President Joe Biden seeks to reset the nation’s inconsistent coronavirus testing efforts with a $50 billion plan and more federal oversight.
Biden’s plan calls for a newly created Pandemic Testing Board to coordinate a “clear, unified approach” to testing for COVID-19, a marked difference from the Trump administration’s policy of states establishing their own plans with federal support.
Laboratories have ramped up production to more than 2 million tests each day, but stubborn problems persist. Some labs struggle to complete timely tests – particularly when demand surges – because of shortages of critical supplies.
Public health labs largely are not equipped to detect new coronavirus variants such as ones first identified in the United Kingdom and South Africa. And there’s debate among testing experts on whether wider use of cheaper but less sensitive rapid tests will be the smartest path out of the pandemic.
Biden issued a flurry of executive orders Thursday, from mask mandates on federal property to reopening schools and accelerating vaccine shipments. Fixing the nation’s disparate testing system “will be the most challenging” of all, said Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials.
Former Centers for Disease Control and Prevention Director Tom Frieden said Biden’s testing initiative fits with his broader, science-based plan to curb a pandemic that’s killed more than 415,000 people in the USA.
“This is a really challenging pandemic to deal with,” said Frieden, president and CEO of Resolve to Save Lives, an initiative of Vital Strategies. “Important as executive orders are, they are only the start of a major effort.”
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Calling a national testing strategy the “cornerstone to reducing the spread of COVID,” Biden’s plan calls for more rapid antigen tests, supplies, lab capacity and genomic sequencing to keep better track of hot spots and new variants.
There are also tidbits for consumers. One executive order requires federal agencies to clarify insurers’ obligation to cover testing, even for people who have no symptoms. For those without health insurance, testing will be free, the order says.
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Hundreds of people who made an appointment to be vaccinated from COVID-19 stand in a line that wraps around the building at the Delco Activity Center in northeast Austin, Texas on Jan. 23, 2021. Ricardo B. Brazziell, Austin American-Statesman/USA TODAY NetworkFullscreen
Workers from Sparrow Healthcare talk to a woman Tuesday, Jan. 19, 2021, as she approaches a checkpoint at the Sparrow Laboratories Drive-Thru Services site at Frandor Shopping Center in Lansing. It is Sparrow’s first day of public vaccinations for those 70 and older, and for frontline essential workers. Matthew Dae Smith, Lansing State Journal/USA TODAY NetworkFullscreen
Systems analyst Michelle Amos rolls a cart from patient to patient doing registration as Ohio State University medical employees receive their first dose of the Pfizer COVID-19 vaccine at the Schottenstein Center in Columbus on Friday, Jan. 15, 2021.
Adam Cairns, Columbus Dispatch/USA TODAY NetworkFullscreen
Clay County residents wait in line for the start of Monday morning’s vaccination effort at the Clay County Fairgrounds. The early appointments for COVID-19 vaccinations begin to line up at the Clay County Fairgrounds west of Green Cove Springs early Monday morning, Jan. 18, 2021. Ascension St. Vincent’s is holding the event for Clay County Residents 65 and older from 8 a.m. to 5 p.m. and plan to provide approximately 2,500 vaccinations.
