Deep Dive: Testing

April 16, 2020

The second episode of Path Forward explores the importance of COVID-19 testing to the short-term recovery of the United States. U.S. Chamber of Commerce President Suzanne Clark was joined by experts who shared their perspectives on the importance of swift and accurate COVID-19 tests, the balance of risk-reward when considering an end to the shutdown, and what we can learn from other parts of the world during this time. In this segment, we hear from Dr. Troyen Brennan, executive vice president and chief medical officer at CVS Health, Dr. Alan Wright, chief medical officer at Roche Diagnostics Corporation, and James Bullard, president and CEO of the Federal Reserve Bank of Saint Louis. 

The conversation covered a lot of territory, but there were three big takeaways: 

  1. Testing is critical for a successful reopening because it will give employers, employees and customers the confidence to engage in commerce.  
  2. There is reason to be optimistic about the testing solutions that are being developed, but we have a ways to go when it comes to scaling those tests and figuring out who’s going to pay for them  
  3. The private-sector is going to drive any large-scale testing solution, starting with pharmaceutical companies that develop the platforms and extending to the retailers and others with the distribution network to deliver tests to every corner of the country. 

Importance of testing..

Widespread testing is the key to understanding this virus. The more information we have, especially who is and isn’t infected, the more likely we can operate more normally as an economy.  

From an economic standpoint, the U.S. Government is spending a lot of money to stabilize the ship through the storm. The shutdown is costing us close to $25 billion a day. James Bullard, President of Federal Reserve Bank of Saint Louis, shared one proposal on how we can increase testing to get people back to normal life. This proposal involves the U.S. Government creating a pop-up industry in testing, essentially enlarging the already existing industry, so as to widen the availability of tests for Americans.  

Dr. Alan Wright, Chief Medical Officer at Roche Diagnostics Corporation, touched upon the different types of tests, the logistics for getting results, and its accuracy. There are two main types of tests that are vital to understanding the magnitude of the spread and eventually achieving an end to the economic shutdown. The first test is to determine if someone is infected or not. The polymerase chain reaction (PCR) test detects the nuclear material of the coronavirus and determines if someone has the virus. The second test is to determine if someone has been exposed to the virus in the past. This is called an antibody test. When the body is exposed to the virus, it raises an immune response antibody that can be detected in the blood.  

Can we trust the results? When speaking about accuracy, there are two components to consider: the accuracy precision of the device running the test and the quality of the sample. With PCR testing, throat swabs are more accurate than nasal swabs. Dr. Wright emphasized that coronaviruses are made up of ribonucleic acid (RNA), which is fragile. They need to be handled with certain types of transport media, and if the transport media is not the correct transport media, then the sample can degrade over time. This can lead to a false-negative result. Lastly, while widespread testing is becoming more rapidly available, it is important to note that there is variation in the accuracy precision with the tests that are available in the market today.  

Dr. Troyen Brennan, Executive Vice President and Chief Medical Officer at CVS Health, expressed his eagerness to contribute to the public health crisis. Dr. Brennan emphasized that healthcare workers should be conducting both tests, PCR and antibody, on patients to boost accuracy and reduce the number of false-negative results. CVS believes they can train nurse practitioners, pharmacist, and pharmacy technicians to conduct point-of-care tests at their locations to increase the volume of testing. Point-of-care testing is likely to be the best route because people are going to need results fast if we are only going to allow people who are immune return to work.  

Risk management. 

James Bullard spoke about the impact COVID-19 is having on the economy. With GDP way down, unemployment at roughly 20%, what we do in the second quarter is going to be critical in our recovery. Parts of our society have learned to adapt to the shutdown in certain ways, but we can only do this for a little while longer before it becomes even more detrimental. Better policy is needed to handle this moving forward. Bullard likened the current situation to driving a car down a freeway at 70 mph, then when you get to a construction zone, you must slow down until you can get past the construction zone and you’re free to resume normal speed. We are currently in that construction zone and we have no idea how long it will take to get to the other side.  

In order to increase our chances of a V-shaped recovery, we must get to a high scale of testing by the third quarter. We cannot limp by with half-measures, rather we have to attack the virus directly. Taking temperatures and mandating that everyone wear masks are imperfect substitutes. We must know who has the virus or who has been exposed to it. Waiting 12-18 months for a vaccine with this many healthy people out of work will damage the economy immensely.  

Learning from other countries. 

If there’s one thing for certain, this coronavirus has sparked global learning. Research is occurring around the world, giving scientists and medical staff a great deal of optimism to learn about the virus. With a virus as mysterious as this, we know nothing about contagion and at what point a person with the virus is contagious. No one knows how strong the immunity is going to be, and whether people can be re-infected or not. In fact, we don’t know how long the virus lasts in the body once testing positive. While so many unknowns exist, we can be optimistic that such a steep learning curve can be conquered with the vast number of researchers dedicated to the cause. There are a number of new entrants coming in to develop tests, and while there has never been a vaccine created for a coronavirus in the past, there is always new technology and thus hope. Dr. Wright remains hopeful that a vaccine can be created. 

Global information sharing will be helpful in learning from this virus. Comparing different country reactions, approaches, and results will prove important. We should remain optimistic about innovation and people finding new ways to work. We will recover from this, but the world will look differently. We’ll work differently and various parts of the economy will be affected in different ways.  

Watch the full recording of the online event

Path Forward: Deep Dive: Testing