Demand for COVID-19 testing could soar in the fall with the reopening of some universities and schools, threatening to overburden an already strained system.
Many schools and universities are planning to regularly test students and staff in an effort to stop the spread of COVID-19 on their campuses.
But public health officials and experts worry there is not enough capacity and supplies to test thousands of people who aren’t showing any symptoms of the disease.
“I think what we’re starting to recognize is that it really is not going to be feasible in probably most areas of the U.S. to try to put together some type of testing strategy where you’re testing multiple times, especially if the results don’t come back for a while,” said Dr. Tina Tan, a member of the board of directors for the Infectious Diseases Society of America.
“I don’t think it really gives you a lot of information, and you’re using critical resources that could be better spent in other places.”
While capacity for COVID-19 testing has improved significantly since the early days of the pandemic, there is still not enough to handle the increased demand caused by surging outbreaks in the South and West.
About half of COVID-19 testing in the U.S. is performed by commercial labs like Quest and Labcorp, which are reporting turnaround times of several days, or even weeks.
Labs are still experiencing shortages of supplies needed to process tests, including chemicals, pipettes and personal protective equipment, due to the global demand caused by the pandemic.
Widespread testing of students and staff without symptoms could further overwhelm the nation’s testing capacity and stretch resources, experts warn.
“There is a thirst to do non-medical, non-clinical testing so people can get back to work, back to school,” said Scott Becker, chief executive officer of America’s Public Health Labs.
But, he added, it would require an “enormous amount of supply” to test people for non-medical reasons, and those are supplies needed to test people who have COVID-19 symptoms or have had contact with a confirmed case.
“The answer is not going to be to test everyone all the time. That’s not possible.”
The concern about potentially infected students returning to school in the fall is heightened by worries that many potentially infected young adults will not show symptoms of COVID-19 but could transmit it to others who can experience serious illness.
Some colleges like the University of Virginia and Purdue University in Indiana will require returning students show proof of a negative COVID-19 test before returning to campus.
Others institutions, like Harvard, Yale and Princeton, plan to test students once they arrive, and several times thereafter throughout the semester, in an attempt to quickly squash any COVID-19 cases from becoming large outbreaks that force closures.
Colby College in Maine will test all students three times a week at the beginning of the semester, with results delivered by a local lab within 24 hours.
Department of Health and Human Services (HHS) Secretary Alex Azar told governors on a call this week that he is hearing too many cases of universities striking deals with private labs. He wants to discourage this, he said, because there is just not enough supply.
Admiral Brett Giroir, the administration’s testing czar, added that the U.S. needs to avoid putting 75 million students into the testing pool, and universities and schools should instead rely on surveillance as opposed to widespread testing. He gave the example of Louisiana State University, which plans to test 10 to 15 percent of their student population in the fall, rather than doing universal testing.
“In general, testing people before going back to the university… is not a strategy that we recommend, nor does the [Centers for Disease Control and Prevention] recommend, because you’re only negative for that one moment, you could be positive the next day and it doesn’t relieve any responsibility about wearing a mask and doing all those kinds,” Giroir told reporters Thursday.
The CDC recommends against so-called “entry testing” of all students, faculty and staff because its effectiveness in stopping its spread has not been “systematically studied,” according to its guidance.
Giroir said schools should use surveillance testing instead of universal testing of all students. That could be done through pool testing, Giroir said, in which samples from several people are combined and then tested together instead of individually.
Pool tests that come back positive are followed by individual tests for everyone in the group, while negative pool tests are cleared.
Pool testing is thought to work best in areas where virus spread is low.
“Nothing’s a perfect solution, but it does not burden the health care system. It lets colleges keep control of how they want to do it,” he said.
However, Dr. Thomas Tsai, an assistant professor in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health, said he thinks it is important students be tested before they come onto campus followed by surveillance testing focused on certain populations afterward.
“I think everybody agrees that it’s important to test before students come onto campus,” he said. “The hope is to really change the conversation and stop letting capacity dictate our guidance.”
He argued the U.S. has become too reliant on commercial labs like Quest and LabCorp when there are other options available.
“We need to think beyond just the traditional capacity for providing tests and there’s capacity available beyond the commercial laboratories,” he said, like at health care systems, academic research groups.
Point of care tests are becoming more widely available, he noted.
Labs have also said they can’t do it on their own, and new technologies are needed to ease the demand for their services.
“This is something we have said from the beginning: labs can’t do this alone,” an American Clinical Lab Association spokesperson told The Hill. “Labs, diagnostic manufacturers, providers, public health officials the federal government all have a role here.”
“I think when you look to the fall it continues to be the case that we need to put the full range of testing tools we have available to deploy where they’re most needed and that includes point of care testing, which is not something we currently perform,” the spokesperson also said. “The bottom line is it’s going to take all of us.”
The Trump administration is hoping to expand access to point of care tests which can give results in 15 minutes at a doctor’s office or a patient’s bedside without lab processing.
Giroir told NPR last week he expects the U.S. to have 15 million to 20 million point of care tests ready for use by September.
“That’s going to dramatically reduce the burden [on labs],” he said.
The National Institutes of Health (NIH) is currently running a “Shark Tank”-like contest that seeks to accelerate the arrival of point of care tests to the market.
Still, the ACLA and other groups are asking Congress for more funding to expand testing capacity into the fall. Some of the nation’s largest labs have already maxed out at their testing capacity due to shortages of machines and chemicals needed to process tests.
“We share the goal of safely reopening the economy and returning to normal business, but this will require a sustained federal investment in testing facilitated by the public health and existing health care delivery system,” reads a letter sent Tuesday to Congressional leaders.