Trump administration eyes new strategy on COVID-19 tests

The Trump administration is eyeing the use of a new strategy that would allow states to dramatically expand their testing capabilities as several areas seek to get coronavirus outbreaks under control.

Public health officials have in recent days discussed the benefits of pool testing, an approach that allows several samples to be tested at once to reduce the time and resources needed to test large groups. Such a strategy could prove helpful to allowing schools to reopen, experts said, and could preserve supplies as states like Texas, Florida and Arizona attempt to rein in spiking case numbers.

Administration officials have been kicking around the use of pool testing, also referred to as batch testing, for some time. But they began discussing it more publicly over the past week.

Deborah Birx, the coordinator of the White House coronavirus task force, discussed the strategy during a conference call with governors Monday, according to two sources on the call. Birx did not explicitly encourage states to adopt pool testing, but informed them of its merits and value.

Anthony Fauci, the government’s top infectious diseases expert, has given multiple interviews over the past week signaling the administration is trying to formulate a pool-based testing approach, while Adm. Brett Giroir, the administration’s designated testing czar, touted this week that pooling samples could help allow the country to conduct up to 60 million tests per month by September.

If health officials are attempting to test 10 asymptomatic people for coronavirus, they can use pool testing to collect samples from each of them, and then test all of the samples at once. If that one test comes back negative, the entire group can be deemed negative without conducting individual tests.

If the test is positive, each individual can be tested separately to determine the source of the positive result.

“This is being done now in many universities and many commercial laboratories, and we are absolutely working with everyone in the community to do this,” Grioir told reporters Tuesday. “It’s not right all the time, but it’s right a lot of the time.”

Pool testing has been used in the past to conduct widespread testing for other viral outbreaks, including HIV. Experts cautioned that pooling too many samples can dilute a positive test and lead to false negatives, making it important to conduct regular testing.

Sen. Marco Rubio (R), whose home state of Florida has reported record-shattering numbers of coronavirus cases in recent days, wrote to Vice President Pence and Department of Health and Human Services (HHS) Secretary Alex Azar on Thursday urging the administration to develop a “nationwide pool testing strategy in the immediate future.”

The senator called for the national strategy to include cost estimates that would allow Congress to allocate funding to ensure pool testing can continue throughout the duration of the pandemic.

“I believe pool testing can be effectively used in schools so that students are able to safely return to the classroom this fall, where they can gain from the well-documented benefits of in-person learning and socialization,” Rubio wrote.

The Trump administration has yet to outline a national testing plan, instead leaving it to states to determine their own course of action. HHS will outline situations where it is most useful for states to conduct pool testing and offer technical assistance on the approach as needed, HHS spokesperson Mia Heck said.

The United States has made significant gains in its testing capabilities since the early weeks of the pandemic, when the federal government struggled to roll out an effective test and procure the resources needed to process samples.

But the country now faces a fresh set of challenges as more than half of states are seeing either an increase in case numbers or an increase in the rate of tests coming back positive. Florida, Texas, Arizona and California alone have accounted for roughly half of the new positive tests in recent days.

Some government officials, including President Trump, have chalked the rising numbers up to increased testing, but Pence, Giroir and others have acknowledged that it is not the lone factor. More Americans have contracted the virus as states loosen restrictions meant to slow the spread of the disease, with people under the age of 35 accounting for a portion of the spikes.

Experts say that pooled testing alone will not be enough to get these new outbreaks under control.

Anand Parekh, who served as deputy assistant secretary at HHS from 2008 to 2015, called the use of pool testing a “promising strategy,” but said at least a few other protocols must be in place to get the surge in cases under control.

Local leaders must be willing to pause reopenings or reinstate restrictions meant to slow the spread, individuals must wear masks and social distance, and health officials must establish testing for asymptomatic individuals and contact tracing, he said.

Leana Wen, a physician and former health commissioner for the city of Baltimore, said pool testing would help address the latter point.

“At this point, though, we can’t just have piecemeal approaches,” she said. “We are long overdue for having a national strategy around testing, which is essential to containing COVID-19 and allowing for safer reopening.”