Are we there yet? COVID-19 test and trace in MA still lags

What on earth does that slide mean? You know, the Massachusetts Testing & Tracing Strategy page from the highly anticipated Reopening Massachusetts plan. We were hoping it would provide some clarity and confidence, especially since testing and tracing are the only green lights on the reopening dashboard.Unfortunately, the graphic raises more questions than it answers. Here are a few that come to mind.

1. Why are we only using 1/3 of our available testing capacity now?
2. What good is capacity if we can’t get the tests to the people most in need (symptomatic and high-risk)?
3. How do we know if the actual caseload is declining if testing continues to be underutilized?
4. By July, testing will be available for "all symptomatic individuals, even mild symptoms." Does that mean having symptoms now isn't enough to justify a test? Is it really true that testing won't be available for asymptomatic individuals even by summer?
5. According to the projection, we will be filling all of our available capacity at 45,000 tests per day in just 6 short weeks. However, at that level, we will still be well under the estimated capacity that public health and infectious disease experts are calling for (71,000 – 100,000 tests per day). Why is this an acceptable target?
6. By December, we still remain at the lower end of target capacity, and woefully under it in terms of daily tests administered. What is the plan for getting further ahead of the necessary testing for the ‘second wave’ – and to avoid making the same costly mistake twice?
7. Comparing the testing projections in the plan and what many of us believe is required, should we conclude that the committee doesn't believe the need for more testing is real?
8. There are a variety of tests available currently – some accurate and some no better than a coin flip.
   1. What types of tests are included in these figures at the various timepoints?
   2. In July, is only RT-PCR with nasopharyngeal samples collected by healthcare professionals accounted for? Or are other tests and collection methods included?
   3. Other methods are mentioned in the December description, so does this assume that there is no use of antigen or sequencing based tests until then?
9. If commercial entities increase the availability of at-home testing, how does this factor into the plan?
10. So, thinking through all of this, how can we have a green status on testing capacity now? In July?  Ever?

We have heard repeatedly that adequate COVID-19 testing capacity and contact tracing would be necessary for the safe reopening of our economy.  Until these questions are answered it's hard to be confident.We hope that everything will work out for the best, but we also know that hope is not a substitute for a strategy. Some answers to these questions would be a helpful place to start.

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By Surya Singh MD, president of Singh Healthcare Advisors and healthcare business consultant David E. Williams, president of Health Business Group