Source: United States House of Representatives – Congressman Jimmy Panetta (D-Calif)
SALINAS, CA – Congressman Jimmy Panetta (D-Carmel Valley) joined 63 Representatives in calling on Administration officials for improved testing and contact tracing infrastructure in order to manage the novel coronavirus, citing an inadequate and opaque response by the Administration that is insufficient to prevent epidemic spread and reopen the economy. In their letter, they demanded answers to increase transparency, accountability, and improve management of the novel coronavirus.
The members wrote, “Until a vaccine or viable treatment strategy is developed, ongoing testing, isolation, monitoring, and contact tracing is necessary to contain the epidemic, prevent future spikes, and reopen the economy. Despite the surge in private lab capacity and work by our local public health professionals, we have not built up sufficient testing and contact tracing capabilities to adequately manage the novel coronavirus.”
The signed full text of the letter is available here and below.
April 29, 2020
Director Robert R. Redfield
Centers for Disease Control and Prevention (CDC)
1600 Clifton Road,
Atlanta, GA 30329
Vice President Mike Pence
White House Coronavirus Task Force
1600 Pennsylvania Avenue, NW
Washington, DC 20502
Secretary Alex M. Azar II
Department of Health and Human Services (HHS)
200 Independence Avenue S.W.
Washington, D.C., 20201
Adm. Brett P. Giroir, M.D.
Assistant Secretary for Health, HHS
Testing Czar, White House Coronavirus Task Force
Dear Director Redfield, Secretary Azar, Adm. Giroir, and Vice President Pence:
Until a vaccine or viable treatment strategy is developed, ongoing testing, isolation, monitoring, and contact tracing is necessary to contain the epidemic, prevent future spikes, and reopen the economy. Despite the surge in private lab capacity and work by our local public health professionals, we have not built up sufficient testing and contact tracing capabilities to adequately manage the novel coronavirus.
The actual number of Americans who have been exposed to or infected with the coronavirus is unknown because of the insufficient testing infrastructure. Testing not only allows for diagnosis and treatment, but also establishes how widespread a virus is. When public health experts know the size of the problem, they can analyze the rate at which people are hospitalized or die, and can follow its movements, making recommendations to policymakers on best management practices.[i] CDC does not publicly share comprehensive testing data despite the requirement in Families First Coronavirus Response Act that gave CDC access to that data.[ii] Instead, Americans, including policymakers, are relying on the volunteer heroism of The COVID Tracking Project to access daily testing information, rather than the appropriate primary source, the Centers for Disease Control and Prevention.[iii]
Of those who do get tested for the coronavirus in the United States, nearly one in five people is found to have it. The U.S. therefore has a “test-positivity rate” of nearly twenty percent.[iv] When compared to other infectious diseases, hypothetically a managed COVID-19 might look like a test-positivity rate around one percent. Other countries are managing COVID more effectively. For example, South Korea has a positivity rate of around two percent.[v] Enough testing is necessary to reach a lower test positivity rate that manages COVID-19 and prevents epidemic spread. For a sense of scale, we have performed around 5 million tests to date in total, but at our current rate of confirmed cases, we would need to have run more than 70 million tests.[vi] Some experts argue that we should currently run up to 20 million tests a day, not 200,000.[vii] Given the sheer scale of testing needed, only the federal government has the means to incentivize increased production of diagnostic tests, swabs, reagents and other elements necessary to meet this scale while also controlling the supply chain.[viii] Reagents, swabs, personal protective equipment, and testing kits are all in short supply.
Data from Wuhan, China showed that social distancing alone could not bring the virus’ spread rate low enough to lift the restrictions.[ix] In order to manage COVID-19 and reopen the economy, we must reduce the epidemic to case-based management which requires increased testing and contact tracing. Sufficient public health infrastructure to contact trace makes it possible to proactively identify cases, identify contacts, and follow up on those contacts. We currently do not have enough staff in public health departments to do contact tracing. Right now, our system is unable to contact trace for every confirmed positive test result, much less every diagnosed case.[x] Former CDC Director Thomas R. Frieden recommended “an army” of 300,000 contact tracers for the whole country, comparing it to the Depression-era Civilian Conservation Corps.[xi] Massachusetts and San Francisco themselves have set up pilot contact tracing programs.[xii] Other countries found more success when incorporating digital surveillance as a component of their contact tracing regime.[xiii] Google and Apple announced plans to help trace coronavirus exposure risks, but not much clarity has been provided since.[xiv]
Given these considerations, we request the following responses by May 13, 2020:
- We request that daily updates on the number of individuals being tested from all public and private lab infrastructure, including a breakdown between antibody testing and active coronavirus testing.
