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Speaker 1: Hi, I'm Carol Masser and I'm Jason Kelly. It's time

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Speaker 1: for this week's cover story. Well, Carol, we're still at

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Speaker 1: the earliest months away from a working, widely available vaccine.

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Speaker 1: Until then, rapid COVID night teen tests could help close

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Speaker 1: the gap between normalcy and where we are right now. Yeah,

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Speaker 1: it's pretty simple, Jason. If Americans want to safely send

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Speaker 1: kids to school, go to a restaurant, travel somewhere, or

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Speaker 1: even host a holiday party, well, the United States needs

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Speaker 1: to test a lot more people and a lot faster. Faster,

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Speaker 1: cheaper testing which several companies are working on, may not

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Speaker 1: flag every new case of COVID, but that shouldn't mean

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Speaker 1: we should settle for the status quo that's right. At

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Speaker 1: the minimum, a new approach to testing might allow us

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Speaker 1: to enjoy a semblance of our normal lives. Coronavirus testing

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Speaker 1: could even become a habit. If not like brushing your teeth,

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Speaker 1: then at least like flossing. Check it out. If your

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Speaker 1: preferred climate as business friendly, check out Ohio with zero

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Speaker 1: presents taxes on corporate income, R and D investments, and

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Speaker 1: good sold out of state, Ohio was better for business

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Speaker 1: because Ohio was a built for followers. They're building for

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Speaker 1: leaders Ohios for leaders dot com. We can still pass

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Speaker 1: this test with the seasons changing and a vaccine a

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Speaker 1: ways off. The US needs to dramatically improve its infrastructure

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Speaker 1: for rapid COVID testing. It's got options by Drake Bennett

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Speaker 1: and Michelle fay Cortes. As undergraduates returned to the University

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Speaker 1: of Arizona for the fall semester, many of the new

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Speaker 1: precautions were hard to miss. Plexiglass dividers were affixed in

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Speaker 1: front of lecterns and between lab benches. Giant tents were

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Speaker 1: set up so students arriving early for a class could

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Speaker 1: wait outdoors, sheltered from the punishing sun. Roving teams of

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Speaker 1: student health ambassadors tooled around in golf carts, handing out

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Speaker 1: masks and politely chiding their peers for standing less than

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Speaker 1: six ft apart. But the first thing students had to

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Speaker 1: do was visit one of the university gyms for a

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Speaker 1: rapid stars cove to test. The results took an hour

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Speaker 1: negative and you could move into your residence hall right away.

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Speaker 1: Positive and you were sent to a special isolation dorm

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Speaker 1: where you spent the next ten days taking classes online.

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Speaker 1: Many of these safety measures emerged from discussions headed by

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Speaker 1: Richard Carmona, a former U S Surgeon General who is

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Speaker 1: a professor of public health at the university. Carmona's medical

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Speaker 1: career stretches back to the Vietnam War, where he served

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Speaker 1: as a Special Forces medic after dropping out of high school.

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Speaker 1: Over the years, he's developed an expertise in emergency preparedness

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Speaker 1: and disaster response. As news of the novel coronavirus began

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Speaker 1: making its way out of China last winter, the university's

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Speaker 1: president asked Carmona to form a working group and propose

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Speaker 1: ways to keep the institution functioning during a pandemic. The

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Speaker 1: question was what were the metrics were going to look

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Speaker 1: at and how are we going to be able to

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Speaker 1: make a reasonable determination that this is somewhat safe. Carmona says,

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Speaker 1: we didn't have a playbook for this. Nobody had a playbook.

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Speaker 1: In early spring, the team reached out to Ian Pepper,

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Speaker 1: an environmental microbiologist on the faculty who had experience with

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Speaker 1: wastewater testing. It used to be called sewage surveillance, says Pepper.

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Speaker 1: Now the preferred term seems to be wastewater based epidemiology.

