We Can Solve the Coronavirus-Test Mess Now—If We Want To

From the New Yorker by Atul Gawande

Ed Note: When Atul Gawande speaks, we should listen. He is one of the best thinkers in medicine and an amazing analyst of systems. This article is a bit long, but worth reading! Let’s hope against hope, the Federal Government is listening.

o get out of this pandemic, we need fast, easy coronavirus testing that’s accessible to everyone. From the way people often talk, you might think we need a technological breakthrough to achieve this. In fact, we don’t have a technological problem; we’ve got an implementation problem. We could have the testing capacity we need within weeks. The reason we don’t is not simply that our national leadership is unfit but also that our health-care system is dysfunctional.

Many developed countries have met their testing needs, and ready access to speedy tests has been key to containing outbreaks and resuming social and economic activity. Whether you live in England or South Korea, scheduling is straightforward. No doctor’s order is required. Tests, where indicated, are free. And you typically get results within forty-eight hours.

In the United States, getting a test is anything but easy. Take a look at the Texas public directory of covid-19 testing sites, which features a bold, red-highlighted disclaimer: “ATTENTION: Unless otherwise stated, deductible, co-pay, or co-insurance may apply. May require physician referral or prior authorization. Please call site to confirm.” Congress has mandated that insurers fully cover the costs both of testing and of the medical-office visit that produces the test order. But providers may still require payment until the insurer has confirmed coverage. Some twenty-eight million Americans had no insurance before the pandemic, including eighteen per cent of Texans, and millions more have lost their insurance since it started. Although legislation allowed states to expand Medicaid to cover coronavirus testing-related costs for the uninsured, many states (including Texas) have yet to do so. Health-care providers are left to seek disaster-relief funds to cover testing costs for the uninsured. The Texas disclaimer also warns that its test-site directory is incomplete. On another page, the Web site alerts you to additional considerations to take into account when seeking a test site, including what the screening criteria are (sites vary as to whom they are willing to test); whether the site is covered by your insurer; and what types of tests they provide (some may have only antibody tests, which do not help establish a diagnosis).

Appointments can take days, results days more. Most testing in the United States is done by four companies—Quest Diagnostics, LabCorp, BioReference Laboratories, and Sonic Healthcare. Through early August, results routinely took four days or more, making the tests essentially useless. Times improved only when testing volumes declined, because many people gave up on getting tested. The vast majority of infected Americans, including those with symptoms, never get tested. And we have not even reached the fall, when flu season will hit and coronavirus-testing needs and demand are expected to rise substantially. As the saying goes, it’s as messed up as a pile of coat hangers.