Trump COVID-19 test czar defends record, pledges more tests

Trump administration touts progress on testing as public health experts see need for more urgency

Adm. Brett P. Giroir, assistant secretary for health at the Department of Health and Human Services. (Tom Williams/CQ Roll Call file photo)
Adm. Brett P. Giroir, assistant secretary for health at the Department of Health and Human Services. (Tom Williams/CQ Roll Call file photo)
Posted July 23, 2020 at 6:17pm

The United States is conducting 770,000 COVID-19 tests per day and the average national rate of positive tests over the past week is 9.1 percent, a top federal official said Thursday, touting the statistics although public health experts say more urgency is needed as the nation struggles with the highest number of cases worldwide. 

“We are seeing that our public health measures are starting to make a difference and we are making progress,” said Assistant Secretary for Health at the Department of Health and Human Services Brett P. Giroir in a call with reporters.

Giroir, who oversees testing, said the earliest indicator of a change is the positivity rate. He noted that the seven-day average of positive cases is starting to trend downward after initially flattening. Still, public health experts say the percentage of positive tests should be below 5 percent, and in some hot spots the rate is currently in double digits.

“No one is declaring victory about this,” said Giroir. “We anticipate, and hope and need to continue to work for that in the next couple of weeks, our death rate will come down as well.”

The U.S. has about 26 percent of the world's COVID-19 cases although it has only about 4 percent of global population, according to the Johns Hopkins School of Medicine Coronavirus Resource Center. 

More than 4 million U.S. cases have been diagnosed. Giroir said about 51.7 million tests were administered so far this year. 

Giroir said that recent reports criticizing the turnaround time for COVID-19 test results were taken out of context.

In some areas, patients have waited more than a week to get results. Public health experts such as Richard Besser, former acting director for the Centers for Disease Control and Prevention, have said delays defeat the point of testing, which is to isolate infected people and prevent further transmission. 

“Half of the testing in the country is done either by point of care, which is a turnaround of 15 minutes, or it is done at local hospitals,” said Giroir. “The other half is done by major commercial laboratories, and that’s the stats that we have all been talking about — the Quest, the LabCorp, etc.”

Giroir said the current average national turnaround for commercial lab tests by companies such as Quest Diagnostics, the Laboratory Corporation of America and others is nearly 4.3 days, up 0.8 days from what it was in June. 

“That is not as bad of a number as many people talk about,” said Giroir, adding that officials want to drive that number down through the use of surge testing sites in areas reeling from a high number of cases.

Jennifer Nuzzo, a Johns Hopkins Center for Health Security senior scholar and Johns Hopkins Bloomberg School of Public Health associate professor, said the turnaround time of five days doesn't seem to match the concerns voiced by states about long testing delays.

"A national average turnaround time of under five days sounds faster than I would expect based on what I’ve been hearing from states," she said. "In many states, it seems to be taking seven or more days to get test results. Specimens from hospitalized patients is expedited, but other specimens likely aren’t."

"The critical piece right now is turnaround time. If we can’t get test results back in a timely fashion, it doesn’t matter how many tests we do," she added.

Giroir also spoke positively about testing a pool of samples as a way to increase test capacity, and hinted that more action through emergency use authorizations related to pooling would come from the Food and Drug Administration in the next week or two.

Quest recently received the first FDA authorization for pooling through an effort aimed at boosting efficiency that tests four samples at once. If all samples are negative, then the samples do not have to assessed individually. 

Giroir said that in August he expects 51 million tests to be available for use in the U.S., with 13 million available through rapid point-of-care tests. By September, he expects that number to increase to 65 million tests, with 20 million available at the site of care.

“That point of care is going to go up and improve the turnaround time and the responsiveness,” said Giroir, adding that number could go up through pooling.

Shortages of supplies needed for testing, such as reagents, will remain a challenge, though.

“There is no doubt that reagent supplies will remain tight as long as there is infinite demand, which we have now,” he said.

School safety

Giroir also spoke at length about testing strategies for schools and universities, which are currently planning how and if to incorporate in-person learning this fall.

On Friday, he said, he, National Institutes of Health Director Francis Collins and Centers for Medicare and Medicaid Services Administrator Seema Verma will speak on a call with a large group of university presidents. A different call was held Thursday with representatives from historically Black colleges and universities and the White House.

Giroir did not offer a broad cookie-cutter strategy for colleges to follow but instead said “a lot depends on the rates in the community and the specific demographics of the community.”

He said many universities plan to use a strategy he recommends of surveillance instead of diagnostic testing at university research labs using excess reagents.

“You don’t need an emergency to do surveillance,” said Giroir. “That’s really important. There are a lot of tests that are scientifically proven but have not reached the bar or done the paperwork or had the sponsor to have an EUA with the FDA.”

Giroir said this method and using pooling is being adopted in places like Louisiana State University, and will be incorporated alongside long-term studies on vulnerable populations.

“It does not burden the health care system. It lets colleges keep control with how they want to do it,” said Giroir.