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Speaker 1: The technique traditionally has been used in population level studies

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Speaker 1: of illegal drug use or viral infections. Carmona's team, however,

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Speaker 1: wanted to go upstream from the treatment plant to determine

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Speaker 1: not just if the coronavirus was on campus, but where

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Speaker 1: the sampling would provide an early warning system. People ill

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Speaker 1: with COVID nineteen can start shedding the virus in their

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Speaker 1: stool as many as seven days before showing symptoms. That

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Speaker 1: gives you seven precious days for intervention, Pepper says. Over

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Speaker 1: the summer, Carmona poured over university blueprints with the facilities department,

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Speaker 1: tracing decades old sewage pipes back to the dorms they drain,

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Speaker 1: while Pepper worked on filtering samples and identifying trace amounts

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Speaker 1: of the virus. By the time students returned in August,

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Speaker 1: the program was in place each morning at eight thirty,

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Speaker 1: an hour chosen to give residence a chance to visit

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Speaker 1: the bathroom. A faculty engineer working with an underground assistant

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Speaker 1: would make the rounds at each stop, prying off a

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Speaker 1: manhole cover and lowering an open nalgene water bottle at

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Speaker 1: the end of a long aluminum pole into the river

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Speaker 1: of waste below. The pair would place the samples in

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Speaker 1: a cooler and drive them back to the lab, where

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Speaker 1: Pepper's crew would turn around the results by the afternoon.

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Speaker 1: On Tuesday, August twenty fifth, a week and a half

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Speaker 1: after students started to return, Pepper got his first positive

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Speaker 1: from the pipe, leaving a dorm called Lichens Hall. The

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Speaker 1: next day, all three hundred and eleven Lichens residents took

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Speaker 1: COVID tests. Two students, both without symptoms, came back positive

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Speaker 1: and were relocated to the isolation dorm. Thanks to the

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Speaker 1: head start, no other residence would contract the virus. Since then,

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Speaker 1: the university has stemmed outbreaks in at least eight other

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Speaker 1: dorms using the same method. Pepper is scaling up his lab,

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Speaker 1: training more teams of samplers, and expanding the effort to

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Speaker 1: off campus apartments and Greek houses. He's fielding requests from

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Speaker 1: around the world for help setting up similar programs. Carmona,

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Speaker 1: for his part, is careful not to get ahead of himself.

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Speaker 1: It's a tool that's just evolving, he says, But we

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Speaker 1: see value. Ever since the novel coronavirus began circulating in

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Speaker 1: the US, the country's response has been crippled by a

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Speaker 1: failure to see the spread in anything close to real time.

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Speaker 1: Half a year after the first wave of US lockdowns,

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Speaker 1: with more than two hundred thousand Americans dead from COVID,

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Speaker 1: we're still playing catch up. The Trump Administration's botched rollout

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Speaker 1: of its first tests and the supply chain shortages that

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Speaker 1: followed helped the disease spread unchecked. Today, processing bottlenecks still

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Speaker 1: render many test results worthless by the time people get them.

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Speaker 1: This blindness has left public health officials only the crudest

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Speaker 1: measures of containment, such as braw add social distancing mandates

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Speaker 1: and lockdowns. It's turned the loosening of restrictions on restaurants,

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Speaker 1: sports offices, gems, and schools into terrifying leaps of faith,

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Speaker 1: and it has surely killed people. The testing we are

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Speaker 1: doing today is mostly just keeping score for the virus.

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Speaker 1: Since William Hannage, an epidemiology professor at Harvard, even that

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Speaker 1: grim framing gives the u S system too much credit.

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Speaker 1: The Centers for Disease Control and Preventions sampling of Americans

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Speaker 1: with stars COVE two antibodies shows that the true number

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Speaker 1: of infections is as many as seven times higher than

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Speaker 1: the official count. Over time, though, the problem of testing

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Speaker 1: has attracted new focus, new thinking, and new money. Experimental

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Speaker 1: viral screening technologies have taken big steps forward, and researchers

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Speaker 1: have found ways to retool existing procedures. Some of that

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Speaker 1: work isn't likely to pay off in time to change

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Speaker 1: the course of the pandemic, but some of it already has,

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Speaker 1: and the outbreak's global scale has rd epidemiologists and policymakers

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Speaker 1: to seek better answers to fundamental questions about the management

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Speaker 1: of a modern plague, not only how to test, but

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Speaker 1: whom to test and why. Those debates are particularly vital now.

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Speaker 1: The number of new US COVID cases, which peaked this

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Speaker 1: summer before dropping significantly, is climbing again. The c d

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Speaker 1: c's seven day moving average rose from thirty four thousand,

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Speaker 1: three D seventy one on September twelve to forty four thousand,

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Speaker 1: three D seven on September Colder weather and classroom reopenings

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Speaker 1: threatened an explosion of cases at a time when the

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Speaker 1: public has tired of social distancing's heavy costs, and we're

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Speaker 1: still at the earliest months away from a working, widely

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Speaker 1: available vaccine. Until then testing can help close the gap

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Speaker 1: between normalcy and where we are. If Americans want to

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Speaker 1: safely send kids to school, eat in a cafe, go

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Speaker 1: to a basketball game, or get on a plane, the

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Speaker 1: US needs to test a lot more people, a lot faster, faster, cheaper.