Bob Self, Florida Times-Union/USA TODAY NetworkFullscreen
Jack Horneman of Townville gets his COVID-19 vaccine from Missy Cooley, LPN, during the AnMed Health Covid-19 Vaccine clinic at the Anderson Civic Center Saturday, January 16, 2021. Ken Ruinard, USA TODAY NetworkFullscreen
Revonda Wood, RN, pulls a dose from a Pfizer-BioNTech COVID-19 vial at the AnMed Health Covid-19 Vaccine clinic at the Anderson Civic Center Saturday, January 16, 2021. Ken Ruinard, USA TODAY NetworkFullscreen
Century Village residents wait before appointments are handed out for the COVID-19 vaccine in West Palm Beach, Florida on Jan. 11, 2021. The community will receive 3,000 doses to use starting on Wednesday. Greg Lovett, The Palm Beach Post-USA TODAY NETWORKFullscreen
Karen MacDonald, a nurse at Gates Middle School in Scituate, Mass. lays out her syringes while getting ready to administer the COVID-19 vaccine to first responders on Jan. 11, 2021. Robin Chan, Wicked Local via USA TODAY NETWORKFullscreen
Gabriel Fernandez, a registered nurse from Texas Tech University Health Sciences Center El Paso, injects a COVID-19 vaccine into the arm of an Emergence Health Network client with developmental disabilities at the EHN DayHab center in East El Paso on Jan. 7, 2021. Aaron E. Martinez, El Paso Times via USA TODAY NETWORKFullscreen
A line of Duval County residents snakes around the campus of the Mandarin Senior Center on Hartley Road on Jan. 11, 2021, as people wait for COVID-19 vaccine injections at one of the two City of Jacksonville vaccine sites which opened Monday. Bob Self, Florida Times-Union via USA TODAY NETWORKFullscreen
Century Village resident Maria Cole shows identification to make an appointment for the COVID-19 vaccine in West Palm Beach, Florida on Jan. 11, 2021. The community will receive 3,000 doses to use starting on Jan. 13, 2021. Greg Lovett, PALM BEACH POST via USA TODAY NETWORKFullscreen
Medical professionals from Oregon Health & Science University load syringes with the Moderna COVID-19 vaccine at a drive-thru vaccination clinic in Portland, Ore., Jan. 10, 2021. The clinic is a partnership between the Service Employees International Union and Oregon Health & Science University, aiming to vaccinate Oregon’s 32,000 home health care workers and their patients. Pool photo by Kristyna Wentz-GraffFullscreen
James Hill, 69, who served separate stints in both the Army and Navy, left, holds his sleeve as Brent Myers, a CVS pharmacist, readies to administer the Pfizer COVID-19 vaccination, at the Mississippi State Veterans Home in Jackson, Miss., Jan. 9, 2021. Hill was among the first residents to receive the Pfizer covid vaccination. Residents and staff at two of the four veterans homes were inoculated on Saturday with the vaccinations planned for the two other homes next week. The veterans homes were among the hardest hit senior living facilities by the virus. Rogelio V. Solis, APFullscreen
Patient care technician Carolyn Nesby, 62, holds still as medical assistance care coordinator Beatriz Pantoja administers the Moderna coronavirus vaccine at Rosewood Zaragosa Health Center in East Austin on Jan. 8, 2021. Bronte Wittpenn, Austin American-Statesman via USA TODAY NETWORKFullscreen
Certified medical assistant Maria Lawlor administers the Moderna coronavirus vaccine to Michael Burns, 62, at Rosewood Zaragosa Health Center in East Austin on Friday, Jan. 8, 2021. Currently, vaccines generally are restricted to¤first responders, health care personnel, people 65 and older, and those 16 and older with at least one chronic medical condition. Bronte Wittpenn, Austin American-Statesman/ USA TODAY NetworkFullscreen
Nurses have COVID-19 vaccines drawn and ready to administer as people pull into a bay at the former State Farm building in Murfreesboro, Tenn. to receive their first dose on Jan. 4, 2021. Helen Comer, The Daily News Journal via USA TODAY NETWORKFullscreen
A woman takes a selfie with the medical worker who administered her COVID-19 vaccination at a drive-thru at Broadbent Arena in Louisville, Ky. on Jan. 4, 2021. Pat McDonogh, The Courier Journal via USA TODAY NETWORKFullscreen
Paulette Brown gets the Moderna vaccine, Jan. 3, 2021 during the Florida Division of Emergency Management’s vaccination point distribution at Brownsville Community Center in Pensacola, Fla. John Blackie, Pensacola News-Journal via USA TODAY NETWORKFullscreen
April Smith, RN, puts a bandage on Jeanne Biada, 66, after vaccinating her and her husband, Gregory Biada, 68, during a COVID-19 vaccine distribution run by the Collier Department of Health at North Collier Regional Park in Naples. Fla. on Jan. 4, 2021. Alex Driehaus, Naples Daily News via USA TODAY NETWORKFullscreen
Herbert Bello, 88, receives the Moderna COVID-19 vaccine in the King’s Point clubhouse in Delray Beach, Fla. on Dec. 30, 2020. GREG LOVETT, Palm Beach Post via USA TODAY NETWORKFullscreen
Seniors stand in line to make an appointment to receive the Moderna COVID-19 vaccine outside the King’s Point clubhouse in Delray Beach, Fla. on Dec. 30, 2020. GREG LOVETT, Palm Beach Post via USA TODAY NETWORKFullscreen
Kellie Grover, left, receives her first dose of the Moderna COVID-19 vaccine through the Knox County Health Department at the Knoxville Expo Center on Monday, January 4, 2021.
