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How the U.S. can get coronavirus testing where it needs to be

As summer comes to a close, the United States is averaging about 830 coronavirus deaths per day, along with tens of thousands of new cases. Although testing for the virus has improved, problems with access and obtaining expedient results persist. But Dr. Atul Gawande of Brigham and Women’s Hospital has a plan for how testing can be improved. He joins Amna Nawaz to discuss.

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  • Amna Nawaz:

    As the summer comes to a close, and fall begins, experts worry flu season could further complicate the pandemic response. In the U.S. today, there are about 830 COVID-19 deaths a day, and nearly 20,000 more cases per day than when the Memorial Day weekend started.

    Since then, the overall death toll has grown by nearly 90,000. Now, testing has improved, but problems with access and delays continue.

    Dr. Atul Gawande of Brigham and Women's Hospital examines our country's testing system in his new piece for The New Yorker. And he offers a plan for how he says it can be fixed.

    Dr. Gawande, welcome back to the "NewsHour."

    You deliver a message a lot of people want to hear right now, which is that we can control the pandemic soon, before the flu season, if we want to, and it will take a nationwide commitment, you say.

    And you focus in on one thing called assurance testing. You say that is crucial to making this happen. What is assurance testing?

  • Atul Gawande:

    Well, what it is, is the kind of testing that you see that the NBA is doing. It's being able to screen people to say, are you safe to work with in environments where we can't wear our masks, we can't socially distance?

    Assurance testing is testing to assure that we can live together and work together. And that's going to be an important part of what we have to be able to do.

  • Amna Nawaz:

    So, it's really regular, much more widespread testing than we have right now, because, right now, the process is, you make an appointment. Sometimes, you wait days for that. You maybe have to pay the provider. You wait days for the results.

    There's problems at each step along the way I want to ask you about. Start with how we're testing. And, right now, there is sort of a patchwork of testing technology. There's the nasal swabs we have all seen. There's antigen tests. There's these at-home test collection kits hitting the market now.

    Is that patchwork going to work, if we're going to get our arms around this very soon, as you say we can?

  • Atul Gawande:

    Well, what is cool is that American innovation is bringing a whole emporium of different kinds of capabilities to the table.

    And we have a lot of laboratory capacity that has grown up. But so much of it is untapped. It's not being delivered to the places that we need.

    So, I think the technology is great, but we don't have a technology problem. We have an implementation problem. I name a number of labs that would double the amount of capacity we have today for just making sure that — you know, forget being able to test whether everybody is safe for working together.

    We can't even test people to make sure that the sick people are getting tested in a consistent, timely and easy way. And that's the dysfunction of our health system and our implementation system.

    We can — there is enough capacity. We can bring it to the people who need it, and we can make it work. But it depends on understanding that this is the problem we have to tackle. And then we have to want to. We need our leaders to want to take that on.

  • Amna Nawaz:

    You mentioned the labs and the processing of those tests. That is a major choke point in the process right now.

    There's basically four big commercial labs that kind of dominate all of this, Quest Diagnostics, LabCorp, BioReference Laboratories and Sonic Healthcare. You mentioned there are a bunch of available labs that aren't brought online as part of this process.

    How does that happen?

  • Atul Gawande:

    The majority of U.S. testing is by a very small number of labs that have not just the laboratory capacity; they have the logistics.

    They can do the billing in our crazy system that has different people paying for different this insurer and that insurer, Medicaid, paying for each part of it. They can do the — make sure that there's the right bar codes on the samples. They have the software systems.

    But there are dozens, really hundreds of labs that have capacity that would be willing to bring that to bear. You know, think about it. Korea, in the first week of approving capacity for labs, had 47 labs online.

    We have three or four national labs that are the dominant source of U.S. testing, when we actually have scores to hundreds that are ready to bring that capacity forward. And the problem is that, again, it's not technology. You have to make sure that all of the connection points are there.

    It's basic public health: Match the need to the capacity that's there and create the interlinks between them. We have had a few places that have done that. For the most part, though, we have not taken that on nationally.

  • Amna Nawaz:

    You mentioned insurance, which has also been a major source of confusion for a lot of Americans, because most people aren't clear on whether or not they should be paying or have to pay to get tested in the first place.

    Without completely revamping the insurance system, how does that part of this get solved quickly?

  • Atul Gawande:

    Well, I will get — I will point to the example of San Francisco.

    San Francisco was one of the first hit, and then they stood up a rapid testing capacity. They opened nine sites that were ones where the city would pay for it. They didn't try to do all the complex and very expensive billing process. They negotiated lower prices. They made sure that they were able to get great service.

    And they got, you know, turnaround times that were, on average, overnight results back. And the result was that two-thirds of all the testing in the city ended up coming through this public option. And it's been a key to the fact that San Francisco has had some of the lowest rates of transmission across the United States and consistently have been able to keep it that way.

  • Amna Nawaz:

    Dr. Gawande, I mentioned at the beginning of our conversation, the message is one a lot of people need to hear, that there is a way to get our arms around this, and not have the flu season make the pandemic even worse for millions of Americans.

    But you mentioned the leadership, that it will take a kind of national leadership to pull this off that we haven't seen so far in the pandemic. So, is there a way this plan gets put into place in the absence of federal leadership?

  • Atul Gawande:

    It is very hard, but I am encouraged by things like, there is a compact of 10 states that have committed to work together to access low-cost rapid tests and buy together, work together, basically a confederation of states to make sure that they're serving the common interests.

    That's what the federal government is here for. But in the absence of that leadership, they're building those connections, so that, this fall, they're not ending — trying to outbid one another for ventilators and tests and masks, et cetera, but instead are working together to make it happen.

    And I hope that we are able to get all of the states working together to join that kind of confederation. It's what the national government needs to be doing.

  • Amna Nawaz:

    The message I think a lot of people would welcome right now.

    That is Dr. Atul Gawande from Brigham and Women's Hospital in Boston, Massachusetts.

    Thank you so much for your time.

  • Atul Gawande:

    Thank you.

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