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Speaker 1: Testing may not flag every new case of COVID, but

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Speaker 1: that shouldn't mean settling for the current level of blindness

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Speaker 1: with its tortuous drip of preventable deaths. Even world class

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Speaker 1: testing won't rid us of the virus, but it can

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Speaker 1: allow us to live our lives in the meanwhile. Well

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Speaker 1: before this year, the US had ample warning about the

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Speaker 1: health care system's vulnerability to a pandemic. An industry long

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Speaker 1: kept as lean as possible, lacked the personnel and hospital

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Speaker 1: beds needed to respond to a national crisis, let alone

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Speaker 1: the protective gear and ventilators. The coronavirus requires. Testing was

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Speaker 1: the one thing the US had supposedly handled. The c

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Speaker 1: DCS early warning system for epidemics, based on reports from

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Speaker 1: medical professionals all over the country, was designed to spot

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Speaker 1: new diseases in time to head off bigger problems, and

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Speaker 1: the technology to create tests for new viral diseases is

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Speaker 1: so straightforward. It can really be done in a few days.

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Speaker 1: When the time came, though, the apparatus worked against itself.

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Speaker 1: After its Chinese counterparts published stars Cove two's genetic sequence

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Speaker 1: on January eleven, the CDC did indeed create its own

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Speaker 1: test in a matter of days, but because of regulatory

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Speaker 1: requirements and limited access to the relevant viral samples, the

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Speaker 1: agency's Atlanta headquarters was the only place it could be done.

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Speaker 1: In early February, the CDC produced tests that state labs

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Speaker 1: around the country could use, but they were faulty and

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Speaker 1: returned in conclusive results. Public and private clinical labs rushed

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Speaker 1: to fill the void, only to be stymied by the

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Speaker 1: Food and Drug Administration, which demanded extensive data and a

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Speaker 1: regulatory submission before authorizing alternatives. By early March, the US

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Speaker 1: was struggling to run one thousand tests a day, while

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Speaker 1: South Korea, which confirmed its first case the same day

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Speaker 1: the US did, was running ten thousand. By the end

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Speaker 1: of that month, lab giants, ab Labs, hal Logic Lab, Corps,

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Speaker 1: Quest Diagnostics, and Roche had rolled out US tests of

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Speaker 1: their own, but at one to a hundred and fifty

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Speaker 1: dollars apiece, they were expensive and labs were short on

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Speaker 1: technicians trained to run them. Long complex supply chains led

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Speaker 1: to further shortages from the swabs needed to gather nasopharyngeal

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Speaker 1: samples to the reagents used to process the tests. The

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Speaker 1: tests in use at the time were molecular diagnostics known

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Speaker 1: as polymerase chain reaction tests, performed by medical professionals and

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Speaker 1: processed in specialized labs. PCR tests identify segments of a

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Speaker 1: virus's genetic material in secretions swabbed from the back of

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Speaker 1: a patient's throat or nose. The process starts with enzymes

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Speaker 1: being added to the sample, which is then repeatedly heated

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Speaker 1: and cooled to create billions of copies of the viral genome.

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Speaker 1: Special probe molecules bind to the copy genetic material, releasing

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Speaker 1: fluorescing nanoparticles whose globe signals the virus's presence. Used everything

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Speaker 1: from food safety to DNA profiling. PCR tests take several

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Speaker 1: hours and are extremely sensitive. If the virus is present

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Speaker 1: in a sample, even in infinitesimal amounts, PCR will find

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Speaker 1: it to public health officials. In the early days of

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Speaker 1: the pandemic, reliability seemed like the most important quality, but

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Speaker 1: the hospitals, dodgers offices, and pop up testing facilities where

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Speaker 1: PCR tests are given often don't have the equipment to

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Speaker 1: process the results on site. The thermo cycler that incubates

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Speaker 1: the samples costs at least a hundred thousand dollars, so

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Speaker 1: the swabs are usually sent out. That's resulted in massive

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Speaker 1: backlogs and severely limited the tests usefulness. There are alternatives. One.

