National Strategy Needed Now More Than Ever
The AAMC (Association of American Medical Colleges) is calling for a coordinated national testing strategy to identify, track, and help curtail the spread of COVID-19, which has already taken the lives of more than 220,000 Americans and more than one million people worldwide.
“Seven months after the onset of the pandemic, COVID-19 cases continue to increase in most states and in the nation’s capital,” said David J. Skorton, MD, AAMC president and CEO. “At the same time, current testing levels for the SARS-CoV-2 virus are inadequate in identifying the actual number of individuals infected and in suppressing the potential spread of the virus in our country.”
The AAMC’s recommendations include:
- A clear and transparent national testing strategy with specific methods to calculate diagnostic and screening testing targets, and a mandate that each state implements the standards the same way;
- Ensuring government action is transparent by detailing each use of the Defense Production Act for testing supplies on a publicly available website; and,
- A functional partnership between the federal government, state health authorities, academic institutions, and industry to fund and accelerate screening and surveillance testing for COVID-19 to be smarter and more effective in the way we use our resources.
As part of a national pandemic response strategy, the AAMC recognizes the need for a rapid and dramatic increase in testing, from the current level of less than one million tests per day to a sustained and regular testing target of as many as nine million people each day based on the current reach of the virus.
Immediate testing needs for a strategic, risk-based testing program include:
Over 800,000 diagnostic tests each day for:
- Each person who is symptomatic; and
- Close contacts of every positive case identified (whether symptomatic or asymptomatic).
Over eight million screening tests each day to:
- Test every person who enters a health care facility for an inpatient admission or outpatient surgery;
- Conduct routine testing of every K-12 teacher, all health care providers in hospital settings, and first responders (including law enforcement officers, paramedics, and EMTs); and
- Conduct a strategic sampling of incarcerated individuals, residents and staff in homeless shelters, and residents in nursing homes and assisted living facilities.
These categories are not exhaustive. Additional testing may be needed for other essential workers and individuals, such as contact tracers, delivery and retail personnel, employees of agricultural and meatpacking businesses, and public transportation employees.
The estimation of testing needs reflects the current status of COVID-19 in the United States. Surges in infection rates or failure to follow recommended public health measures for controlling the virus could increase diagnostic or screening testing needs. High levels of vaccination or improved surveillance testing could decrease the number of tests needed.
These testing recommendations, developed by the AAMC Research and Action Institute, follow the AAMC’s July release of The Way Forward on COVID-19: A Road Map to Reset the Nation’s Approach to the Pandemic, which outline immediate, evidence-based, common sense actions to contain the virus and end the pandemic. At that time, the AAMC noted that 2.3 million tests per day were needed to decrease the rate of positive tests below 3%. The failure to contain the spread of the virus since then has increased the number of tests needed to continue to safely open schools, universities, businesses, and public gathering spaces.
“While testing alone is not sufficient to detect and eradicate COVID-19, there is no question that increasing testing through a national strategy remains a powerful tool against the spread and recurrence of COVID-19,” said Atul Grover, MD, PhD, executive director of the AAMC Research and Action Institute. “Only a national collaborative strategy involving the federal government and other public and private stakeholders focused on accelerating testing can help the country achieve an adequate testing capacity in a manner that is rapid, scalable, and equitable.”
The testing recommendations and call to action issued by the AAMC Research and Action Institute today were authored by Heather Pierce, JD, MPH, AAMC senior director for science policy and regulatory counsel, and Ross McKinney, Jr., MD, AAMC chief scientific officer, with input from AAMC staff and national policy and testing experts.
Today’s recommendations are a companion piece to the recently released AAMC Guide to COVID-19 Tests and Testing, a practical review of different types of tests and why and when to use each test. From diagnostic tests to wastewater surveillance and everything in-between, the guide is the first stop in untangling the complex issues of COVID-19 testing.