Solving the 'Coronavirus Test Mess'

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Brian: It's The Brian Lehrer Show on WNYC. Good morning, everyone. We talked on yesterday's show about the various ways out of the coronavirus pandemic. There's vaccinating our way out, eventually, we hope, but certainly not yet, suppressing our way out through intense and longer lockdowns like China and New Zealand, infecting our way out through herd immunity like Sweden, and testing, tracing, and quarantining our way out like South Korea and some other countries. None of these is perfect, but of them, testing and tracing might be the best cultural fit with American individualism and also the most ready to go, technologically, if only we could get our act together on fast and plentiful tests.

Let's take a closer look at that with Dr. Atul Gawande, staff writer for The New Yorker, a surgeon at Brigham and Women's Hospital in Boston, and professor at the Harvard T.H. Chan School of Public Health. His latest New Yorker article is called We Can Solve the Coronavirus-Test Mess Now, If We Want To. Dr. Gawande, we so appreciate your time. Welcome back to WNYC.

Dr. Atul Gawande: Glad to be here.

Brian: You write that, "We don't have a technological problem, we have an implementation problem," what do you mean by that?

Dr. Gawande: Back in the early phases of the pandemic, we had a technological problem. We didn't have tests, and there was a good two to three-month delay in approving tests and making it possible for laboratories to get out there and test people. Now, today, our problem is not that we don't have tests. We have hundreds of laboratories approved to provide testing.

I say it's an implementation problem because we have effectively three or four national labs that provide the vast majority of the testing, but there are lots of regional labs that have an enormous amount of untapped capacity. I point to examples of about half a dozen labs that would double the amount of US capacity if we tapped into their capabilities. It's like having electricity blackout in New York City but finding that there are lots of other cities that have lots of supply and no electric grid to connect them. That's the situation we have now.

Brian: The current testing is done largely by these four giant vertical monopolies that you referred to as a group, and people know these names. They're Quest Diagnostics, LabCorp, BioReference Laboratories, and Sonic Healthcare. Is there any indication that those companies are ramping up testing ahead of the fall and winter seasons?

Dr. Gawande: They are indeed ramping up testing, but four labs-- Quest and LabCorp, the two biggest, came out and said there is no way that they alone, those big labs, can manage the fall volume, let alone, what we've hit in the summer, where you see people and still have people reporting a week or more delay in getting results back, which basically makes the results useless. What I point to, for example, one of these companies, Quest, for example, will have 175,000 tests they do per day. We have two laboratories with untapped capacity in Boston that have, at least, that much capacity available if we were to begin to tap into that capacity.

We do about 650,000 or 700,000 tests a day in the United States. We should be roughly three times that, and we have that capacity around. Now, why does it not come to the table? What makes Quest, LabCorp, and other places so effective is that they're not just laboratories that can process the test, they are big logistics operations that can collect the tubes and samples from all of the doctor's offices and testing locations. They can make sure they have the barcoding software and systems like that. They have the shipping arrangements to move tests around the country, nationally.

We have not set up that basic public health infrastructure of being able to match capacity to need and have the interconnections to make it possible, but we can create that. It's quite possible to create that. I started an alliance of three companies for doing it in New England, where all we did was made sure that the tubes could get shipped, the barcode could get put on them, a doctor's order could be there and you can have a proper follow-up for people. We've been able, just in the last few weeks, to bring on capacity in New England that's moving thousands of tests per day now, and it can become 10 times that in a few weeks more to come.

Brian: Wow. To cut to the chase, you write, "We could have the testing capacity we need nationally within weeks."

Dr. Gawande: Absolutely.

Brian: Compare us to a couple of other countries that you write about, other developed countries around the world that have met their testing needs. How does the United States compare to South Korea or England, two examples you cite when it comes to testing, and what can we learn from them?

Dr. Gawande: Basically, the critical part of testing is that it should be easy to get. It should be free so there are no barriers. We're economically constrained by how much virus we have and making it so that testing is free should be feasible. It should be possible without a doctor's order. You shouldn't have to go get a clinic visit and the charges for that in order to get the test. Then, it should be at least within 48-hour turnaround time. Typically, it will be one-day turnaround time.

