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Rockefeller Foundation Presents COVID-19 National Testing Plan

NEW YORK – The Rockefeller Foundation on Tuesday published a national COVID-19 action plan that called for a significant ramp-up in testing, an expansion of contact tracing, a public-private testing technology accelerator, a national initiative to rapidly expand and optimize the use of lab capacity, and a testing data commons and digital platform to track COVID-19 statuses, among other things.

The plan was created by experts in science, industry, academia, public policy, and government to create a pragmatic and data-driven strategy to protect the health of Americans and get the country's economy back on its feet, the foundation said. This would be the largest public health testing program in American history, and its success would depend on the active engagement of the government, the public, and businesses across the country.

The first step is a rapid and significant expansion in testing to 30 million tests per week over the next six months, the foundation said. This "1-3-30 Plan" would be achieved by creating an Emergency Network for Covid-19 Testing (ENCT) to coordinate and underwrite the testing market, launching an eight-week National Testing Laboratory Optimization Initiative to increase output to 3 million tests per week from the current 1 million, and investing in a Testing Technology Accelerator to further grow US testing capacity from 3 million to 30 million tests per week.

Although there was a steady increase in testing in the US in February, that has now plateaued, the foundation said. During the first two weeks of April, the US averaged 143,000 tests per day, or about 1 million tests per week, with no appreciable upward trend. Current barriers to rapid increases include uncertainty over financing and payment, lack of coordination among local, state, and national purchasers, uneven distribution of test kits, severe shortages of reagents, regulatory barriers, and a lack of staffing.

In order to overcome these problems, the ENCT will work with producers of testing equipment, reagents, and other lab consumables, as well as purchasers, funders, and financial institutions to identify and resolve choke points in the supply chain, and to undertake an analysis of testing for workplace monitoring and early detection of COVID recurrences.

"This increase will depend on realizing and rolling out the best mix of new technologies for higher efficiency laboratory testing, point-of-care office testing, and home-testing," the foundation also noted. "In addition, some of this increase can be achieved through process efficiencies and lab techniques such as batch sampling. The powers of the Defense Production Act may will be need to be invoked given the inherent commercial uncertainties in this tenfold production increase."

Step two of the plan would be to launch a COVID community healthcare corps for testing and contact tracing, according to the foundation. The number of tests needed to successfully prevent recurrent outbreaks while allowing some relaxation of social distancing will depend on the vigilance of contact tracing. 

"With the kind of high-precision contact tracing used in South Korea, just 2.5 to 5 million tests per day would be required. With the imprecise tracing of a country like Taiwan, 30 million tests per day would be needed — a level far beyond present capacities," the foundation said.

About 100,000 to 300,000 people would be needed to administer tests and undertake contact tracing, and they would have to be supported by computer systems networked with regional and national viral datasets, and electronic health records from local hospital systems.

The plan also calls for a national health system to be created to track COVID-19 health statuses, and the adoption of digital apps accompanied by privacy-protected tracking software to make contact tracing more complete.

"Policy makers and the public must find the balance between privacy concerns and infection control to allow the infection status of most Americans to be accessed and validated in a few required settings and many voluntary ones," the foundation noted. "Whenever possible, incentives should be used to nudge the voluntary use of these apps rather than require them."

Finally, the plan's third step would be to create a COVID-19 data commons and digital platform that would allow for real-time analyses of resource allocations, disease tracing results, and patient medical records, enabling policy makers and researchers to make the best use of available testing resources, identify potential recurrent outbreaks, and find the most promising treatments.

This effort would support recent collaborations of the US Department of Health and Human Services with leading data technical firms to develop an integrated, real-time data platform so that testing levels can be aligned at regional levels with illness burden, the foundation said. This platform can enhance procurement, distribution, and deployment of tests as they evolve in quantity and function. It should also enable state and local authorities to track testing results and capacities to identify shortages.

In a note to investors, Evercore ISI analysts Vijay Kumar, Josh Schimmer, and Luke Sergott said that the foundation's plan could cost more than $100 billion for the first year, assuming a reimbursement rate of $100 per test. They also noted that hiring 100,000 to 300,000 people to do contact tracing would cost another $4 billion to $12 billion, and that this doesn't yet take into account the incremental overhead costs of setting up drive-in test centers, buying personal protective equipment, and administrative costs, among other things.

But considering that the US economy loses about $350 billion to $400 billion each month that it's shut down, a $100 billion price tag for a plan to get it back up and running "is well worth the effort," they added.