Michael Mina is a professor of epidemiology at Harvard, where he studies the diagnostic testing of infectious diseases. He has watched, with disgust and disbelief, as the United States has struggled for months to obtain enough tests to fight the coronavirus. In January, he assured a newspaper reporter that he had “absolute faith” in the ability of the Centers for Disease Control and Prevention to contain the virus. By early March, that conviction was in crisis. “The incompetence has really exceeded what anyone would expect,” he told The New York Times. His astonishment has only intensified since.
Many Americans may understand that testing has failed in this country—that it has been inadequate, in one form or another, since February. What they may not understand is that it is failing, now. In each of the past two weeks, and for the first time since the pandemic began, the country performed fewer COVID-19 tests than it did in the week prior. The system is deteriorating.
Testing is a non-optional problem. Tests permit us to do the most basic task in disease control: Identify the sick, and separate them from the well. When tests are abundant, they can dispel the fear of contagion that has quieted public life. “The only thing that makes a difference in the economy is public health, and the only thing that makes a difference in public health is testing,” Simon Johnson, the former chief economist of the International Monetary Fund, told us. Optimistic timelines suggest that vaccines won’t be widely available, in the hundreds of millions of doses, until May or June. There will be a transition period in which doctors and health-care workers are vaccinated, but teachers, letter carriers, and police officers are not. We will need better testing then. But we need it now, too.
Why has testing failed so completely? By the end of March, Mina had identified a culprit: “There’s little ability for a central command unit to pool all the resources from around the country,” he said at a Harvard event. “We have no way to centralize things in this country short of declaring martial law.” It took several more months for him to find a solution to this problem, which is to circumvent it altogether. In the past several weeks, he has become an evangelist for a total revolution in how the U.S. controls the pandemic. Instead of restructuring daily life around the American way of testing, he argues, the country should build testing into the American way of life.
The wand that will accomplish this feat is a thin paper strip, no longer than a finger. It is a coronavirus test. Mina says that the U.S. should mass-produce these inexpensive and relatively insensitive tests—unlike other methods, they require only a saliva sample—in quantities of tens of millions a day. These tests, which can deliver a result in 15 minutes or less, should then become a ubiquitous part of daily life. Before anyone enters a school or an office, a movie theater or a Walmart, they must take one of these tests. Test negative, and you may enter the public space. Test positive, and you are sent home. In other words: Mina wants to test nearly everyone, nearly every day.
The tests Mina describes already exist: They are sitting in the office of e25 Bio, a small start-up in Cambridge, Massachusetts; half a dozen other companies are working on similar products. But implementing his vision will require changing how we think about tests. These new tests are much less sensitive than the ones we run today, which means that regulations must be relaxed before they can be sold or used. Their closest analogue is rapid dengue-virus tests, used in India, which are manufactured in a quantity of 100 million a year. Mina envisions nearly as many rapid COVID-19 tests being manufactured a day. Only the federal government, acting as customer and controller, can accomplish such a feat. [Continue reading…]