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. – Tests for coronavirus in the United States are disorganized and need coordination at the national level, infectious disease experts said in a new report released Wednesday.
At the moment, the tests aren’t accurate enough to use to make most decisions, including who should go back to work or school, the University of Minnesota team said.
“It’s a disaster,” Mike Osterholm, head of the university’s Center for Infectious Disease Research and Policy (CIDRAP), who released the report, told CNN.
“The tests are very, very important, but we are not doing the correct tests.”
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The amount of testing that has been completed, numbers widely reported by states and by the White House, shows only part of the picture, the report says.
“The data is really screwed up,” said Osterholm. “It is because the public health system is overwhelmed.”
The report has some specific recommendations for diagnostic tests that verify whether someone is currently infected with coronavirus.
The tests are most useful for clinical care of patients, for disease surveillance and contact tracing, and for monitoring frontline workers such as emergency services, doctors and nurses who may have been exposed, recommends the report. People with symptoms should also be tested, he says.
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But the coronavirus test is not yet accurate enough to use it in many other ways, the CIDRAP team said.
The report does not recommend:
• Universal tests in hospital settings
• Testing in schools or other low-risk settings
• Generalized community testing
• Antibody tests to decide who goes back to work
• Immunity passports
It may be useful in evaluating asymptomatic people in long-term care facilities in some cases because they are likely to have many cases, according to the report. “Asymptomatic virus shedding can be detected with a molecular test (that looks for the virus itself) or an antigen test (that looks for important parts of the virus). It is still unclear where, when, and how asymptomatic individuals tested should be. ”
The report also says that antibody tests should be used only with caution. These tests check the blood for evidence of an immune response to the virus and indicate that someone has been infected for a few days or has even cleared an infection. They are most useful for identifying plasma donors used to treat patients or for deciding how to manage patients when standard diagnostic tests are negative, according to the report.
It is unclear whether antibody tests are helpful in evaluating health workers to determine immune status, according to the report.
“We believe that greatly expanding SARSCoV-2 testing is a critical element in our response to covid-19,” the report reads. “For testing to be most effective, coordination across the system and in all jurisdictions is necessary. Ideally, this requires federal guidance, leadership, and support, with strong jurisdictional acceptance at the state and local levels. ”
The report asks the US Department of Health and Human Services. to appoint a panel to supervise and organize the tests. “The panel should include representatives from public health, clinical laboratory, and medicine; product research, development, marketing and support testing laboratories; ethics specialists, law specialists and elected officials, ”he says.
Osterholm noted that some states are combining data from diagnostic tests and antibody tests to make estimates of how many people have been infected. The Food and Drug Administration discourages the use of tests in this way and Osterholm also. “You have to do the right test at the right time to get the right result,” he said. “No one is thinking about it.”
Also, there is not enough coordination to ensure states have the test supplies they need. “This is a system and if a system breaks down anywhere, it breaks down everywhere,” Osterholm said. “What use are the test results if you can’t trust them?”