Brianna Paciorka, News Sentinel / USA TODAY NetworkFullscreen
A health-care worker reacts as she receives the COVID-19 vaccine at Lake-Sumter State College in Leesburg, Fla., on Friday, Jan. 1, 2021. Long lines of cars were at the site as the Lake County vaccines are currently being given to people who are 65 years and older and front line workers. Stephen M. Dowell /Orlando Sentinel via APFullscreen
Nurse Shanteria Johnson, who is with the Medical Reserve Core at the Alachua County Health Department, draws a dose of the Moderna COVID-19 vaccine during a vaccination session for local firefighters at the Gainesville Professional Firefighters Union Hall in Gainesville Fla., Dec. 31, 2020. Brad McClenny, The Gainesville Sun via USA TODAY NETWORKFullscreen
Cape Coral residents wait in line to receive a COVID-19 vaccine on Dec. 30, 2020 during first day of vaccinations in the city at Cultural Park Theater. The Florida Department of Health in Lee County is offering COVID-19 vaccine to high-risk frontline health care workers and those 65 and older. Ricardo Rolon, The News-Press via USA TODAY NETWORKFullscreen
Winona McCain, 71, a resident at Patewood Rehabilitation and Healthcare Center in Greenville, S.C., raises her fist after receiving the Moderna COVID-19 vaccine from Jamie, a pharmacist with CVS on Dec. 28, 2020. MATT BURKHARTT, The Greenville News via USA TODAY NETWORKFullscreen
Friends Terri Kado,66, right and Patty Tubbs,68, from Fort Myers Beach wait in line for the the COVID-19 vaccine in the early morning hours of Dec. 30, 2020 at Lakes Park Regional Library in Fort Myers, Fla. The two were having a pleasant experience and were watching the moon as it moved through the sky. To them the vaccine brings a peace of mind and a positive start to the New Year. They got in line at 12:00 a.m. on Wednesday. Andrew West/The News-Press, The News-PressFullscreen
CHEMED nurse and vaccine coordinator Tzipporah Zar shows a sticker patients get after they get their first shot of the Moderna COVID-19 vaccine at the Center for Health Education, Medicine and Dentistry in Lakewood, N.J., on Dec. 28, 2020. Gustavo Martinez Contreras, Asbury Park Press via USA TODAY NETWORKFullscreen
Corpus Christi-Nueces County Public Health District personnel administer COVID-19 vaccinations to colleagues during a test drive-thru event at the Richard M. Borchard Regional Fairgrounds in Corpus Christi, Texas on Dec. 23, 2020. Courtney Sacco, The Corpus Christi Caller Times via USA TODAY NETWORKFullscreen
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Jessica Miles, left, of CVS, gives resident Wanda Kilgore a Moderna COVID-19 vaccine at Linley Park Rehabilitation and Healthcare in Anderson, S.C., Dec. 29, 2020. The first dose of the vaccine was administered to 51 residents and 32 staff, with the second dose planned for Jan. 26, 2021. Ken Ruinard, Anderson Independent Mail via USA TODAY NETWORKFullscreen
Pharmacists prepare doses of the COVID-19 vaccine at the Life Care Center of Kirkland on Dec. 28, 2020 in Kirkland, Wash. The Life Care Center of Kirkland, a nursing home, was an early epicenter for coronavirus outbreaks in the U.S. Karen Ducey, Getty ImagesFullscreen
Henry Jackson, an employee of Lee Health in the transportation services department is one of the first front-line workers for Lee Health to get the COVID-19 vaccine. The vaccine was administered at Lee Health Gulf Coast Medical Center in Fort Myers, Fla. on Dec. 22, 2020. Andrew West, The News-Press via USA TODAY NETWORKFullscreen
Chief Nursing Officer Robin L. Steaban, left, who administered the vaccine, stands with nurse practitioner Lisa Flemmons, Dr. Todd Rice, nurse Cody Hamilton and respiratory therapist Sophie Whitaker after they received a COVID-19 vaccine at Vanderbilt University Medical Center in Nashville, Tenn., Dec. 17, 2020. George Walker IV, THE TENNESSEAN via USA TODAY NETWORKFullscreen
