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Why is the U.S. still struggling to test everyone who needs it?

Since the earliest days of the coronavirus pandemic, public health experts have emphasized that having an efficient system for wide-scale testing was key to bringing the COVID-19 outbreak under control. But in reality, virus testing in the United States has consistently missed the mark. William Brangham talks to Dr. Jennifer Nuzzo, an epidemiologist at Johns Hopkins Center for Health Security.

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  • Judy Woodruff:

    Public health experts continue to say that wide-scale virus testing is key to bringing the pandemic under control.

    And yet, as William Brangham reports, testing in this country has consistently missed the mark.

  • William Brangham:

    That's right, Judy.

    Six months into this pandemic, and we still cannot test everyone who needs a test. On Monday, a New Orleans testing site opened at 8:00 a.m., but had to close minutes later, because the line was so long.

    In Sacramento, California, five testing centers were closed in hard-hit areas. They'd run out of supplies. In Arizona, the state with the highest number of new cases nationally, people waited in their cars for eight hours in the sweltering heat to get a test.

    While the U.S. has ramped up testing considerably — the country ran 15 million tests last month — by all measures, we are still falling short.

    To help us understand more about all this, I'm joined now by Dr. Jennifer Nuzzo. She is an epidemiologist and senior scholar at Johns Hopkins Center for Health Security.

    Dr. Nuzzo, great to have you back on the "NewsHour."

    Help us understand why we are seeing these shortages. Is it demand? Is it equipment? Is it supplies, manpower? What is it?

  • Jennifer Nuzzo:

    Well, we think it's likely all of the above.

    The situation that we're now in is probably different from where we were in March, when testing was severely constrained. Initially, then, it was a problem with rolling out test kits to public health laboratories and then initially private labs.

    What we're seeing now is, there are many more laboratories who are participating in testing efforts, but the demand has outpaced of supplies that they have, and, also, they're having a really hard time sourcing the things like the chemicals that they need in order to perform the tests.

    But the truth is, we haven't actually done sort of a national assessment of what the testing bottlenecks are. And that's really important for us to do in order to figure out how best to solve them.

  • William Brangham:

    Wait. Months into this process, we still haven't done a real diagnostic of where those hiccups are?

  • Jennifer Nuzzo:

    No, we haven't.

    And, mostly, the approach to testing in the U.S. has been, let every state or in some cases every city figure it out themselves, which has been really inefficient. And it's been — basically put a situation where you have 50 states competing against each other for access to the same supplies that they all need.

    That's really no way to run a national response. And particularly since this is a global response, we also have states and cities basically competing against other countries for the exact same materials.

  • William Brangham:

    Could you remind us again why testing is such a central tool in epidemic control?

  • Jennifer Nuzzo:

    Yes.

    So, testing is the process by which we find cases. If you're infected, we won't know if you have COVID-19 unless you get a test. And particularly with this virus, it's very difficult to just diagnose on symptoms alone.

    Some people never develop symptoms. And so a test is important to understand who has the infection and who doesn't. And that information is the critical start of a process that should lead to isolating people who have the infection, so that they don't transmit it to others.

    But if we don't know who has it, then we can't intervene to stop the spread of the virus.

  • William Brangham:

    The other thing that we have been seeing is delays in people getting their results.

    I have been looking at the — some of the big labs, like Quest Diagnostics. They have been — every week, it seems like, they make an announcement that the quick — the turnaround of the results goes from a couple of days to four to five days to five to six days.

    Why does that delay matter in this process?

  • Jennifer Nuzzo:

    Delays are really unfortunate.

    First of all, we need to know as soon as possible when people are infected, so that we can know who needs to be isolated and not be out and about spreading their infection. If people don't find out until a week or more later whether they have the virus, then they may not know to stay home.

    That doesn't then give us enough time to try to find people who they may have exposed. That's a process called contact tracing. We need to go out and find people who may have been exposed to the virus and tell them, so that they, too, can stay home, so — until we know for sure that they're not contagious.

    But that process can't happen unless we get timely test results back. And, in some cases, we're hearing that it's taking multiple weeks for people to get their test results back. That basically means that everyone they have exposed likely has already developed an infection and is potentially contagious and exposing others.

    So we're really missing critical opportunities to slow the spread.

  • William Brangham:

    Lastly, on a somewhat different issue, the president has kept arguing that it's only because we are testing so many people that we are seeing so many cases, the implication being that it's only because we're looking more that we're finding more cases, and that — so that the rising number of cases is actually a good sign that we're diagnosing more cases.

    How accurate is that?

  • Jennifer Nuzzo:

    Well, it's not accurate.

    It's true that the United States is testing more people than we have ever tested before. But one of the metrics that we look at is the percentage of tests coming back positive.

    And the fact that that percentage is rising tells us that we are finding more infections because more people are getting sick. If finding more cases was just an artifact of surveillance, we would expect to see positivity stay about the same or decrease.

    But what we're seeing is surging positivity in states across the U.S. And it's really alarming, because it means that they, despite efforts to expand testing, will have to do even more testing to cast a net and find those infections.

  • William Brangham:

    All right, Dr. Jennifer Nuzzo of Johns Hopkins University, thank you very much.

  • Jennifer Nuzzo:

    Thanks for having me.

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