Tragically, the United States, unable to match other countries’ response, has tallied the most cases and deaths in the world — and recent data suggest that those tallies are underestimates. Why has the U.S. response been so ineffectual? One key answer is testing, which has been a cornerstone of Covid-19 control elsewhere. U.S. testing to identify people infected with SARS-CoV-2 has been slow to start and to this day has not sufficiently ramped up.
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Having failed to test early enough to contain outbreaks, the country has fallen back on two mitigation strategies: accelerating drug and vaccine development and an unprecedented strategy of nonpharmacologic interventions (NPIs) involving draconian school and business closures, stay-at-home orders, and physical distancing.
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Without testing, the response will continue to fall short. Shortages of test materials have forced a narrow local testing strategy dedicated to managing the care of hospitalized patients and preventing health care workers from transmitting Covid-19. As state government officials and business leaders search for an exit from NPIs and study the success of other countries, they are realizing that testing, contact tracing, and isolation of people who test positive will be essential to successfully reopening economies.
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That the United States is failing such a simple test of its capacity to protect public health is shocking. Collecting and reporting public health data are not rocket science.