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Speaker 1: A lateral flow test is a disposable strip of cellulose

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Speaker 1: or woven fiber picture a home pregnancy test. Instead of

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Speaker 1: looking for viral DNA or RNA, it identifies proteins called

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Speaker 1: antigens that protrude from the virus capsule. It exploits the

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Speaker 1: lock and key relationship between those molecules and the antibodies

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Speaker 1: the human immune system makes to identify them. Lateral flow

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Speaker 1: tests can be done on nasal swabs, but some are

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Speaker 1: in development to work with saliva. The sample is deposited

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Speaker 1: at one end, doused with liquid, and then spreads through

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Speaker 1: the fiber by capillary action, like a spill infusing a sponge.

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Speaker 1: As it advances, the solution flows over antibodies embedded in

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Speaker 1: the fiber with nanoparticles of gold or dye grafted onto

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Speaker 1: them as tags. If the virus is present in the sample,

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Speaker 1: the antibodies latch on and are carried along until the

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Speaker 1: virus antibody pair encounters a second set of antibodies anchored

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Speaker 1: in a line. Those two grab onto the target viruses,

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Speaker 1: activating the tags on the antibodies that hitch deride earlier.

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Speaker 1: As more virus rich liquid reaches the line, the tags,

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Speaker 1: like millions of microscopic pixels, form the telltale stripe of

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Speaker 1: a positive result. The whole process can take as little

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Speaker 1: as fifteen minutes or Assure Technologies has long sold lateral

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Speaker 1: flow tests for habititis C and HIV. In twenties seventeen,

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Speaker 1: it created the only FDA approved ebola antigen test. The

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Speaker 1: company is based in Bethlehem, Pennsylvania, but sells many of

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Speaker 1: its fast, cheap, over the counter diagnostics in sub Saharan

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Speaker 1: African nations that lack the medical infrastructure for PCR testing.

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Speaker 1: At the beginning of this year, with the U S

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Speaker 1: struggling to create reliable tests and its most advanced labs overwhelmed,

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Speaker 1: chief executive Officer Stephen Tang saw the parallels we have

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Speaker 1: to repatriate our experience from low and middle income countries.

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Speaker 1: He says, you have a test that is rapid, that

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Speaker 1: you can take by yourself, that doesn't require an instrument

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Speaker 1: to read or a medical professional to administer. What we

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Speaker 1: have learned from experience is that people will test themselves

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Speaker 1: more frequently in the privacy of their own homes. Tang

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Speaker 1: plans to build on the company's HIV test platform to

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Speaker 1: bring an at home COVID test to market before the

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Speaker 1: end of the year. While the HIV test costs forty

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Speaker 1: to fifty dollars in a U S pharmacy, the company

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Speaker 1: promises its coronavirus test will be cheaper. Other strip test

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Speaker 1: makers have also prioritized the pandemic. Eive Bio, a startup

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Speaker 1: born in an m I T lab two years ago,

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Speaker 1: has temporarily shifted its focus from epidemic fever viruses such

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Speaker 1: as dingey and zica with COVID. There have been maybe

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Speaker 1: fifty million infections worldwide, says CEO Bobby Brooke Herrera. Dinge

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Speaker 1: causes four hundred million every single year. Like Tang, Herrera

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Speaker 1: has been trying to apply lessons from countries with threadbare

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Speaker 1: public health systems to those like the US he's in

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Speaker 1: discussions with US regulators to authorize a coronavirus strip test

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Speaker 1: made to be processed in a lab. Once it reaches

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Speaker 1: the market, he says a home version will be next established.

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Speaker 1: Testing companies are already bringing lateral flow tests to market.

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Speaker 1: On August, Abbott Laboratory Is announced that the f d

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Speaker 1: A had awarded it an emergency use authorization for bin as,

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Speaker 1: now a fifteen minute disposable antigen test priced at five dollars,

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Speaker 1: A so called point of care test, it must be

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Speaker 1: given by a health professional, but since it requires no

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Speaker 1: lab equipment, an unlimited number can be conducted and processed

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Speaker 1: at any given time. Abbott is already producing fifty million

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Speaker 1: of them a month. A test's accuracy is a matter

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Speaker 1: of sensitivity, how often it correctly spots a disease, and specificity,

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Speaker 1: how often it correctly rules the disease out. A test

