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200 Million Monthly COVID-19 Tests Needed in US, Report Says

NEW YORK ─ To open safely and in stages, a US nationwide screening strategy will require about 200 million tests each month for students and staff at the nation’s primary and secondary schools, as well as residents and staff at nursing homes, according to a report released on Wednesday.

The report, titled A National Decision Point: Effective Testing and Screening for COVID-19, was produced by Duke University’s Margolis Center for Health Policy, based in Durham, North Carolina, with funding from New York-based Rockefeller Foundation.

Its objective is to provide schools, businesses, and other institutions with "a pathway toward operating safely even for higher-risk populations with continuing community spread," according to its authors.

Few institutions have broadly accepted plans for reopening safely, they noted, adding that the best methods to return to "some form of normalcy are effective masking and distancing measures to mitigate spread" and "sufficient COVID-19 tests paired with sophisticated strategies for their effective use."

Between 30 percent and 60 percent of COVID-19 cases are transmitted by people carrying the virus without any symptoms, putting those around them at risk of infection and transmission, the authors noted, citing a study published in Clinical Infectious Diseases.

"Screening holds the potential to protect nursing homes, reopen schools, and detect and contain outbreaks in at-risk work and community settings," they said.

According to the authors, a testing strategy should include four basic elements in order to contain outbreaks: assessment of the risk of infection and death depending on the local spread and population characteristics; meaningful and measurable goals for the reduction of infection through screening and surveillance; calculation of budgetary and administrative limitations; and adequate supplies of reliable tests.

The authors noted that the last point has "long been a critical concern" and though supply and other constraints have limited COVID-19 testing to symptomatic and essential workers, limitations on testing are changing with the development of rapid and low-cost tests for regular screening.

They used modeling techniques and local data about COVID-19 infections to conclude that a nationwide screening strategy would require about 200 million tests each month for students and staff at the nation’s primary and secondary schools, and residents and staff at nursing homes to open safely and in stages.

"Even if infection rates decline, the testing needed in just schools and nursing homes exceeds the nation’s entire capacity now," the authors said.

Currently, fewer than 25 million COVID-19 tests are reported monthly in the US, but that gap can close with a growing number of new rapid tests expected to enter the market over the next few months, the authors said, adding, that based on expected market entry plans that have been announced by manufacturers, point-of-care tests will rise to at least 70 million tests per month in October and could rise to almost 200 million tests per month by January.

To date, four such rapid tests, which rely on the detection of protein antigens, have received Emergency Use Authorization from the US Food and Drug Administration. The manufacturers of these tests are Quidel, Becton Dickinson, LumiraDx, and Abbott. However, other firms, including Roche, Qiagen, and Orasure Technologies, have said they plan on launching similar tests soon.

Additional growth is possible if more tests enter the market, additional capacity for research laboratories is recruited and supported, and manufacturers invest further to increase supply, the authors of the report said. "To get this done, the federal government must provide more guidance [and] assistance and advance funding to manufacturers and payors and should take further steps to coordinate these efforts with state and local governments," they added.