Joe Biden's COVID-19 testing plans energize scientists, but lack price tag or specifics
President-elect Joe Biden's pledge to revolutionize COVID-19 testing has offered new optimism to experts who have for months warned that the current U.S. approach isn't working.
Biden's goals, such as increasing testing locations, pushing the development of at-home test kits and finding the money to accomplish his plans, are easier said than done - but, they're not impossible, experts say.
Nearly a year into this crippling pandemic, infection rates are surging; as the nation barrels past consecutive grim milestones, the U.S. still lacks the ability to routinely test its entire population.
'No playbook' for a rocky start flecked by testing failures
As the virus gathered strength and speed, efforts to develop a reliable detection method were plagued with problems from the start: slow response times, scarce supplies, and bottlenecked results. Easy access to testing has faced serious issues of inequitable distribution and inconsistent price points.
"There was no playbook for diagnostics. There's no game plan. There was nothing,” Assistant Health and Human Services Secretary Adm. Brett Giroir said looking back in retrospect this July. “We really needed to start from square one.”
Clarity of public messaging appeared to be a struggle for the Trump administration, experts say: Trump, calling testing a "double-edged sword," has repeatedly blamed the number of tests being done for the nation's high case count.
Biden will inherit an extended global health crisis mile-marked by delay and muddled messaging. Medical officials say we need millions more tests a day nationwide to make a meaningful dent in the pandemic.
"We haven't come anywhere close to finding a majority of the cases occurring on any given day," Dr. Michael Mina, assistant professor of epidemiology at Harvard T.H. Chan School of Public Health, told ABC News. "Right now, we have a flood happening that's pouring into a bucket, and we're using a teaspoon to try and shovel the water out. It's just not working."
Some states have been experimenting with testing groups of people at once, known as “pool testing.” Another strategy has included wastewater surveillance of certain populations. The federal government has pushed out 150 million Abbott BinaxNOW rapid antigen tests to be used to track the virus. New York state, meanwhile, has been at the vanguard of making tests available on a large scale as a surveillance tool, targeting "micro-cluster" hot spots before they gather steam.
Experts emphasize that the importance of testing is not relegated to diagnosing and tallying cases. It can serve as an essential tool in stemming COVID-19's spread among contagious -- though perhaps asymptomatic -- individuals.
American Clinical Laboratory Association President Julie Khani met with the Trump administration's White House coronavirus task force for the first time in March to discuss the role of labs in scaling up adequate testing capacity. Khani told ABC News, the same three core needs she took into that first meeting remain the same, months later.
"To meet the growing need for testing, clinical labs need consistent access to supplies, adequate and predictable reimbursement and clear guidance to clinicians about who should be tested," Khani said. "At a time when thousands of Americans are dying from COVID-19 each week, we believe it's critically important there is a comprehensive federal strategy in place to support broad access to COVID-19 tests, including coverage of these tests for all Americans -- regardless of their insurance status."
'We have a lot of different levers that we can pull.'
When Biden takes the nation's reins in January, the former vice president's first full day in office will mark exactly one year since the novel coronavirus was first discovered in the United States.
On Monday, Biden announced the members of his coronavirus task force and called for a new pandemic testing board; he pledged to double the number of drive-thru testing sites and invest in "next-generation" testing, including at-home rapid tests.
"There's a need for bold action to fight this pandemic. We're still facing a very dark winter," Biden said. "The bottom line, I will spare no effort to turn this pandemic around once we are sworn on Jan. 20."
His team has not yet specified a dollar amount for their priorities in the testing and contact tracing infrastructure, as planning for that work just now gets underway as part of the presidential transition effort.
"It's a pivotal moment, and I think there's an incredible opportunity to send a serious demand signal, and find creative solutions," Dr. Blythe Adamson, an epidemiologist, economist and former member of the White House coronavirus task force, told ABC News. "Even when the vaccine becomes available to the public, it will take a meaningful amount of time for that to get rolled out. And we will still need tests for a long time."
Giroir, who has led the current administration's efforts on COVID-19 testing, told reporters Monday he didn't see anything in the information about the Biden-Harris COVID task force that's different from what the agencies are already doing on testing.
"I only know what I read in the literature and I haven't seen anything in the testing strategy, quite honestly, that we are not already doing," he said. "We're investing in point-of-care technologies. We have high regulatory authorizations on tap. We're working at all levels of the ecosystem. ... So, again, I haven't seen anything in the literature, or any new idea."
Experts emphasize the importance of "good stewardship of resources" moving forward: deploying the right tests to the right people and places at the right time, and fortifying essential supply chain elements.
"We have a lot of different levers that we can pull," Adamson said. "And my hope is that they pull the ones that work the best first."
A strained system looks ahead
Diagnostic labs and testing industry sources told ABC News that the sting is still raw from delayed test results amid the virus's surge this summer.
And that pain may not be over. On Thursday, Khani warned that the testing demand is rising with new infection waves -- again threatening to put strain on the supply chain.
"With demand for testing surging across the country, ACLA member laboratories are experiencing a significant increase in the volume of COVID-19 test orders. Clinical labs are also facing delays or cancellations on orders for critical supplies, such as pipette tips," Khani said in a statement. "The surge in demand for testing will mean that some members could reach or exceed their current testing capacities."
For a strained system, Biden's indication of further investment is welcome.
"It's absolutely essential that we get a handle on ramping up testing," Dr. David Grenache, president of the American Association for Clinical Chemistry, said. "I can't believe that we're 10, 11 months into this, and we're currently back to where we were this spring and early summer, with cases rising very quickly. And laboratories still have capacity issues."
"For months, it's been every laboratory, every state for themselves, clawing and fighting for access to tests, supplies, everything that we need to perform this critical testing, and we haven't had a national strategy," Grenache continued. "It's no easy task. And it's going to require an incredible amount of cooperation."
The challenge for Biden's administration that many foresee will be confronting the challenge of steering a weary people through the protracted health crisis -- and amid a bitterly divided nation.
"There's opportunity in how much more we understand about the virus and disease progression that will enable science teams to be able to give more practical guidance… even the previous task force didn't have that information," Adamson said. "There was just so much uncertainty. Now we have the opportunity to guide which tests should be used where, now that we're past the point of just diagnosing cases."
Along with shoring up infrastructure, experts emphasize the importance of sustaining a clear public message going forward.
"We need to define our goals," Mina said. "These tests don't care if somebody has symptoms. They only care about whether somebody has the virus."
With clear public messaging, new incentives might be introduced that could motivate widespread testing and help inform our knowledge base, Adamson said.
"Employers could offer their employees testing, with a bulk discount by working with a diagnostic testing vendor to secure a supply for your employees," Adamson said. "Then you use that data to make sure the safety protocols in your workplace work, because you're able to keep a tab on the infections. And so it creates the spillover benefit. It's not just a test informing individual decision making, it fuels surveillance and health intelligence decisions."
For now, the Biden team waits, and plans, in the wings.
"Right now they should be working with manufacturers, and even if there's no formal power at the moment, there's a lot of handshakes that can be made," Mina said. "He has a formidable challenge in front of him. But something like an epidemic like this should be a galvanizing event for the country -- something everyone can rally around in defeating. And we haven't seen that happen yet."
ABC News' Anne Flaherty, Eric Strauss and Sony Salzman contributed to this report.