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Speaker 1: with low sensitivity will miss a lot of cases. A

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Speaker 1: test with low specificity will mistakenly tell people they have

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Speaker 1: a disease when they don't. Lateral flow tests are neither

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Speaker 1: as sensitive nor as specific as PCR tests. They're more

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Speaker 1: likely to miss an infection during the incubation period as

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Speaker 1: the invader has just started replicating, or weeks in when

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Speaker 1: the body's immune response has managed to eliminate many of

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Speaker 1: the virus particles. Lateral flow tests lower sensitivity has hampered

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Speaker 1: efforts to bring them to market. There are concerns that

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Speaker 1: tests done at home, where people swab their own noses

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Speaker 1: instead of having a professional du it or at least supervise,

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Speaker 1: could further lessen the sensitivity. Herrera says he doubts E

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Speaker 1: twenty five bios at home test will be approved without

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Speaker 1: a change in expectations from the FDA, which requires accuracy

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Speaker 1: levels difficult for him to achieve outside a lab or.

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Speaker 1: Asher says it's confident it concluded the bar. Some companies

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Speaker 1: are trying to address this shortcoming technologically. Mammoth Biosciences, working

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Speaker 1: with a microbiologist named Charles Chew at the University of

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Speaker 1: California at San Francisco, is using the DNA splicing technology

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Speaker 1: Crisper to improve the accuracy of strip tests. Crisper's potential

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Speaker 1: for precise gene editing rests on its use of sequences

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Speaker 1: of guide RNA that zero in on target genes. Chew

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Speaker 1: and a meth are turning that search engine property to

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Speaker 1: the task of finding the telltale genome of SARS cove two.

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Speaker 1: The effort is taking two parallel paths. One that the

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Speaker 1: FDA cleared this summer runs on the same equipment as

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Speaker 1: PCR tests, but it copies the viral genetic material without

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Speaker 1: the time consuming heating cycles. The other, in development with

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Speaker 1: Glaxo Smith Klein manages to replicate this approach with the

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Speaker 1: attendant sensitivity in a self contained and disposable kit. Not

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Speaker 1: unlike a lateral flow test. You're getting the same accuracy

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Speaker 1: as in the lab, but it's much easier to use,

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Speaker 1: says CEO Trevor Martin. Another school of thought, though, holds

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Speaker 1: that worries about the sensitivity of strip tests missed the point.

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Speaker 1: The way we've been approaching testing so far in this

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Speaker 1: epidemic is to try to shove a public health need

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Speaker 1: through a diagnostic pathway, says Michael Mina, the Harvard epidemiologist

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Speaker 1: who is the leading proponent of this idea. Mina argues

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Speaker 1: that we should essentially test everyone, all the time, everywhere.

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Speaker 1: It's a form of what public health experts call surveillance

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Speaker 1: rather than diagnostic testing. In this model, speed and ubiquity

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Speaker 1: are all that matter, Mina likes to talk about what

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Speaker 1: would happen if we had one dollar self administered saliva tests.

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Speaker 1: Restaurants and bars would have cups of strips on the

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Speaker 1: major dast end by the toothpicks and the mints. Theaters

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Speaker 1: would have them at the door. Air travelers would be

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Speaker 1: tested at their departure gate before boarding. The International Air

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Speaker 1: Transport Association recently announced its determination to put a system

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Speaker 1: like this in place. Coronavirus testing would become a habit.

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Speaker 1: If not like brushing our teeth, then at least like flossing.

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Speaker 1: These tests would be much more reliable than temperature checks,

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Speaker 1: which can miss carriers with mild or non existent symptoms.

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Speaker 1: At a large enough scale and a high enough frequency,

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Speaker 1: the thinking goes, testing is all you need to do.

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Speaker 1: Tests at the entrance to offices and schools would visibly

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Speaker 1: ensure the safety of those spaces encourage people to return

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Speaker 1: to them. People who test positive could immediately isolate themselves,

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Speaker 1: breaking the chain of transmission. In this world, a strip

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Speaker 1: test's relative insensitivity would be less of an issue. Positives

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Speaker 1: could be double checked to make sure they're correct, and

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Speaker 1: false negatives would be caught. A day or two later

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Speaker 1: by the next test, still early in the disease course.

