Calls for at least $75 billion in additional funding and the CDC to lead with testing protocols
Commits $100 Million in Rockefeller Foundation Funding for Global Coronavirus Response
NEW YORK | July 16, 2020 – As cases of Covid-19 continue to accelerate in more than half of the U.S., and as more states begin to relax restrictions, The Rockefeller Foundation, with support from a bipartisan team of top scientists, industry, technologists, and economists, is launching its second National Covid-19 Testing & Tracing Action Plan. In addition to offering four sets of recommendations, including a national strategy for scaling up the use of Covid-19 screening tests for asymptomatic Americans, the plan requires at least $75 billion be made available for testing. It also calls on the U.S. Centers for Disease Control and Prevention (CDC) to lead in developing screening test protocols so organizations know how to protect against outbreaks and keep the economy functioning.
“America faces an impending disaster,” said Dr. Rajiv J. Shah, President of The Rockefeller Foundation. “We need to scale the nationwide screening test strategy to keep essential institutions and parts of the economy open and functional until there is a vaccine or a more effective treatment. This includes massively increasing availability of fast, inexpensive screening tests to identify asymptomatic Americans who carry the virus. Today, we are conducting too few of these types of tests. The Rockefeller Foundation stands ready to work with public, private, and non-profit institutions to implement these protocols by funding pilot projects throughout the country.”
Calling for federal guidelines for testing.
The Foundation is calling on the CDC to immediately lead the development and implementation of protocols for widespread screening testing of asymptomatic people. The protocols should be developed for screening tests for K-12 schools, universities, workplaces, nursing homes, vulnerable communities, and other settings based on their individual levels of risk and exposure. Because this type of testing is the key to keeping institutions and economies open, the screening tests should be government funded with same-day turnaround for schools and workplaces, and even faster turnaround for mobile testing in communities. The Rockefeller Foundation is working with epidemiologists and other experts to help develop these protocols.
“The National Institutes of Health, Rapid Acceleration of Diagnostics (RADX), test developers, and other partners should work together to bring better diagnostic and screening tests to the market at the scale needed for the pandemic, and to implement a strategy for using these tests as effectively as possible,” said Mark B. McClellan, MD, PhD, Director of the Duke-Margolis Center for Health Policy at Duke University and former commissioner of the U.S. Food and Drug Administration (FDA).
The new report calls for four steps: large-scale, asymptomatic screening testing along with diagnostics testing, contact tracing, plus improved data collection, and a robust nationwide communications effort on public safety. Together, this will help with the detection of outbreaks as they emerge, improve the supply of testing and PPE, reduce backlogs at diagnostic labs improving the time from test to result, which improves contact tracing—all of which will mitigate and ultimately suppress the spread of the virus. Without this, the country may be facing more widespread lockdowns, which will be economically devastating.
“We have already seen trillions in economic assistance required to partially counter the effects of a nation-wide economic shutdown,” said Paul Romer, Professor of Economics at New York University, a co-recipient of the 2018 Nobel Prize in Economics. “Many of the jobs lost will be lost for the long-term if we do not re-open and stay open. A massive investment in the development and large-scale production of diagnostic and screening tests is a small price to pay now because the price tag in economic devastation and despair will be far higher the longer we wait.”
Step 1: More and smarter testing is required.
Research now shows the disease presents with mild or no symptoms for most people and up to two-thirds of Covid-19 infections are undetected, but the virus can still be transmitted. Containing the pandemic will require not just more diagnostic tests, but significantly more screening tests of asymptomatic people. An effective national testing strategy should include at least 30 million – roughly 5 million diagnostic and 25 million screening – tests per week within the next three months, specifically:
- Rapid access to diagnostic testing for people with symptoms and close contacts of people with Covid-19 – at least 5 million tests per week with turnaround time of less than 48 hours, and ideally less than 24 hours;
- Wide-scale onsite and home testing of people across the U.S. who are not showing symptoms – known as screening tests for people who are asymptomatic or pre-symptomatic.
“If professional baseball and basketball players can get routine tests, so should our teachers, students, nurses, and bus drivers – in short, America’s essential workers,” said Dr. Jonathan Quick, Managing Director of Pandemic Response, Preparedness and Prevention for The Rockefeller Foundation. “This plan will require significant investment from the government, but investing in these tests will be far less costly for the nation than another economic shutdown, which will happen if we don’t contain the outbreaks.”
To achieve this goal of greater availability and use of pooled PCR lab testing for asymptomatic screening (and not just point of care tests), additional academic and other labs should be recruited. This includes labs not currently involved in providing critical PCR lab testing for people with symptoms and contacts.
“This is not testing to count numbers. It is testing to stop transmission,” said Mara G. Aspinall, co-Founder and Professor of Practice, Biomedical Diagnostics at Arizona State University’s College of Health Solutions. “We need a paradigm shift from exquisitely accurate but slow tests, to fast and good enough to quarantine. Slow and accurate works for clinical management, but this virus is a sprinter not a marathoner. We need fast and frequent tests just to keep up.”
In order to quickly detect where outbreaks are emerging, with special strategies to work with high-risk populations, the report also calls for community-needs based testing protocols in areas where Covid-19 has been prevalent and the risk of transmission and health consequences are high. This includes those living in small multigenerational housing and neighborhoods with many essential workers, along with targeting communities of color as death rates among Black and Latinx communities are much higher than for white people across all age categories. The Foundation will collaborate with the cities of Louisville, New Orleans, and Tulsa, which are members of its Testing Solutions Group, to develop these protocols and plans to announce additional cities and states in the coming weeks.
Step 2: Establish a System of Contact Tracing.
