Biden team plots the country’s first national Covid testing strategy

The Biden administration is preparing to launch the first of several Covid-19 testing hubs to coordinate and oversee a $650 million expansion of testing in K-8 schools and congregate settings like homeless shelters.

The Department of Health and Human Services hopes to open the first hub in April, as part of a public-private partnership that could eventually add up to 25 million tests per month to the nation’s testing totals, two sources briefed on the plans told POLITICO. Administration officials discussed details of the program on Tuesday during a call with industry, government agencies and state and local health departments. They held a second industry call on Thursday.

The effort is the first attempt at formalizing a national testing strategy — something public-health experts have wanted for months. It comes amid a puzzling drop in the total number of tests recorded in the United States, from nearly 2 million a day in mid-January to about 1.5 million a day now. Public health experts attribute the decline to several factors, including widespread winter storms, increased reliance on point-of-care tests with results that are often not reported to health authorities and pandemic fatigue. The number of new cases is also declining, and the number of Americans who have been vaccinated is climbing.

But the widespread testing envisioned by the Biden program is sorely needed to help bring the pandemic to an end, experts said — even with three vaccines now available. A surveillance system that uses testing to track the spread of the virus and its variants can help communities determine how to safely reopen schools and offices, and eventually return to a more normal life.

“You need to be testing broadly even with the vaccine,” said Scott Becker, CEO of the Association of Public Health Laboratories. “We're still going to want to make sure that we have a good handle on this pandemic. We want to watch that tail end.”

During the Tuesday call organized by HHS, administration officials said the public-private partnership aims to conduct 150,000 tests per week by the end of April without interfering with existing testing supply chain and testing infrastructure.

The federal government will begin by creating a list of preferred Covid tests for use in schools and other congregate settings, according to slides presented during one of the HHS calls that were obtained by POLITICO. The administration will seek applications during March from diagnostic manufacturers, commercial labs, academic labs and other health care groups to run four coordinating hubs placed across the U.S. for at least six months. HHS anticipates awarding contracts by March 22.

“The coordinating center is going to have the responsibilities of coordinating with states, counties and local school districts on testing efforts for K-8 students within their region and ensure proper testing at laboratories,” HHS Testing & Diagnostic Working Group lead industry officer Steven Santos said on the Tuesday call.

One industry source predicted that the coordinating hubs’ task will be difficult because schools are not required to participate in the program.

“It's actually the coordinating centers responsibility explicitly to go and set up a testing collection methodology that works for the communities that you're serving,” the source said. “Which is a little insane since you’re serving in theory 25 percent of the country and in any given one of those sectors you’re going to have everything from rural to extremely urban.”

Former Trump testing czar Brett Giroir said the idea for a public-private system to coordinate testing in schools dates back last summer. But the plan didn’t get traction until late November or early December — meaning the Trump administration handed off its concept papers to the incoming Biden team.

“We just couldn’t get it done in time, it’s a big thing: multiple coordinating centers, you can’t just turn that around in a week or two,” Giroir said. “They definitely added the money to it.”

According to an HHS draft document, coordinating hubs will be asked to report county-level data on the number and type of Covid-19 tests administered each month. The hubs will also be tasked with coordinating delivery of test results within two to three days and establish a sustainability plan to ensure testing capacity is maintained after federal support ends.

Marcus Plescia, chief medical officer for the Association of State and Territorial Health Officials, said the push to reinforce the importance of testing as an infection control mechanism is particularly important because states and the public are so focused on vaccine distribution.

Testing works hand-in-hand with vaccination to help beat the virus back, Santos said on the administration’s Thursday call with industry.

"With the vaccine available, there is a real opportunity to get to zero transmission and stay there,” he said. “But to do so we need to increase testing capacity and to continue to identify and stop spread. Maintaining high levels of testing as vaccination rolls out and transmission decreases is critical to controlling this pandemic and to preventing another wave."

Other experts said they expect testing numbers to rebound, even without the new testing program, once the U.S. begins to reopen and more people travel. But the increasing availability of point-of-care tests means many tests may not be reported, said Georges Benjamin, executive director of the American Public Health Association.

That could pose a challenge for public health officials trying to understand the spread of the virus before the country sets up a dedicated surveillance system for Covid-19 that is similar to what it uses to monitor influenza.

“You want your surveillance system set up with some depth, some clear definitions so these ebbs and flows that are outside of that don’t influence your surveillance,” Benjamin said. “I’m worried that we’re not building that other system fast enough.”

Bruce Tromberg, a scientist at the National Institutes of Health who leads the federal government’s Rapid Acceleration of Diagnostics initiative, said his unofficial estimate is that the results of more than 2 million daily point-of-care tests are not being reported to health authorities.

“More and more people are relying on antigen tests and they are just not reported,” Giroir said. “Secondly, when the numbers go down, people are not hyper about being tested. We saw that all the time — when the numbers started going down, people just didn’t go — you couldn’t give away a test.”

An HHS spokesperson said the coordinating hubs are one piece of a broader strategy to ensure the country is testing enough to mitigate spread of the virus. “We look forward to continuing to announce more testing measures in the weeks ahead,” the spokesperson said.

The new federal coordination centers could have long-lasting benefits, beyond increased testing, that are only realized years down the line, Becker and Giroir said. Much of the lab capacity for the public-private partnership is expected to come from academic labs at universities across the country that will train the next generation of biostatisticians and lab workers.

“You’re never going to lose by investing in equipment and training at the universities,” Giroir said. “How many times have you heard, we don't have the lab technicians, we don't have the workforce. All this could be used for that.”

Becker hopes the result will be a more resilient public health system ready to respond when the next threat arrives.

“We needed to stand up this massive testing infrastructure,” Becker said. “And I think the next time there's some new emerging disease, we're going to be much better prepared, based on the experiences we had here.”