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Speaker 1: Mina goes so far is to characterize lower sensitivity as

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Speaker 1: an asset because a PCR test taken in the late

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Speaker 1: stages of COVID nineteen will still show positive even if

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Speaker 1: the patient is well past the contagious stage and no

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Speaker 1: longer needs to be isolated. In that sense, he argues,

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Speaker 1: strip tests can better gauge in individual's risks to the

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Speaker 1: broader population. I don't want to see these kinds of

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Speaker 1: tests being promoted as passports to party or to go

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Speaker 1: out to dinner. That misses the big picture. The epidemiologist says,

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Speaker 1: these aren't passports. These are actually the intervention lack of

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Speaker 1: vaccine to suppress population spread. According to his Budeling, testing

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Speaker 1: just half the population every three days would bring COVID

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Speaker 1: under control within weeks. To make this a reality, the

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Speaker 1: FDA would need to relax its testing standards down from

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Speaker 1: PCR level sensitivity, and someone would need to manufacture and

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Speaker 1: pay for the untold billions of tests. Mina believes it

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Speaker 1: should be Congress. This is a national emergency, he says,

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Speaker 1: and a fifty billion dollar or one billion dollar price

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Speaker 1: tag to stop the virus is easily worth it, given

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Speaker 1: that the US has already spent three trillion dollars in

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Speaker 1: COVID related stimulus money and its economy has lost trillions more.

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Speaker 1: At least one of the two men running for president

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Speaker 1: has unequivocally committed to more testing. The first point in

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Speaker 1: Joe Biden's seven point COVID plan is to ensure all

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Speaker 1: Americans have access to regular, reliable, and free testing. The

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Speaker 1: plan mentions at home and instant tests and proposes a

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Speaker 1: testing board modeled on Franklin D. Roosevelt's War Production Board,

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Speaker 1: which oversaw the Manu facture of weapons and supplies that

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Speaker 1: helped win World War Two. President Trump has publicly called

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Speaker 1: for less testing, and his CDC recently said asymptomatic people

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Speaker 1: who've had contact with a sick person don't need to

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Speaker 1: be tested. Most public health experts strongly disagree, and the

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Speaker 1: agency has since reversed that guidance. On the other hand,

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Speaker 1: the day after ABBOT unveiled its lateral flow kits, the

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Speaker 1: U S Department of Health and Human Services announced a

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Speaker 1: deal to buy and deploy one fifty million of them,

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Speaker 1: and the agency is already distributing a different type of

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Speaker 1: antigen tests to nursing homes across the country. Of course,

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Speaker 1: all of this is a fraction of what Mina's plan

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Speaker 1: would require. Among his fellow epidemiologists and public health experts,

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Speaker 1: Mina's plan does have skeptics. Without reimbursement, the price of

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Speaker 1: even very cheap tests might be a challenge for some

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Speaker 1: families and organizations. New York City School system has more

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Speaker 1: than one million students. The production of billions of new

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Speaker 1: tests could create supply chain problems of its own, and

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Speaker 1: the millions of false positives and negatives that would be

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Speaker 1: produced at that scale could further undermine American's shaky confidence

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Speaker 1: in their public health system, a dangerous prospect in a

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Speaker 1: country where large numbers already refused to wear masks. There's

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Speaker 1: also no mechanism to compel people who test positive at

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Speaker 1: home to stay there, especially if they're living paycheck to

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Speaker 1: paycheck without paid sick leave. It's our failure to act

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Speaker 1: on the test results we have that has been the problem,

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Speaker 1: these skeptics, argue. As Henage, Mina's colleague at Harvard, points

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Speaker 1: out South Korea succeeded in corralling the virus by relentlessly

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Speaker 1: tracking down those put at risk by each discovered case,

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Speaker 1: not by reinventing testing. All of these extraordinarily smart people

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Speaker 1: are coming up with extraordinarily smart things, Hennage says, and

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Speaker 1: we haven't done the basic things right. Whether or not

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Speaker 1: MINA can sell the idea of regular tests for all

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Speaker 1: the imports of faster, more widespread surveillance testing has become clear.

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Speaker 1: Such a model could use strip tests if they can

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Speaker 1: be scaled up, or it could rely on methods such

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Speaker 1: as pooling combining multiple samples to increase the throughput of labs.

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Speaker 1: Hann Edge is particularly excited about the potential of wastewater. A.