Nearly every country that has succeeded in containing their pandemic has been diligent about contact tracing—the act of identifying each case of the disease, tracking down those who may have interacted with that patient and isolating them with regular monitoring to ensure the trail of infections from that patient ends quickly. Few communities in the U.S. have established a strong enough contact tracing program to stop or suppress the Covid outbreak, either through lack of personnel or lack of citizen cooperation. This needs to change.
“Effective contact tracing requires two things: Rapid turnaround of results and the reporting of contacts so that tracers can warn those who may become infected to self-isolate,” Eileen O’Connor, Senior Vice President of Communications, Policy, and Advocacy at The Rockefeller Foundation. “Cooperation also requires communication on privacy safeguards that are in place and the availability of essential services like money for rent, the supply of food, medication, and job security for those who must isolate.”
Step 3: Using Data to Contain the Pandemic.
Collecting accurate and reliable data about the spread of the virus has been the foundation of effective response efforts around the world. Across the United States, however, data collection has been stymied by fragmented data systems and a lack of federal leadership on data standards.
Getting to at least 30 million tests a week and acting on the test results and contacts traced will require:
- Strengthening data infrastructure and reporting which will require more support to under-resourced states, cities, and labs as they work to meet the August 1 deadline for compliance with HHS testing data guidelines;
- Speeding up integration of testing and tracing data systems;
Adapting public health surveillance systems for the arrival of home, school and employer testing of asymptomatic people;
- Shifting from descriptive analytics to predictive analytics and policy modeling as most cities and states still use basic dashboards to inform decision making.
“Managing the next phase of the crisis will require these entities to use and present new models of data collection and analysis to support health and economic policy decisions, said Rick Klausner, Founder of Lyell Immunopharma, Juno and Grail and former Director of the National Cancer Institute. “Data is required not just to suppress the disease but also to manage the supply of testing products, efficient lab throughput, and healthcare requirements like PPE, ventilators, and therapeutic medication.”
Step 4: Communicating effectively to the public.
Finally, although the original report did not include a focus on communications, states and localities have been frustrated by mixed messages from individuals, the media, and even some elected officials. Fighting the war against the virus, the report says, will require public, private, non-profit, and government officials to work together to unite and inspire people to adopt testing, tracing and public safety measures, like wearing masks, washing hands and social distancing. This is the only way to keep the economy open until a vaccine is developed and produced in enough quantities for the entire country.
Without clear information, the public’s response to a pandemic can be unreliable. Since without a vaccine or reliable treatment behavior change and compliance is the only way to contain the pandemic, the plan calls for the formation of a broad-based national Covid-19 Communications Coalition. The Coalition would:
- Develop and implement ways to promote safety measures such as masks and social distancing. The coalition should include non-profits, community organizers and alliances of faith leaders as well as governmental leadership at the federal, state and city levels. Communication should be localized to ensure culturally appropriate messaging and allow for linguistic adaptation.
- Combat rumors and misinformation by working directly with media and social media to encourage direct and speedy correction of mistakes or falsehoods—and to counter the flood of bad information with a steady stream of stories about communities and individuals taking positive action, which promotes wider adoption of those behaviors.
- Educate the public about smart tests, treatments and a vaccine as they become available as way of building awareness, self-efficacy and trust.
“It is essential when combatting any virus – from HIV/AIDS to Ebola – to combat rumors and misinformation and promote safety measures and do it in a consistent and unified fashion,” said Mike Pellini, MD, Managing Partner of Section 32. “We urge states with high infection rates to require masks, establish strict social distancing rules in public places and demand that people who are infected or were in contact with someone who tested positive to obtain a screening test, when available, and self-isolate, with support from their state or locality for food and basic expenses.”
Progress against the 1-3-30 Testing Action Plan.
In April, The Rockefeller Foundation announced the National Covid-19 Testing Action Plan and $50 million to help communities scale up the plan at the Global Citizen Together at Home concert. This new report builds on the original Testing Action Plan, which called for widespread testing as well, scaling from one million tests in April to three million tests a week in June to 30 million tests a week by October, along with contact tracing and supported isolation for those infected. This new report tracks the progress made from that report and reflects where gaps still exist:
- The goal of 3 million tests in June was met on time. Currently an estimated 4.5 million tests a week are being conducted.
- In addition, the Federal Government should throw its full weight behind expediting the production and distribution of diagnostic and screening tests, including, if necessary, through the use of Defense Production Act or other appropriate authorities like BARDA.
We are all in this together.
Building upon its promise to double down on its commitment last month during the Global Citizen Unite for Our Future, the Foundation is announcing an additional $50 million to continue support in the U.S. and expand support to where the need is greatest around the world. This brings the total to $100 million for global Covid-19-related programs.
“We believe everyone should have access to Covid-19 testing, treatment, and vaccine – regardless of who they are or where they live,” said Dr. Shah. “So we are increasing our investment in a data-driven, global pandemic response and demanding that the funding and support for testing and supported isolation be proportionate to the danger to under-served and minority communities who have been twice as likely to be infected and die from this disease, often as essential workers with limited access to healthcare.”
About The Rockefeller Foundation
The Rockefeller Foundation advances new frontiers of science, data, and innovation to solve global challenges related to health, food, power, and economic mobility. As a science-driven philanthropy focused on building collaborative relationships with partners and grantees, The Rockefeller Foundation seeks to inspire and foster large-scale human impact that promotes the well-being of humanity throughout the world by identifying and accelerating breakthrough solutions, ideas, and conversations. For more information, sign up for our newsletter at rockefellerfoundation.org and follow us on Twitter @RockefellerFdn.
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Ashley E. Chang
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