South Korea is a great example of how they went about this. I described the timeline in the article. They had their first three cases by January 27. The government had one laboratory isolate the virus from those specimens. They notified labs and manufacturers that they're going to need coronavirus tests labs and testing and we need it as fast as possible. They then took the samples and created blinded diluted test plates, and then, shipped them to the labs as a final exam for whether your tests work. Within a week, 47 labs had gotten a perfect score on their tests, and they approved them to start testing.

Immediately, you had capacity right in the very beginning of February. We didn't even start any process like that until mid-March and never sped up the process to make that approval process happen. Now, at the same time, South Korea made sure that they had hospitals, clinics, and drive-through facilities. They had 600 sites that they opened up, and they made it possible to call, the equivalent of 311 in New York, in 1339 in South Korea anywhere in the country and you could schedule a test near you that same day.

That meant you had several things. You had free sites where you could go get your tests, the scheduling process meant that they had a handle on where they were getting bottlenecks and backups on turnaround time, and then, they could shift their labs and it became over a hundred labs that had availability. They could shift the supplies so that they can make sure you still kept to a roughly one-day turnaround time. It's very similar to that in England as well. Now, we have examples in different parts of the country where we've made that happen. We are capable of doing it. It really isn't rocket science. It's connecting the dots.

Brian: We'll get into how all this would make it possible if we did connect those dots to go back to work, to go back to school, to open the businesses, to have normal life as we thought of it before. Let me ask you one skeptical question about whether that really is the door to that. Since you're using Britain as an example, Britain is having a surge in cases right now from what I read in the news just this morning. How does that fit in with the fully available testing picture you were just painting actually leading to suppressing the virus?

Dr. Gawande: Any testing approach is going to be just part of the picture. Donald Trump tweeted, just the last day or two, about there being a surge of cases in New Zealand, which has been a poster child for doing it absolutely the right way. They had a surge of a dozen cases. Our surges are of thousands of cases. We have 51,000 college students who've tested positive so far just in the last two weeks. The question is, how can you react to the surges? A, can you know that they've happened because you have enough testing to know where they are? B, are you able to implement the right procedures so you can contain it locally?

The steps we had in the early part of the infectious outbreak, we had the opportunity to do local level containment by testing and containing and tracing people. We could have kept it to the Seattle, San Francisco, a few entry points, and soon after that, we did that. We saw that happen with Ebola. The next part, though, that's when it spread more widely, we then needed to do national containment. We needed to use the lockdown to have deployed our testing and tracing capability, as well as, testing and tracing alone won't do it, you've got to wear masks and Britain was late to adopting masks. We've actually done better in much of the US than Britain has in adapting masks. They're only getting there now.

These are all factors that play in. Our basic problem is we've never decided to fight the virus. We have argued about fighting the virus. We've argued about whether it's just the flu, whether it's no big deal, but on some of the locations like New York, Connecticut, New Jersey, Massachusetts, we've taken it on, and we've beat it back. It's impressive that New York is now down to a test positivity rate below 1%. There are still things we have to fix around our testing process, and we have much of the country where they're not committed to avoiding large gatherings and wearing masks. They don't have the consistent leadership the way that we've been following it in the northeast.

Brian: Last week, in this country, we had an average of more than 800 deaths per day from coronavirus, whereas, in the five Western European countries that we think of as in a group with us, around the same population, they had under 100 deaths a day last week. It all adds up with the testing piece, the lack of will piece, the skepticism of science piece, all that stuff.

Listeners, if you have a question for Dr. Atul Gawande, primarily about testing in his article in The New Yorker, We Can Solve the Coronavirus-Test Mess Now, If We Want To, we can take your phone calls for him. Maybe you're an Atul Gawande fan for a long time now and you want to ask him something that you never had him over to dinner to be able to ask him about, 646-435-7280, 646-435-7280. Another piece of your article that introduces a phrase that I think people should know and would like to know is, it's the phrase assurance testing. This is on people who don't have symptoms but they would get testing that you characterize as assurance testing as important to stopping the spread. Can you talk about assurance testing?

