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America's Lag In Expansion Of Coronavirus Testing


We're going to spend some time now looking at the issue of testing and why it's been so hard to get as many tests as needed to medical professionals and the public in the United States. Robert Baird wrote about this for The New Yorker in a recent article titled "What Went Wrong With Coronavirus Testing In The U.S." And he's with us now.

Robert Baird, welcome. Thanks so much for joining us.

ROBERT BAIRD: Thanks for having me.

MARTIN: So did I frame this correctly, just to start with? Is that the core of the issue - that there just aren't as many tests as needed for the public?

BAIRD: Yes, it's certainly one of the major problems. But it's probably worth clarifying what the point of the testing was in this early phase. So in the early days of the epidemic, there was never an expectation really among any public health authorities that everyone would be able to get a test. That's not how the system is designed.

What we want in those early parts of the epidemic is really to be able to do what's called disease surveillance, where you're tracking the spread and the rate of spread of the disease. Then you're using tools like contact tracing and isolation and quarantine to really figure out, you know, if you can stop the disease before it gets to the levels that we're seeing now.

MARTIN: So you explain that the first misstep started with the CDC, the Centers for Disease Control. What happened?

BAIRD: So, you know, basically what happened was very early on, the CDC, along with a number of other groups around the world, was able to develop a working test for what we now call COVID-19. What happened, though, was on February 5, the CDC sent out about - a little more than 50 kits to a group of public health laboratories. And when the public health labs tried to verify these kits, they found that they were getting inconclusive results. And so the test was not working the way it was supposed to.

MARTIN: So, first of all, there was this three-week delay because the CDC didn't get working test kits into the hands of the public health labs. And that just came at exactly the wrong time. Is that about right?

BAIRD: That's correct. Yeah. One way to think about it is that there's sort of three phases of testing. So in the very earliest, earliest phases, the CDC alone is doing tests. And one thing to say is that the test the CDC developed, as far as we know, has always worked at the CDC. But they have a very small capacity for testing relative to what we need. The second phase was the phase done by these public health laboratories.

And then the third phase of testing is the phase that we're in now, where large commercial manufacturers are producing tests in the tens and hundreds of thousands and even the millions. And that's the phase where you can start to think about, OK, maybe we'll try to get testing for everybody.

MARTIN: I think the question that a lot of people would have is, given what we know now about our systems for getting tests created and disseminated, is there something that should be changed?

BAIRD: Yes. I mean, certainly, there are a number of things that should be changed. One of the biggest things that we'll have to change, I think, is rethinking a system that really depended on the CDC to get things right. So Keith Jerome, head of the University of Washington virology lab, said that the dependence on the CDC really created what he called an agriculture - monoculture. So, essentially, we're depending on one single point to get it right.

And the CDC, to its credit, had been so good in past epidemics that everybody just sort of trusted that that would work. It was never seen that this might be a point of failure. But now, we've learned that that, in fact, can fail.

And so what we need to do is we need to make sure that when a new epidemic comes along, we're not relying on the CDC, as good as it is and as good as it can be, to provide our only source of testing. We need to make sure that there's a broader array of things possible for us to do.

MARTIN: Just to sum it up, so, Robert, yes, there were some logistical failures that could have worked better. But part of it is the uncertainty and people not managing people's expectations correctly. People are told they should probably get a test. They don't really know what to do. And if they can't get a test, then they panic.

BAIRD: That's absolutely the case, yes. I mean, when the president tells people, if you want a test, you can get a test, it really sends the wrong message to the American people, especially at a time when the system was not capable of providing those tests. You know, right now, public health authorities are really telling people, don't go get a test unless you really, really need one. And that means that you've been told by your health care provider to go seek a test.

MARTIN: But the tests would have been helpful - right? - in figuring out the course of this thing, wouldn't it? I mean...

BAIRD: They absolutely would have, but let's think about who they'd be helpful for. So at a individual level, you know, if I think that I'm sick, I might think that it's helpful for me to know whether or not I need a test.

But really, at the phase where the problems emerge that we're talking about, those tests are mostly helpful for epidemiologists and other public health officials to see the spread of the disease. They need to use that testing capacity to be able to monitor the country and figure out, where do we have hotspots? Where do we have people who might have been exposed to the disease, people who we need to ask to quarantine themselves?

MARTIN: That's Robert P. Baird. He's a contributing writer for many publications, including The New Yorker. We're talking about a piece that he wrote titled "What Went Wrong With Coronavirus Testing In The U.S."

Robert Baird, thanks so much for talking to us.

BAIRD: Thanks for having me. Transcript provided by NPR, Copyright NPR.