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Speaker 1: Shish Jaw, a physician and the dean of the Brown

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Speaker 1: University School of Public Health, is among the scholars who

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Speaker 1: have tried to calculate how many tests the country actually

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Speaker 1: needs early in the pandemic. His team came up with

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Speaker 1: a range of five hundred thousand to six hundred thousand

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Speaker 1: per day. Those estimates, though assumed that positive results would

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Speaker 1: be followed by South Korea style contact tracing. So far,

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Speaker 1: such programs have largely failed in the US, and Jaw

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Speaker 1: is reassessing. I have increasingly come to believe that a

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Speaker 1: large army of contact tracers may not work in our country,

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Speaker 1: he says, and that will need large scale surveillance testing

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Speaker 1: as a strategy for building a high degree of safety

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Speaker 1: into a lot of our activity these Jaw's new approach

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Speaker 1: focuses less on how many tests the nation needs than

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Speaker 1: on where they're needed. Nursing homes and hospitals are places

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Speaker 1: where people should be tested all the time, he argues.

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Speaker 1: With meat packing plants, prisons and schools close behind, you

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Speaker 1: could make the case for any place where you can

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Speaker 1: get large numbers of people gathering indoors for extended periods.

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Speaker 1: He says. My argument has been that we have to

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Speaker 1: make decisions if we don't have tens of millions of

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Speaker 1: tests a day, and we don't who do we want

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00:24:30,760 --> 00:24:35,160
Speaker 1: to leave out. The American healthcare system, with its balkanized

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Speaker 1: tangle of private and public providers, consumers, and often reluctant reimbursers,

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Speaker 1: is structurally resistant to nationwide interventions. With a few exceptions,

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Speaker 1: we don't have a national or even a statewide public

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Speaker 1: health infrastructure that scales to administering many many procedures directly

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Speaker 1: to patients, says Katerine Hempstead, a healthcare policy adviser at

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Speaker 1: the Robert Wood Johnson Foundation. It's possible that an imagined

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Speaker 1: pandemic testing board on a war footing could overcome some

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Speaker 1: of those limitations. If not, and at least until then,

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Speaker 1: it's likely that the US will see the uneven growth

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Speaker 1: of the patchwork testing quilt. We already have individual companies, schools,

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Speaker 1: even states could put together effective testing programs while other

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Speaker 1: efforts fail. In August, a group of governors announced to

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Speaker 1: joint effort with the Rockefeller Foundation to purchase millions of

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Speaker 1: antigen tests. The patchwork model means gaps, blind spots, and inequity,

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Speaker 1: but it will nonetheless embed the idea of disease surveillance

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Speaker 1: in our lives long after this pandemic is over. One

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Speaker 1: of the problems that's bedeviled the u S response at

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Speaker 1: every level is the nation's short attention span. Public and

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Speaker 1: private funding goes to swine flu or zeca or ribola,

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Speaker 1: then evaporates once the immediate danger has passed. It's short sighted.

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Speaker 1: The fact that we only deal with the outbreak of

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Speaker 1: the day says you see s F. S. Chew. Had

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Speaker 1: we had ongoing funding to do diagnostics for zeka, maybe

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Speaker 1: the tests that we're now struggling to develop in real time,

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Speaker 1: would have already been developed. Even the terrible costs of

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Speaker 1: COVID probably won't curb these human tendencies, but more durable

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Speaker 1: changes might help. In Arizona, Carmona has been meeting with

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Speaker 1: architects trying to figure out how to design buildings with

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Speaker 1: wastewater epidemiology in mind. One of their goals is to

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Speaker 1: enable future sewage samplers to trace pathogens not just to

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Speaker 1: a building, but to individual floors or even rooms. It

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Speaker 1: may be what we're going to need in the future,

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Speaker 1: Carmona says, we probably will have other biologic hazards. Maybe

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Speaker 1: not a pandemic, but it could be an epidemic or

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Speaker 1: just an outbreak where you'd like to know where the

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Speaker 1: sick people are. That's the cover story in the magazine

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Speaker 1: this week, and you can find the magazine on newsstands.

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Speaker 1: It's also online at Bloomberg dot com and of course

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Speaker 1: on the Bloomberg terminal. I'm Carol Masser and I'm Jason Kelly.

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Speaker 1: Check us out every day on the radio are Bloomberg

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Speaker 1: Business Week Radio show starts at two pm Wall Street Time,

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Speaker 1: Monday through Friday, or check us out on our podcast feed.

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Speaker 1: This is Bloomberg