Dr. Gawande: Yes. The basic level of testing that we absolutely need is that if you are sick with any symptoms, you should be able to go out and get diagnostic testing to diagnose what is going on with you. However, the next level, what you see is when the NBA goes into the bubble and has everybody testing every few days, that's assurance testing. That's so that people can get out and do things where the known practices of wearing a mask and maintaining social distancing. That works, but there are situations where you can't do that, where we want to resume normal human physical activity.

People are seeking testing to go visit an older relative, people are seeking testing to cross borders when they come from higher risk areas, they want to come to New York and be able to come in. Then, also, you have entire industries like the film industry that can't even run because you need to have people in close connection with one another not wearing masks, talking. Music groups, symphony, there's so many human activities that need us to be able to be close together, and that only right now is possible, while we wait a vaccine, with what can be termed assurance testing. Meaning, testing regularly enough that you can catch people to know whether they're cleared, not infected, and people can be safe to have those kinds of interactions.

Brian: For that kind of testing, using the NBA example that you gave, where those professional athletes who are privileged enough to have access to being tested every other day, have pretty much been able to run their playoffs without infecting anybody else. Even in Major League Baseball, where they're not in the bubble, they still can go out in the world that they follow certain safety protocols. They're getting tested every other day too, and the outbreaks have been very few and limited when they occurred, except for one case that took place very early in the Miami Marlins.

The reason that I come back to your example of pro-sports is the ease of testing that they are privileged to have. They get it every other day. Are we capable of developing a world where pretty soon, before we go to work every other day, before we go to school every other day, we test ourselves, and that level of assurance testing keeps the spread down because we certainly don't have that capacity and neither do those labs even in the network that you described as they ramp up?

Dr. Gawande: Well, I want to push on that. Massachusetts, for example, our economy is deeply tied to education, colleges, and universities. We have well over 100 universities that are bringing students back to campus. We have a laboratory here that I reported on, called the Broad Institute, which is an academic laboratory affiliated with MIT and Harvard, where when I visited them in July, they had 3,000 tests a day they did for our state.

In our state, we're doing about 9,000 to 10,000 tests per day. They were pretty big testing organization for our state, and they provided guaranteed overnight turnaround time. The reality was that in mid-July, they already had 35,000 tests a day of capacity that wasn't being tapped, and with a few weeks' notice, they could get up to 100,000 tests a day, which would be a sixth of the entire country's capacity in this one lab. There are more than one in our area that has that kind of capacity.

In order to bring the colleges and universities back, the Broad committed to supporting those universities to have testing on at least a weekly, if not, twice or more weekly basis. As of yesterday, they were past 60,000 tests a day. They ramped up. They've provided it. They've lowered the cost dramatically. It's at under-- For the universities, it's around $25 a test instead of the $100 a test, plus logistics and everything else to run them. They're continuing to have overnight turnaround, and they still have more capacity.

My alliance is bringing together smaller players, nursing homes, schools, and others in providing logistics so that that lab can manage it and process it. This is possible. It demonstrates, yes, we can make this happen for universities and colleges. The places we need to make this happen as well are nursing homes, places where you have essential workers or really high-risk people, and then-

Brian: Prisons, meatpacking plants, things like that.

Dr. Gawande: Completely. That's the phase we're in. We're ready to be able to get to the place. I start talking about some of the testing technologies where quicker, faster turnaround technologies are coming available that would allow you to begin to potentially have testing when you go to get an airplane flight or go in for a meal.

Brian: This is all very hopeful what you're laying out about the colleges and the capacity in the Boston area, but does that mean all these people are going out to a lab somewhere every other day or twice a week?

Dr. Gawande: No, the way that it's organized is that-- First of all, it's not the deep probe your brain swab because the FDA has approved now that there's been demonstrated ability to do just inside the nose swabs, and then, it's done in such a way that you swab your own nose under observation by a clinician. You can have a group of a dozen kids come up, grab the kit, swab while being observed, and then, hand the kit off and send it off. You're able to get through large volumes of people with a small production operation, all on campus with the help of a nursing team.

