Covid Shows the Need for a Diagnostic Stockpile

Congress can meet the current surge in demand for testing and be ready for the next pandemic.

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Health-care workers prepare a Covid-19 test sample in Miami, July 23.

Photo: DAVID SANTIAGO/Associated Press

A surge in demand for Covid-19 tests is straining supplies, and patients have to wait too long for results. LabCorp, which handles about 25% of U.S. Covid testing, is adding more machines and employees and is running 180,000 tests a day, up from a few thousand a week in March. Quest and BioReference Laboratories are also overextended.

The ability to coordinate a surge in testing capacity is essential in a medical crisis. This isn’t the first time an epidemic has put stress on capabilities. In 2015, the mosquito-borne Zika infection strained the ability of public-health and commercial labs to develop and deploy tests, including for asymptomatic patients. Covid is much more widespread, and more testing is required since many with the virus show no symptoms.

Over the next few weeks, Congress will consider legislation to help get through the next phase of the pandemic. Lawmakers can alleviate the current shortages and shore up the ability to respond to future pandemics with adequate testing.

Like ensuring supplies of pharmaceuticals and personal protective gear such as masks, this is a matter of national security. The government already pays manufacturers to ensure a permanent supply of certain medical products. One example is Neupogen, a drug used to reconstitute white blood cells in chemotherapy patients. In a dirty bomb attack, it can treat people whose bone marrow has been poisoned by radiation. The drug’s manufacturer, Amgen, built a network of hardened domestic manufacturing sites. Amgen’s contracts with the feds bake in a margin to support guarantees that supply will always be available.

Similarly, Washington could contract with commercial labs and point-of-care test manufacturers to develop and maintain diagnostic capacity for a crisis. Think of it as part of the national stockpile. Under such contracts, companies would build more labs and sprinkle them throughout the country so capacity could be available wherever it’s needed. Labs usually run very efficiently at 70% or 80% of capacity. Under this arrangement, a facility with 5,000 testing machines might run each of them at 60% capacity, building in room for a surge. The federal government would pay the labs for maintaining the extra equipment and materials.

The federal government could also offer capacity contracts to manufacturers of point-of-care tests to maintain sufficient platforms to use in screening settings, such as workplaces and schools.

For now, Congress should allocate money to buy screening capacity in bulk for the next year. Unlike diagnostic tests ordered by a physician based on symptoms or a known exposure, screening tests are used in broad populations such as workers or students. Such tests generally aren’t covered by insurance. The White House, professional sports leagues, and some businesses can afford to cover the costs, but that isn’t a viable option for public transit systems, schools or other essential businesses. More such screening is also needed in low-income neighborhoods, where infection and death rates are often higher.

Providing advance funding for such large-scale screening would complement the “prizes” offered by National Institutes of Health for developing better and cheaper rapid tests. It would send a strong signal to the companies investing in these areas that there will be demand for their products. More investment in rapid screening options would also reduce the burden on labs. These options might be readily available and as accurate as lab tests by the time the next pandemic arrives.

There’s also unused research-lab capacity that could be converted to run screening tests. These labs aren’t certified to diagnose patients but could be recruited to run pooled tests of a large number of people. Universities are using research facilities to test students. With proper oversight and quality control, these tests could be used in settings where the risk of spread is high but screening asymptomatic people is unrealistic because there isn’t enough capacity to test even those with symptoms.

America’s lack of preparation for the pandemic had devastating health and economic consequences. We can build the capacities to prevent this from happening again.

Dr. Gottlieb, a resident fellow at the American Enterprise Institute and partner at New Enterprise Associates, was commissioner of the Food and Drug Administration, 2017-19. Dr. McClellan is the director of the Duke-Margolis Center for Health Policy at Duke University and was FDA commissioner, 2002-04. They are board members and advisers for several health-care companies.

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Appeared in the July 27, 2020, print edition as '.'