California seeks to test 60,000-80,000 a day for coronavirus

California will have to ramp up COVID-19 testing four to five times today’s level as a key part of its plan for being able to loosen lockdown orders imposed to check the virus’ spread, reaching a level of 60,000 to 80,000 tests a day from the current 16,000, Gov. Gavin Newsom said Wednesday.

Newsom’s announcement came as governors across the country are facing pressure to ease devastating stay-home orders that have shut schools and businesses and hammered the economy, while also trying to avoid a resurgence of new cases that could overwhelm hospitals. Newsom continued to stress there is no time frame for reopening.

“I wish I could provide a specific date and say we’ll turn on a light switch and go back to normalcy,” Newsom said, but added that testing for COVID-19 and tracing those exposed to the infected “will be foundational” to reopening. “The clarity we are providing today is the clarity of indicators that will guide that decision.”

Newsom’s announcement came as the state’s hospitalizations and intensive care needs for those sickened with the respiratory illness have continued to plateau, and he announced the first small step forward in easing his stay-home order — resuming non-emergency surgeries.

Elective surgeries had been halted throughout the state to free up medical resources for treating coronavirus patients, but the governor said the state has had enough success “flattening the curve” that it’s now in a position to resume things like heart operations or tumor removal. Purely cosmetic procedures are still on hold.

“The stay at home order as it currently is drafted is working,” Newsom said. “We have flattened the curve and created stability to allow us this first announcement. Continue to practice physical distancing, and we will be making more announcements sooner than we otherwise would. If we pull back too soon, those announcements will not be forthcoming.”

Experts agree more coronavirus testing to confirm infections is key to corralling the contagion and easing the stay-home orders. It is not only first among Newsom’s six conditions but also a key part of the White House’s three-phase guidelines for states on reopening.

But while health officials and government leaders have said they are short of being able to test those who might be infected and others close to them because of supply and logistical constraints, they have not indicated how much testing capacity needs to increase to reach that goal.

In New York, the state hardest hit by the outbreak, Governor Andrew Cuomo said this week his administration plans to double its testing capabilities, from a current average of 20,000 to 40,000 a day. But he made clear that goal may be a stretch.

“If you took every machine we had and they had all the supplies they needed from the national manufacturers and you ran that machine seven days a week, 24 hours a day, how many tests could you do? About 40,000,” Cuomo said in his Wednesday news briefing. “Might be a little unrealistic. But I’d rather set the bar high and try to get there and then whatever we get is what we get.”

Newsom said California, with more than 600 testing sites, has the capacity “if 100 percent were full throttle and everybody was being tested and all supply chains are intact” to conduct about 95,000 tests a day. He set his goal below that out of ongoing concern about supplies needed to conduct and process tests.

Newsom said surveys of testing labs found that more than half cited a shortage of nasal swabs needed to retrieve samples as their biggest obstacle. He said he was encouraged by a phone call with President Donaldl Trump earlier in the day who promised to deliver 100,000 swabs this week and 250,000 next week.

“I want to thank the president for being willing to directly commit to all of us in the state of California a substantial increase in the supply of swabs,” Newsom said.  “That gives us confidence we can meet these goals.”

How long will it take California to reach 60,000 to 80,000 tests a day? Newsom said the state already exceeded its goal of 10,000 tests a day by April 14, up from 2,000 a day in March, and that he expects the state to meet its next goal of 25,000 by the end of the month.

“Eighty thousand is within the range we think we can achieve,” Newsom said.

New York has led the country in cases and, according to a recent analysis, in testing as well, with more tests conducted in total and one of the highest rates of testing per capita among the states. California conducted the second-most tests in total among the states but with a population roughly twice New York’s, the Golden State’s testing per capita is among the lowest among the states, the analysis found.

How much testing is needed has been a subject of robust debate. Newsom alluded to that in his Tuesday briefing, when he said “depending on who you talk to, people will suggest we need to be doing a minimum of 1 percent of our population every week. Others say it needs to be every day.”

To put that into perspective, 1 percent of California’s nearly 40 million residents is 400,000 people. To reach 400,000 tests a week, California would need to average more than 57,100 tests a day, nearly four times today’s level. To test 400,000 a day, the state would have to increase its current capacity almost 28 times.

The U.S. is averaging about 150,000 COVID-19 tests a day now. Harvard researchers have indicated 500,000 to 700,000 tests a day are needed. Former Food and Drug Administration Commissioner Scott Gottlieb has said that the country will need to initially conduct up to 3 million tests a week — about 429,000 a day — to reopen.

But Newsom added on Tuesday that the question gets more complicated than that, as people might need to be retested multiple times, because someone who tests negative for the virus one day might catch it the next. On Wednesday, he said the 60,000-80,000 daily test figure was based on an assessment of needing to test 152 people per 100,000.

California Health and Human Services Secretary Dr. Mark Ghaly said Wednesday that goal was based on assumptions about the number of new cases each day, with an expected boost when the lockdown eases, the needs for testing health care workers and an average 10 people exposed to the newly infected.

Newsom said California will be opening up 86 new testing sites throughout the state, with a focus on rural and poorer areas he said have been “testing deserts.” He also said the state plans to assemble a force of 10,000 workers to help trace and monitor close contacts of the newly infected, perhaps with help from smartphone applications his administration is reviewing.

Newsom also said the state expects to be able to conduct 1.5 million blood tests for antibodies that can determine if a person has had the disease already at 130 sites statewide. But he added that while that is helpful in understanding the outbreak, it is not key to managing it and easing the stay-home order.

New York’s Cuomo acknowledged Wednesday that the level of testing and tracing of exposed people now being rolled out across the country has never been attempted before.

“There are a few textbooks that spoke about it, but we’ve never done it and we’ve never done it anywhere near this scale,” Cuomo said. “So it is an intimidating exercise. But I say so what? Who cares that you’ve never done it. It’s what we have to do now, so figure out how to do it.”

Experts concede that although the threat of a widespread deadly pandemic has loomed for decades, and that planning playbooks acknowledged the need for testing to monitor infections, government and health officials at all levels didn’t fully grasp the logistical problems that have emerged to hinder that response.

“Having a pandemic poses these unique challenges,” said Dylan B. George, vice president of technical staff at In-Q-Tel, a Washington, D.C., nonprofit that helps develop national security technologies who worked as a White House senior advisor for biological threats defense from 2014 to 2016. “Reallocating resources from one region to another is much more readily done in a regional epidemic than a pandemic where there are multiple outbreaks.”

In pandemic influenza preparedness studies, George said, “there hadn’t been a visceral understanding it would be this challenging.”

J. Stephen Morrison, senior vice president at the Center for Strategic and International Studies, a Washington, D.C. research organization, and director of its Global Health Policy Center, said the constraints on reaching adequate testing across the country have been “shocking to everyone.”

“Bear in mind, this is a hundred-year pandemic, this is an unusual, transformative-type thing we’re facing here,” Morrison said. “We’re much more accustomed natural disasters that are more localized or regionalized, where you can concentrate your response… I don’t think anybody imagined this.”