Congress steps up on testing and tracing
Even though the Trump administration is eager to ease up on the coronavirus lockdown, it isn’t providing the leadership that would allow a safe reopening to occur. Fortunately, Congress has begun to fill the void. The latest round of COVID-19 emergency legislation includes $25 billion for expanded testing and contact tracing capacity across the country. The next bill should build upon this foundation.
There is broad agreement on what needs to happen next in the coronavirus battle. Without an effective treatment or vaccine, a resumption of economic activity carries risks for public health unless new outbreaks can be contained quickly. More testing across larger segments of the population, including asymptomatic individuals, is needed for rapid identification of new cases. Further, public health workers need to be able to locate persons who may have contracted the virus because of contact with COVID+ patients. Anyone who tests positive should self-isolate for a period of two weeks, perhaps by relocating to hotels and other facilities converted into temporary treatment and quarantine locations. Some individuals who contract the SARS-CoV-2 virus may need financial support to offset income lost from an absence from work. All of this will require resources.
The Trump administration wants the states to take the lead, but the states are hemorrhaging revenue from a collapsing economy. Most governors are concerned about meeting their existing obligations and see no possibility of taking on substantial additional commitments. Only the federal government has the capacity to borrow funds in public markets commensurate with the severity and urgency of the current crisis.
Congressional leaders recognized that states could not do what is needed on their own and insisted on including the federal $25 billion investment in the fourth emergency bill, signed by President Trump on April 24th. The funds are to be allocated as follows:
- $11 billion for the States, Territories, and Native American Tribes, to support acquisition of tests, scale up lab processing capacity, and hire contact tracers;
- $1 billion for the Centers for Disease Control and Prevention (CDC) to enhance its capacity to provide national coordination of this effort and to broaden and modernize its surveillance capacities;
- $1.8 billion for the National Institutes of Health (NIH), to speed research on accurate serologic and point-of-care testing kits, and to work without outside researchers and organizations on improved test-processing platforms;
- $1.0 billion for the Biomedical Advanced Research and Development Authority (BARDA) to work with private industry on ramping up production of tests and securing contracts for stockpiling kits and related supplies;
- $0.8 billion for community and rural health clinics, to facilitate their role in administering expanded testing programs; and
- $1.0 billion to pay for testing for the uninsured.
The balance of the funds can be used at the discretion of the Secretary of Health and Human Services (HHS) to pay for construction, leasing, and related expenses to facilitate an expansion of the production of testing kits, and to purchase supplies that will speed up test processing for the states.
The legislation also stipulated that the Secretary must submit a strategic plan for effective nationwide testing during the pandemic within 30 days of enactment of the law. This requirement will force the administration to account for how it will use the funds to build a coordinated and coherent program that maximizes the full testing capacity around the country.
The $25 billion provided in this latest bill is unlikely to be the final word on this subject. Another emergency bill will be required in May to replenish the business support programs that are burning through resources at a rapid rate. Congress is expected to attach additional funding for state and local governments to the bill, and perhaps expanded direct support for American households. It is also likely that more funding will be provided for testing and contact tracing.
A recent bipartisan letter from former public health officials provides a sensible overview of what more needs to be done. Beyond expanded testing capacity, they recommend substantial support for an expanded contact tracing workforce, and direct financial support to COVID+ individuals to improve compliance with self-isolation. Federal funding also could help finance the costs of repurposing hotels, dormitories, and other facilities as temporary isolation locations, perhaps with the ability to provide early treatment for patients suffering from mild symptoms. They estimate their program will cost $46 billion over a period of about eighteen months.
To this point in the crisis, the public has largely cooperated with social distancing protocols, and thus helped slow the spread of the virus. The economic cost has been severe, however. Soon, it will be necessary to allow more people to resume productive work, to prevent even more economic dislocation. The only safe way to reopen, absent better medical interventions, is with rapid identification and isolation of persons who contract the virus. To its credit, Congress has recognized that this is an urgent priority, and is providing the leadership necessary to develop a nationwide solution.
James C. Capretta is a columnist for State of Reform and holds the Milton Friedman Chair at the American Enterprise Institute.