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Technology Opinion: Four crucial lessons for improving Covid-19 testing

23:40  08 april  2021
23:40  08 april  2021 Source:   cnn.com

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Even as the number of administered Covid-19 vaccines grows, America's need for reliable access to Covid-19 testing will extend well into the future. As the Centers for Disease Control and Prevention notes, early data suggesting fully-vaccinated people are less likely to spread Covid-19 are promising, but "we're still learning how well Covid-19 vaccines keep people from spreading the disease" as well as "how effective the vaccines are against variants of the virus." Given this continued risk, it is important that the federal government remains focused on testing.

SYDNEY, AUSTRALIA - MAY 15: Registered Nurse Laxman Adhikari conducts a nasal swab test in the clinical assessment room at St George Hospital COVID-19/ Flu Assessment Clinic on May 15, 2020 in Sydney, Australia. St George Hospital has been operating a COVID-19 and flu assessment clinic since 19 March 2020. Since being set up in response to the global coronavirus pandemic, approximately 4107 patients have visited the clinic (as of 13 May 2020), an average of 513 patients per week or 75 per day. The COVID-19 clinic operates seven days a week and is staffed by a team of doctors, nurses, admin support workers, wardspersons and cleaners. All patients are provided with education regarding COVID-19 symptoms, home isolation requirements, hand and respiratory hygiene. If they meet testing criteria, a nose and throat swab is collected. Patients who have been tested are given masks to take home and further information on how to register for AutoSMS or NSW Service App to retrieve their results. While testing in Australia was initially restricted to people who had been in contact with a confirmed COVID-19 case or had severe symptoms, as the country's confirmed infection rate continues to decline and restrictions on social distancing and gatherings begin to ease around the country, Australians with even the mildest symptoms are now being urged to get tested to avoid any coronavirus infection flare ups. In New South Wales nearly 346,000 people have been tested for COVID-19 (as of 14 May 2020), which is one of the highest testing rates in the world. (Photo by Lisa Maree Williams/Getty Images) © Lisa Maree Williams/Getty Images AsiaPac/Getty Images SYDNEY, AUSTRALIA - MAY 15: Registered Nurse Laxman Adhikari conducts a nasal swab test in the clinical assessment room at St George Hospital COVID-19/ Flu Assessment Clinic on May 15, 2020 in Sydney, Australia. St George Hospital has been operating a COVID-19 and flu assessment clinic since 19 March 2020. Since being set up in response to the global coronavirus pandemic, approximately 4107 patients have visited the clinic (as of 13 May 2020), an average of 513 patients per week or 75 per day. The COVID-19 clinic operates seven days a week and is staffed by a team of doctors, nurses, admin support workers, wardspersons and cleaners. All patients are provided with education regarding COVID-19 symptoms, home isolation requirements, hand and respiratory hygiene. If they meet testing criteria, a nose and throat swab is collected. Patients who have been tested are given masks to take home and further information on how to register for AutoSMS or NSW Service App to retrieve their results. While testing in Australia was initially restricted to people who had been in contact with a confirmed COVID-19 case or had severe symptoms, as the country's confirmed infection rate continues to decline and restrictions on social distancing and gatherings begin to ease around the country, Australians with even the mildest symptoms are now being urged to get tested to avoid any coronavirus infection flare ups. In New South Wales nearly 346,000 people have been tested for COVID-19 (as of 14 May 2020), which is one of the highest testing rates in the world. (Photo by Lisa Maree Williams/Getty Images)

Indeed, in January, the Government Accountability Office warned that without a comprehensive national testing strategy, "[the US Department of Health and Human Services] is at risk of key stakeholders and the public lacking crucial information to support an informed and coordinated testing response."

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Around the same time, President Joe Biden announced actions as part of the National Strategy for Covid-19 Response and Preparedness to improve availability of tests and prepare for the threat of variants. These efforts focus on schools and congregate care settings, increasing manufacturing of tests and genome sequencing.