- Congressional legislation has repeatedly allocated funding for surveillance and testing to the CDC, can you please indicate state and insular area allocations for funding and what that money is being used for and in what amounts?
- How many diagnostic tests have you identified are needed daily to consider COVID-19 managed? When do you expect we will be without the need for CDC guidelines for who can be tested?
- Do you have a system for people diagnosed but not tested or those who self-identify for COVID-19 so they can be updated on antibody testing? What information are you providing to the public on antibody tests, specifically those that the FDA waived quality assurance on?
- Do you have a national surveillance strategy? How do you plan to conduct surveillance? Is there a plan to focus on certain populations that are disproportionately impacted like those in elder care facilities?
- What information and reporting standards are being developed to more effectively collect data?
- What is being done to incentivize domestic manufacturing of testing supplies? How is Congress being updated on this information and how frequently can we expect to be updated?
- What is being done to address the supply chain issues that inhibit increased testing capacity?
- What guidance is being given to hospitals to share with COVID-19 diagnosed, but not tested patients? Or for providers to share with those who are caring for COVID-19 discharge patients?
- Director Redfield previously noted that it was “premature” to say how CDC would expand contact tracing, but that planning was “far along.” What is CDC’s contact tracing strategy, beyond just funding allocations?
- Can you provide the number of contact tracers the United States currently has?
- Is there a federal plan to help expedite training for new contact tracers, beyond funding to local jurisdictions?
- What communication has this Administration had with Google and Apple about digital contact tracing and what is being done without private industry to look at digital contact tracing infrastructure?
[i] Cain, P. (2020, April 26). What does doing enough coronavirus testing look like? Here’s a number to watch. Retrieved April 29, 2020, from https://globalnews.ca/news/6841144/enough-coronavirus-testing-number-to-watch/;
Robinson Meyer, A. C. M. (2020, April 17). A New Statistic Reveals Why America’s COVID-19 Numbers Are Flat. Retrieved April 20, 2020, from https://www.theatlantic.com/technology/archive/2020/04/us-coronavirus-outbreak-out-control-test-positivity-rate/610132/;
Scott, D. (2020, March 16). Coronavirus is exposing all of the weaknesses in the US health system. Retrieved April 29, 2020, from https://www.vox.com/policy-and-politics/2020/3/16/21173766/coronavirus-covid-19-us-cases-health-care-system
[iii] Meyer, Robinson, et al. “Most Recent Data.” The COVID Tracking Project, Mar. 2020, www.covidtracking.com/data;
CDC. Testing in the U.S. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/testing-in-us.html;
Lopez, G. (2020, April 24). America’s coronavirus testing is increasing. It’s still not enough. Retrieved April 29, 2020, from https://www.vox.com/2020/4/24/21232955/coronavirus-testing-covid-19-contact-tracing-trump;
Kates, Jennifer, et al. “What Testing Capacity Do We Need?” The Henry J. Kaiser Family Foundation, 17 Apr. 2020, www.kff.org/coronavirus-policy-watch/what-testing-capacity-do-we-need/.
[vii] Yong, E. (2020, April 15). Our Pandemic Summer. https://www.theatlantic.com/health/archive/2020/04/pandemic-summer-coronavirus-reopening-back-normal/609940/;
Morrison, S. (2020, April 24). Why America’s coronavirus testing problem is still so difficult to solve. https://www.vox.com/recode/2020/4/24/21229774/coronavirus-covid-19-testing-social-distancing;
Whitcraft, T et al. (2020, April 20). ‘Road map’ to recovery report: 20 million coronavirus tests per day needed to fully open economy. https://abcnews.go.com/US/road-map-recovery-report-20-million-coronavirus-tests/story?id=70230097;
Kates, Jennifer, et al. “What Testing Capacity Do We Need?” The Henry J. Kaiser Family Foundation, 17 Apr. 2020, www.kff.org/coronavirus-policy-watch/what-testing-capacity-do-we-need/
[ix] Wang, P. C., Liu, L., Hao, X., Guo, H., Wang, Q., Huang, J., … Wu, T. (2020, March 6). Evolving Epidemiology and Impact of Non-pharmaceutical Interventions on the Outbreak of Coronavirus Disease 2019 in Wuhan, China. https://www.medrxiv.org/content/10.1101/2020.03.03.20030593v1
[x] Congressional communications, Hospitals and local health departments to Congressman Beyer’s office.
[xiii] Ferretti, L., Wymant, C., Kendall, M., Zhao, L., Nurtay, A., Abeler-Dörner, L., … Fraser, C. (2020, March 31). Quantifying SARS-CoV-2 transmission suggests epidemic control with digital contact tracing. Science. https://science.sciencemag.org/content/early/2020/04/09/science.abb6936