US needs national COVID 'smart testing' strategy, APHL says

As the United States starts off 2021 with COVID-19 vaccines as well as variants, the Association of Public Health Laboratories (APHL) reasserts the importance of strategic COVID-19 testing strategies with a report published late last week.

In the report, "Smart Testing for Optimizing Pandemic Response," the group recommends a coordinated national approach, supply chain management, and a focus on using test results as a means to improve public health surveillance.

"We've outlined a range of steps that will strengthen our response to COVID-19 now along with actions to ensure that we are better prepared for future pandemics," said Kelly Wroblewski, MPH, director of infectious diseases at APHL, in a press release. "This, of course, requires adequate funding for our nation's public health laboratories so they are amply equipped and sufficiently staffed."

Securing supplies via coordination, stockpiles

At the start of the COVID-19 pandemic, the Centers for Disease Control and Prevention's (CDC's) original test difficulties opened the door to an explosion of lab-developed tests, commercial tests, and other testing-related services and added more chaos to chronic shortages and uncoordinated testing approaches, writes the APHL.

"It is imperative that, in order to make the best use of scarce testing resources including supplies, equipment, and testing personnel, that we develop and implement a coordinated testing strategy for where we are in the current pandemic, plan for post-vaccine testing, and develop a plan to ensure optimal and appropriate use of laboratory testing for future infectious disease threats," the report says.

For future public health emergencies, the APHL recommends that the government chooses a few screening and point-of-care tests, creates consistent and coordinated administration guidelines, and develops streamlined training processes. Communication to the public around test availability and the implications of test results should also be more consistent and clear.

New tests will inevitably be developed as well, says the APHL, so US Food and Drug Administration regulations should be retooled to slot somewhere between the dashed-together changes used at the beginning of the pandemic and the minimal emergency-use-authorization requirements. A stockpile of materials like reagents and laboratory plastic consumables should also be established, and necessary testing instruments should be standardized across low-, medium-, and high-throughput testing needs for ease of distribution.

Need for a national strategy

During a public health emergency, the CDC and public health laboratories take on the initial brunt of testing, but eventually those duties shift to commercial and clinical labs, the report writes. While this transition has been made rockier by issues with the CDC test and what the APHL describes as a lack of federal leadership, the way forward is a unified plan that both dictates data interpretation and leaves room for flexibility.

If the US government continues to forgo a national testing strategy, the APHL recommends that professional organizations unite and create their own agreed-upon testing strategies. For examples of strategic outcomes, the association points to the May 20, 2020, Center for Infectious Disease Research and Policy (CIDRAP) COVID-19 Viewpoint report, "Smart Testing for COVID-19 Virus and Antibodies," which discusses appropriate infrastructure, priority populations, data interpretation, and actionable measures off the data. CIDRAP, at the University of Minnesota, publishes CIDRAP News.

As COVID-19 vaccines become more commonplace, the APHL concludes that public health laboratories may want to begin focusing on evaluating vaccine efficacy and viral surveillance.

"Similar to influenza surveillance such testing should be prioritized with baseline targets established using a statistical approach," the report states. "The [virologic surveillance] system should be geographically and demographically representative and include a pathway to conduct additional studies to further characterize genetic mutations."

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