As the government works to expand and improve Covid-19 testing, federal health care programs' experiences with testing during the early months of the pandemic are instructive. It is important that policymakers use this information to ensure that tests are effective, payment rates are set appropriately, testing efforts work as intended and testing is available to those most in need.

The Pandemic Response Accountability Committee, PRAC, created by Congress to conduct oversight of emergency pandemic spending and comprised of federal inspectors general, issued a January 2021 report, "Federal COVID-19 Testing Report: Data Insights from Six Federal Health Care Programs," that analyzed Covid-19 testing data collected in several diverse federal health programs from February through August 2020 to provide policymakers with objective, data-driven insights. These programs administered or paid for Covid-19 tests in the populations they serve, including Medicare Part B beneficiaries, military personnel and federal inmates. The data illuminated potential gaps and offer four key insights that can help inform the way forward for both federal and non-federal testing programs.

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First, at a macro level, the federal health care infrastructure is not currently designed for massive public health efforts. Data show most testing in the federal health programs was for the purpose of diagnosing current infections, as opposed to antibody tests that are primarily valuable for understanding the virus' epidemiology in the general population and identifying groups at risk for infection. This is not surprising. Many of these programs, historically distinct from the public health infrastructure, pay for services such as testing that are medically necessary and provided to individuals, rather than non-diagnostic testing done for public health surveillance purposes that meets broader public health goals. This continues to be the case during the pandemic as programs such as Medicare Part B cover only diagnostic testing. Moving forward, policymakers should consider how the federal health care system can better aid public health testing needed during a pandemic.

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Second, quick test results are imperative for patients and for an effective public health response. But information about test processing times was not readily available in all federal health programs included in the PRAC report. This meant that programs, including Medicare Part B and the Federal Employees Health Benefits Program, reimbursed providers of tests without knowing whether the tests were timely enough to enable people to make informed health care decisions such as whether to isolate from others. Some programs that collected data on test processing times reported improvements in the speed of testing over time. To further improve testing, public and private insurers should consider incentive payment structures that reward labs that return test results quickly. Also promising is the development of effective, affordable rapid point-of-care and home tests.

Third, the average costs for tests varied across federal programs. These variations likely reflect a number of factors, such as use of different types of tests, cost of supplies and the reimbursement policies for each program. However, given the sizeable taxpayer investment in Covid-19 testing, this variation warrants further study to ensure that payment for tests is economical and that programs are not overpaying for tests.

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Fourth, the PRAC report found that, for programs with available data, Covid-19 test recipients generally represented the demographics of the populations served by those federal health care programs. This raises the important question of whether testing efforts targeted groups within these populations that are disproportionately affected by Covid-19. Programs collected varying levels of demographic data, making it difficult to assess equitable testing practices and access to testing. Government programs need access to more and better multi-dimensional demographic data (including race and ethnicity) about those receiving tests -- such data could be available from sources including federal, state and local organizations. This information would inform policy decisions that target testing efforts and help further monitor public health in disproportionately impacted groups

The PRAC report does not tell the full story of Covid-19 testing nationwide, much of which occurred outside the selected federal health care programs. But it provides instructive data and points towards solutions. It also raises critical questions that decision makers should consider in further refining testing, especially as the country faces new variants:

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  • What factors may hinder the rapid development and deployment of Covid-19 tests?
  • What payment policies are appropriate for testing during a public health emergency?
  • What data is needed to ensure effective and efficient testing efforts?
  • Will testing be available to populations most impacted by Covid-19?

As the PRAC report reflects, reliable, accurate and timely Covid-19 testing data can help end the pandemic. The time to consider these questions is now, while plans for more robust testing infrastructure are underway.

Michael Horowitz wearing a suit and tie smiling and looking at the camera © OIG for the U.S. Department of Justice Michael Horowitz a close up of a woman who is smiling and looking at the camera: Christi Grimm © Courtesy of HHS-OIG Christi Grimm

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