The Rockefeller Foundation – National COVID-19 Testing & Tracing Action Plan

We’ve gone from 1 million to 4.5 million tests per week in the U.S., but we’ll need to redouble our efforts to make it to 30 million tests per week and beyond in order to reopen communities and economies, and keep them open.

Foreword to National Covid-19 Testing & Tracing Action Plan

America faces an impending disaster. The extraordinary scale of the Covid-19 crisis is evident in the growing deaths and economic losses the pandemic has wrought in every state. Devastated minority and low-income families bore the brunt of those costs. As the virus tore across the country, it exposed the structural inequities that have underpinned and undermined our economy for decades. And it will only worsen during fall’s cold and flu season.

This terrifying tragedy was not and is not inevitable. America can function safely, even as we fight Covid-19. Other countries have shown that a better alternative is possible. But as we said in April – when we first released The Rockefeller Foundation’s National Covid-19 Testing Action Plan – testing is the only way out of our present disaster, and it will remain the case until a vaccine or effective therapeutics are widely available.

When we were barely a month into this pandemic, we brought together scientists, industry, technologists, economists, and Republicans and Democrats alike to formulate an action plan to expedite the development of our nation’s widespread testing and tracing system. We called for rapidly expanded diagnostic testing capacity from 1 million tests per week to 3 million tests per week by June, and to 30 million tests per week by October. Today we’re at 4.5 million tests per week, but unfortunately it’s taking far too long to get to 30 million tests per week, and communities that most need them – low-income families, minorities, and highly vulnerable essential workers – find it most difficult to gain access, while elite institutions, companies, and enterprises seem to be able to access them on the private market. We need to urgently fix clinical diagnostic testing and accelerate the introduction of faster, cheaper, point-of-care screening tests to prepare for next flu season. Some say it’s impossible. Some say America has already given up. But we know it can be done, and we present here a renewed national action plan to help get there.

Across the board, federal leadership and genuine public-private partnership will be essential to meeting three key needs identified in this updated plan. First, we need to massively scale up fast, cheap screening tests to identify asymptomatic Americans who are currently infected. Today the country conducts almost zero such tests, and we need at least 25 million per week for schools, health facilities, and essential workers to function safely. Teachers, healthcare workers, grocery store workers: these are the real heroes of this crisis, and they should be able to support our country without the all-consuming fear that they’re jeopardizing their lives or the lives of their loved ones.

Second, we need to dramatically reduce the processing time for diagnostic tests, from the current 5-14 days to a 48-hour standard turnaround time that every state and community should meet. Many businesses that are privately contracting with lab companies already meet this standard. We propose a public-private collaboration between government, lab companies, and scientists in order to alleviate the very basic constraints that are leading to these extraordinary delays.

Third, this reinvestment in testing must be tied to the basics of any pandemic response to really work: clear public health communications from trusted community leaders, and robust contact tracing and support for targeted isolation to reduce the contagion of the disease.

The Rockefeller Foundation will invest an additional $50 million toward realizing the emergency requirements we outline in this updated plan. But make no mistake: this crisis demands immediate federal funding. Congress took a first step by including $25 billion for testing in the Coronavirus Aid, Relief, and Economic Security (CARES) Act. This plan requires another $75 billion as soon as possible, because tests should be free and accessible to all who need them – with extra effort to make sure low-income and minority communities, those who are more financially vulnerable and critical institutions like nursing homes, schools, and community centers are supported, and that we address the sharp racial injustices and inequities that plague our country. This represents the single best investment America could make in averting an even more tragic and pending disaster.

Today Covid-19 cases are spiking, and the trajectory in much of America is rising rapidly. In addition, we will soon enter a new cold and flu season with potentially 100 million cases of flu-like symptoms that stand to overwhelm our current testing capacity. Not only do we need to bend the curve of this epidemic; we need to provide America’s essential workers and children with a way to go about their work and lives more safely, so that critical institutions can survive and function during this period of time. The only alternative is more large-scale lockdowns. The price of that is too high to pay when we don’t have to, if we make smart, strategic, science-based investments now.

Dr. Rajiv J. Shah
President, The Rockefeller Foundation