been pointless, so we left the line," said Schumacher.

The number of confirmed infections in the US has exceeded 4.7 million, with the number of new cases averaging almost 60,000 a day, after more than 70,000 in the second half of July.

The US tests are mainly based on highly sensitive molecular tests that detect the genetic code of the coronavirus. Although the test is seen as the gold standard for accuracy, experts are increasingly saying that the country's congested laboratory system is unable to keep up with the outbreak and achieve results within two or three days. This time frame is critical for isolating patients and containing the virus.

"They are doing as good a job as possible, but the current system will not allow them to keep up with demand," said Mara Aspinall of Arizona State University College of Health Solutions.

Delays in testing have prompted researchers in Harvard and elsewhere to propose a new approach called antigen testing – a fast technology that's already used to screen for flu, strep throat, and other common infections. Instead of detecting the virus itself, such tests look for viral proteins or antigens, which are generally considered to be a less accurate measure of infection.

A number of companies are investigating COVID-19 antigen tests, where you spit on a specially coated piece of paper. If you are infected, the color changes. Experts say that the speed and widespread availability of such tests would more than offset their lower precision.

While there are no such tests for corona virus on the US market, experts say the technology is simple and the hurdles are more regulatory than technical. The Harvard researchers say production could quickly scale into the millions.

A proposal from the Harvard researchers calls on the federal government to distribute $ 1 worth of saliva-based antigen tests to all Americans so that they can test themselves regularly, perhaps even daily.

Even with an accuracy of only 50%, the researchers estimate that the paper strip tests would reveal five times more COVID-19 cases than the current laboratory-based approach, in which federal officials estimate that only 1 in 10 infections occur.

However, the approach has met with resistance in Washington, where federal regulators have requested at least 80% accuracy for new COVID-19 tests.

So far, the Food and Drug Administration has only launched two COVID-19 antigen tests. These tests require a nasal swab, monitored by a healthcare professional, and can only be performed on special equipment found in hospitals, doctor's offices, and clinics.

Because of the risk of false negative results, doctors may need to test for a negative result with a genetic test if patients have possible symptoms of COVID-19.

On Tuesday, governors from Maryland, Virginia, Louisiana, and three other states announced an agreement with the Rockefeller Foundation to purchase more than 3 million of the FDA-approved antigen tests, which underscores the growing interest in the technology.

When asked about the introduction of cheaper paper-based tests, the government's “Testzar”, Adm. Brett Giroir that their accuracy could drop to 20% to 30%.

"I don't think this would serve the American public if seven out of ten cases were wrong," said Giroir last week. "I think that could be catastrophic."

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Associated press writers Brian Witte of Annapolis, Md., David Pitt of Des Moines, Iowa, and Mike Schneider of Orlando, Florida, contributed to this story. Liu reported from Columbia, S.C., and Forster from New York.

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