The CVS Health team arrives with the Pfizer COVID-19 vaccine at the Sivercrest Health and Rehabilitation Center in Crestview, Fla. on Dec. 21, 2020. This was one of the first administrations of the vaccine in the state. Michael Snyder, The Northwest Florida Daily News via USA Today NETWORKFullscreen
Nurse practitioner Franklin Grauzer receives a high-five from his daughter, Emerson, 5, after he received a COVID-19 vaccine at Ascension Saint Thomas Hospital West in Nashville, Tenn., Dec. 17, 2020. Andrew Nelles, The Tennessean via USA TODAY NETWORKFullscreen
VA pharmacist Wes Romanello carefully fills syringes of the COVID-19 vaccine to give to Chillicothe VA staff in Chillicothe, Ohio on Dec. 23, 2020. Robert McGraw, Chillicothe Gazette via USA TODAY NETWORKFullscreen
VA nurse Sarah Hembre, left, gives Ed Tassy, a veteran who served two tours of duty in Iraq and now works at the VA as a physician assistant, the first Moderna COVID-19 vaccine delivered to the VA on Dec. 23, 2020. The VA received 1,000 doses to give to VA personnel and patients. Robert McGraw, Chillicothe Gazette via USA TODAY NETWORKFullscreen
Dr. Theresa Maresca from the Seattle Indian Health Board (SIHB), lets a collegue write on her arm For the Love of Native People over the spot where she received a shot of the Moderna COVID-19 vaccine, at the SIHB, on Dec. 21, 2020 in Seattle, Wash. The Seattle Indian Health Board (SIHB) received 500 doses of the FDA-approved Moderna COVID-19 vaccine today. Karen Ducey, Getty ImagesFullscreen
A member of FDNY EMS gives a thumbs up while receiving the coronavirus (COVID-19) vaccine on Dec. 23, 2020 in New York City. Members of FDNY EMS were given doses of the Moderna coronavirus (COVID-19) vaccine allotted for the department. Michael M. Santiago, Getty ImagesFullscreen
Dr. Cletus Oppong, who specializes in occupational medicine, is the first to receive the first round of the Moderna vaccine by Clinical Pharmacist Erin Conkright on Dec. 24, 2020, at the Owensboro Health Regional Hospital in Owensboro, Ky. “It’s an exciting day,” said Oppong. Alan Warren, The Messenger-Inquirer via APFullscreen
Command Sgt. Maj. John Raines of the Mississippi National Guard, looks away as he receives a dose of the Moderna COVID-19 vaccine in his arm, by a fellow guard member, Dec. 23, 2020, in Flowood, Miss. One hundred doses of the vaccine were administered to both Mississippi Air and Army National Guard service members who serve as first responders and currently assist with the administering of the COVID-19 test at Mississippi Department of Health drive through community testing sites across the state. Rogelio V. Solis, APFullscreen
Tim King, a citizen of the Cherokee nation and a Cherokee language speaker, receives ther COVID-19 vaccine at the Cherokee Nation Outpatient Health Center Dec. 17, 2020, in Tahlequah, Okla. On his left arm is a tattoo of a dreamcatcher with the word Cherokee. Mike Simons, APFullscreen
Long-term care patient Carlos Alegre receives the Pfizer-BioNTech COVID-19 vaccine from licensed vocational nurse Virgie Vivar at Birch Patrick Skilled Nursing Facility at Sharp Chula Vista Medical Center on Dec. 21, 2020 in Chula Vista, Calif. 72-year-old Alegre is the first patient to receive the vaccine in San Diego County. Long-term care patients and frontline workers are among those in the CDCÕs highest priority group for vaccination. Mario Tama, Getty ImagesFullscreen
Hartford HealthCare employee Wilfredo Rivera reacts after receiving the Moderna vaccine for COVID-19 as Hartford HealthCare Nurse Laura Bailey, right, looks on at Hartford Hospital, Dec. 21, 2020, in Hartford, Conn. Hartford HealthCare was the first in the state to administer the Moderna vaccine. Jessica Hill, APFullscreen
Nursing student Abriana Martinez administers the Pfizer coronavirus vaccine to Dr. Erik Pronske at the University of Texas Health Austin Dell Medical School on Tuesday December 15, 2020. Jay Janner, Austin American-StatesmanFullscreen
