Commentary: Let’s not blow a second chance to halt Covid-19

By Noah Smith / Bloomberg Opinion

This summer, the U.S. once again failed to control the coronavirus pandemic. This should be a source of great national shame, given how even such hard-hit countries as Italy and the United Kingdom have managed to control the virus much more effectively.

The U.S. outbreak rages on, with tens of thousands of new cases and about a thousand deaths per day. The economy is suffering accordingly, as people stay in their homes for fear of the virus.

But this fall, the U.S. will have another chance. And thanks to new testing technology, its odds of beating Covid-19 and kickstarting an economic recovery might be better this time; if only it can muster the necessary political will and government competence.

The first step to beating the pandemic is to mandate masks in public spaces. Mask-wearing is scientifically and empirically proven to be an effective way of slowing the spread of coronavirus, but some Americans still refuse to do their duty and wear a mask in public. A national mask mandate is overwhelmingly popular, with more than 8 out of 10 Americans in support. But states and cities shouldn’t wait for the federal government; they should all issue their own mandates.

Second, the whole country should engage in a narrowly targeted lockdown program. Bars, indoor dining, house parties, and other events that create prolonged indoor contact should be banned. Businesses that suffer from those bans should be bailed out for the duration of the pandemic.

Colleges also need to keep students away from campus for the fall. Many colleges, desperate not to lose revenue and relevance, have allowed students back into dorms and resumed in-person classes in spite of the well-known risks. This was a coldly cynical move; an administrator at Yale University warned students to “be emotionally prepared for widespread infections — and possibly deaths — in our community.” Utterly predictably, this led to an immediate surge in Covid-19 cases as students partied and socialized. Students need to immediately be kicked off campus, quarantined for two weeks to avoid infecting others, and resume learning over Zoom.

Along with all these measures, the U.S. desperately needs an improvement in its ability to test for the coronavirus. At the outset of the pandemic, the Food and Drug Administration and the Centers for Disease Control and Prevention badly bungled the rollout of widespread testing. Eventually, the situation seemed to improve, with tests surging to about 800,000 per day in July.

But those impressive numbers didn’t tell the whole story. Most tests in the U.S. are handled by private laboratories that ship samples to centralized processing facilities. That takes a long time, meaning people are waiting a week or more to get results. The delay is exacerbated by shortages of chemical reagents and other materials necessary for testing, which in turn is a function of the Trump administration’s refusal to roll out a national testing effort. Tests that don’t come back for a week are sufficient to tell people if they’ve been infected but are useless for most other purposes.

In particular, slow tests don’t help contain the virus through contact tracing. The test-and-trace approach relies on being able to quickly contact people who have been exposed to an infected individual and telling them to isolate themselves. But a delayed result means that, by the time a contact tracing worker calls an infected person, that person has already been spreading the virus for days.

Fortunately, technological solutions to the slow test problem may now be available. One option is antigen tests, which come back in an hour or so rather than a week. Another is saliva tests, which simply require someone to spit on a piece of paper. Saliva tests are much cheaper and can get results much faster than a typical nasal swab test. Antigen tests were first authorized by the FDA back in May, and saliva tests have just been authorized recently.

The concern about these tests is their accuracy. Both kinds of rapid tests are less accurate than the slow nasal swab tests, meaning that if you test negative, there’s a small but real chance you could still be infected. Saliva tests, for example, catch infections only about 90 percent of the time. People who test positive on an antigen or saliva test will still probably want to confirm their diagnosis with a slower traditional test.

But antigen and saliva tests can be extremely effective for contact tracing. Even 90 percent accuracy is good enough to identify the majority of people who have been exposed through personal contact.

Saliva tests’ very low cost could also make mass testing feasible. Essential workers and vulnerable populations such as the elderly could literally be tested every day, reducing the need for contact tracing and allowing virus outbreaks to be contained very quickly.

Finally, rapid tests will make it easier to do clinical trials for Covid-19 treatments. Treatments such as monoclonal antibodies have great promise as potential cures for coronavirus, and they could potentially be available earlier than a vaccine. But trials for these therapies have been held up by the slowness of U.S. testing; subjects must take the drug within just a few days of being infected, so if they can’t be tested in time, they’re ineligible. Rapid tests could potentially solve this problem, if regulatory agencies allow it.

If past behavior is any guide, the Trump administration is unlikely to roll out a national effort to make rapid testing widespread. But now that the FDA has authorized such tests, state governments and philanthropic organizations can still do their utmost to make them available to all Americans. There’s no better hope for stopping the virus this fall.

Noah Smith is a Bloomberg Opinion columnist.