NEJM: Failing the Test -- The Tragic Data Gap Undermining the U.S. Pandemic Response

As the United States navigates one of the most serious pandemics in history, much of the country has been shut down to prevent devastating local outbreaks that threaten lives and can overwhelm hospitals. A breakdown in the federal disaster response delayed state and local responses, allowing SARS-CoV-2 to spread rapidly in New York, New Jersey, Michigan, Louisiana, and other states. Only astute early interventions in Seattle and the San Francisco Bay Area seem to have stemmed a potential tide of cases and deaths. Covid-19 has taken more American lives in 1 month than the Vietnam War claimed over 8 years. Other countries, such as Australia, South Korea, Germany, Singapore, and Taiwan, managed to contain the virus early and are working hard to keep it suppressed as they reopen their economies.

...................

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. Drugs and vaccines are extremely unlikely to alter the early course of the pandemic. In the short term, only NPIs have slowed the spread of disease. Yet NPIs carry a heavy economic price as well as their own health burdens, as people fail to receive care for other conditions or suffer mental health consequences from isolation, unemployment, and sudden poverty. Whether NPIs are maintained or not, serious health consequences appear inescapable.

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. The most recent congressional rescue package featured $25 billion for testing.

the rest:
https://www.nejm.org/doi/full/10.1056/NEJMp2014836