Lerma Ballesteros, left, a technical laboratory assistant with Diagnostic Laboratory Services, remains rock steady even as she is administered a Pfizer-BioNTech COVID-19 vaccination during a temporary clinic conducted by Department of Public Health and Social Services workers and other support staff at the Okkodo High School cafeteria in Dededo on Tuesday, Dec. 22, 2020. Rick Cruz/PDNFullscreen
Pharmacy manager John Wininger prepares the COVID-19 vaccine at McLaren Greater Lansing hospital on Thursday, Dec. 17, 2020, in Lansing, Mich. Nick King, Lansing State Journal via USA TODAY NETWORKFullscreen
Marie Branham, right, resident services director at Atria Springdale assisted living community, receives the Pfizer coronavirus vaccine from CVS pharmacist Shereen Keshta at the facility in Louisville, Ky. on Dec. 21, 2020. Sam Upshaw Jr., Courier Journal via USA TODAY NETWORKFullscreen
Rochester General Hospital received the new Pfizer-BioNTech COVID-19 vaccine and started vaccinating some of their high-risk healthcare workers on December 15, 2020. Nancy Nicoletta, assistant director of pharmacy, brings up a bag of the vaccine. The vaccine has to be kept at a very cold temperature. Tina MacIntyre-Yee/ Rochester Democrat and ChronicleFullscreen
Boxes containing the Moderna COVID-19 vaccine are prepared to be shipped at the McKesson distribution center in Olive Branch, Miss. on Dec. 20, 2020. While shipments of the vaccine are rolling out to many health care workers and nursing homes across the country, it could be months before itÕs available for the general public. Paul Sancya, APFullscreen
Dr. Julie Kennerly-Shah draws out a dose of the Pfizer COVID-19 vaccine as its distributed to healthcare workers on Tuesday, Dec. 15, 2020 at Ohio State University Wexner Medical Center East in Columbus, Ohio. Vaccine shipments began arriving in Ohio on Monday and frontline health care workers have been the first to receive the vaccine. Joshua A. Bickel, Columbus DispatchFullscreen
RN Gisela Bunch administers the vaccine for COVID-19 to CVI outreach coordinator Lynde Sain at Methodist Le Bonheur Germantown Hospital in Germantown, Tenn., on Dec. 17, 2020. Ariel Cobbert, The Commercial Appeal via USA TODAY NETWORKFullscreen
Allison Wynes, a University of Iowa Hospitals and Clinics (UIHC) nurse practitioner, records a video for her friends announcing she had received one of first doses of the Pfizer-BioNTech COVID-19 vaccine at the hospital, Monday, Dec. 14, 2020, on the 12th floor of the University of Iowa Stead Family Children’s Hospital in Iowa City, Iowa. Joseph Cress/Iowa City Press-CitizenFullscreen
Sandra Lindsay, left, a nurse at Long Island Jewish Medical Center, is inoculated with the Pfizer-BioNTech COVID-19 vaccine by Dr. Michelle Chester, Monday, Dec. 14, 2020, in New York. Mark Lennihan, APFullscreen
Courtney Schneider, 40, of Grand Rapids and her son, Elliot Schneider, 8, of Grand Rapids wave flags at the FedEx plane carrying the Pfizer COVID-19 vaccine at the Gerald R. Ford International Airport in Grand Rapids, Mich. on Dec. 13, 2020. Rodney Coleman-Robinson, Detroit Free Press via USA TODAY NETWORKFullscreen
Susan Deur of Plainwell, center, and Nancy Galloway of Plainwell, applaud and cheer as they watch the trucks carrying COVID-19 vaccine leave at Pfizer Global Supply in Portage, Mich., Dec. 13, 2020. Junfu Han, Detroit Free Press via USA TODAY NETWORKFullscreen
Boxes containing the Pfizer-BioNTech Covid-19 vaccine are prepared to be shipped at the Pfizer Global Supply Kalamazoo manufacturing plant in Kalamazoo, Mich. on Dece. 13, 2020. POOL PHOTO BY MORRY GASHFullscreen
Nurse Chris Nelson gets the COVID-19 vaccine at Cape Fear Valley Medical Center on Tuesday, Dec. 15, 2020. Andrew Craft, USA TODAY NetworkFullscreen
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Just as important as a national testing plan is the president’s call for better data reporting and a willingness to level with the American public, Frieden said.
“President Biden has been very clear: We’re in it together,” he said. “It’s going to get worse before it gets better. These are all hard truths and important facts that need to be shared and lived. And they have been ignored for a year.”
‘Make a big difference’
The plan calls for federal agencies to use the wartime Defense Production Act to fix persistent shortages of testing and vaccine supplies, as well as protective equipment such as gowns, gloves and N95 masks.
When labs run out of critical supplies such as chemical reagents, plastic tips or swabs, it delays or prevents a lab’s ability to complete a test, said Dr. Patrick Godbey, president of the College of American Pathologists.
Godbey said labs finish tests within hours when all supplies are on hand. When labs can’t get supplies, some must ship samples to other labs to test, which delays results two days or more.
“I still can’t do all the tests I’d like to do,” said Godbey, laboratory director of Southeast Georgia Regional Medical Center in Brunswick. “If we can’t get the reagents necessary, we measure turnaround time in days.”
When testing demand surged this summer in Sun Belt states, labs in communities hard hit by COVID-19 routinely took one week or longer to complete results. Supply shortages snarled results at small and large labs alike.
At home tests?Companies attempt to make coronavirus tests widely available
Public health labs have faced persistent shortages in testing materials since the beginning of the pandemic.
“Those are the kinds of situations where having the federal government step in can make a big difference,” Plescia said.
Biden’s plan calls for federal agencies to use the Defense Production Act or other “appropriate authorities” to accelerate manufacturing of a dozen types of supplies: N95 masks, gowns, gloves, test swabs, reagents, plastic pipette tips, testing machines, swabs, needles and syringes, rapid test kits and material for rapid antigen tests. The federal government can use the act to compel private companies to make critical supplies for national defense or national emergencies.
“We still have supply chain issues that we hope this (Biden’s plan) will address,” Godbey said.
Biden pushes rapid testing
Biden calls for wider use of rapid tests to complement lab testing in settings such as schools.
Molecular PCR (polymerase chain reaction) tests processed at labs remain the gold standard of accurate testing, but they are more expensive and results can take days to process. Rapid antigen tests can be performed outside labs and deliver results in 15 minutes.
Under the Trump administration, the U.S. Department of Health and Human Services purchased rapid testing machines for use in nursing homes nationwide. HHS bought 150 million Abbott BinaxNow portable, rapid tests tests for states, nursing homes, the Indian Health Service and historically Black colleges and universities.
Only one rapid test, made by Australia-based Ellume, has gained U.S. Food and Drug Administration authorization for home use without a medical provider’s prescription. Several other companies are developing tests they hope to sell directly to consumers.
The Biden plan will establish a CDC support team to “fund rapid test acquisition and distribution for priority populations, work to spur development and manufacturing of at-home tests and work to ensure that tests are widely available.”
The rapid tests are typically less sensitive than lab tests, which means they might not detect the virus in some cases. It’s a scenario that concerns lab experts such as Godbey.
“I worry about inaccurate testing,” Godbey said. “Bad tests are worse than no tests at all.”
Others argue rapid testing makes sense when done frequently because they are likely to quickly detect when a person is infectious and prone to spread the virus to others.
“Even if the individual test lacks a certain sensitivity, you do that test on a frequent basis, that can really add a great deal of population security,” said William Schaffner, a Vanderbilt University School of Medicine professor of preventive medicine and an infectious disease doctor.
He said it makes sense to deploy rapid tests in settings such as schools. If students, teachers and other employees are tested frequently with rapid tests, parents can gain confidence the school is safe.
“All of the sudden, the economy gets stimulated again because the parents can go to work,” Schaffner said.
Michael Mina, a Harvard epidemiologist who has advocated for rapid antigen tests, said such testing can be quickly deployed. If the Biden administration authorizes the purchase and widespread use of these tests, they can be shipped directly to Americans homes, and “we can start seeing cases plummet.”
“If we can do that, we can start to see cases come down dramatically across the country within weeks in a way that vaccines could never do in these first 100 days,” Mina said.
Contributing: Karen Weintraub