Brian: That's big. I think we have a call about this from Duke in Jersey City. Duke, you're on WNYC with Dr. Atul Gawande. Hey, there.

Duke: Hey, Brian, how are you?

Brian: Good.

Duke: Okay. I was just going to mention, I was recently listening to Ralph Nader's show, and he had a doctor on there. The doctor's name was Michael Mina. He was an epidemiologist from the Harvard School of Public Health. He was talking about testing like the doctor you have on now. He was talking about this paper strip test that would be something similar to a pregnancy test that you can buy over the counter at Duane Reade or something like that. He was saying how it could be available to everybody immediately almost.

Now, he wrote an op-ed in The Times, I think it was about a week ago. I was just wondering if your guest knows anything about that. Then, my question is, this is like the most fundamental question to me about this whole COVID thing since March, I keep hearing from multiple sources that the accuracy of any of these tests, the PCR tests, or the nasals, the saliva tests, any of them, can test positive for any COVID that you have ever had.

Brian: Duke, let me leave it there and get you some answers. I know you write about test reliability in your article, Dr. Gawande. Duke is asking a few great questions there. What would you say?

Dr. Gawande: First of all, Michael Mina is actually my colleague at the Brigham and Women's Hospital and Harvard Chan School of Public Health. He's been an advocate of the idea that you can in fact have rapid antigen tests. The tests that we were just describing earlier are our molecular tests. They test for the genetic material in the virus. The antigen tests test for the protein in the virus instead of the RNA. They are cruder tests so they need a higher level of virus in order to detect that the person is infected.

Michael Mina makes the point that those are the people who are likely to be most contagious that even though it is a less sensitive test, if you test every day with a cheap fast test, that's better than testing infrequently with a test that has too long a turnaround time. There's probably some truth to that. We haven't fully proven it all out, but just last week, Abbott came out with a 15-minute test card that's very much like what Michael Mina described. This doesn't require a machine. You take a swab, you put it into the test card, and you're able to see whether it's positive or negative. Now, it has to be run with a clinician who is certified to use it because you have to run a positive control and a negative control.

It's still a little bit complex. It's not quite as simple as a pregnancy test, but we're on our way to having-- I've seen the actual pregnancy test equivalent that manufacturing costs are as low as $5 per test, deploying it, making sure you get the positive results reported. There's a whole lot of operational stuff you have to put around it, but these are part of a whole armamentarium of technologies that are going to be available to us very quickly. The key to it is distributing it, using it in the right way, and knowing how to deal appropriately with the ways in which they can have higher inaccuracy rates in certain respects but be powerful and beneficial in others.

Brian: One follow up on that. Duke, the caller, said even the PCR tests, the deep nasal swab tests that we most commonly use now, can be unreliable. I see that from your article it can have a false-negative rate of up to 20%. You write that misrate is even higher during the four days or so before symptoms begin. Are we testing a lot of people too quickly after they're exposed?

Dr. Gawande: When you're exposed, you like to test about four or five days after the moment you've been exposed, but a lot of the time you never know when someone has been exposed. What we know is, when you've been tested, if it's negative, there's a possibility that there might have been a very low level of virus, and with a PCR test, you have about typically, you'd say, on average, about three days that that test "lasts" because the process of an infection with the coronavirus is that you will get infected on day one, and it takes time for the virus to multiply, so you can miss it for those first three or four days.

Then, on the tail end, your immune system will take over and you may have about a week to 10 days after symptoms that the virus will be back. Then, after that, you may still test positive for a period while the dead virus is being cleared from your system. You're catching it during this whole phase when you go in for a single test. Being cleared by a test doesn't mean that you're now totally fine for doing whatever for the next two weeks to come. You're safe and cleared for a few days, which is why when you come into cross border, for example, they'll ask you in Massachusetts, for instance, that you show that you had a negative test in the last 72 hours or have to quarantine if you came from a higher risk state.

Brian: Here is Ray, a pharmacist in The Bronx. Ray, you're on WNYC with Dr. Atul Gawande from Harvard and The New Yorker. Hi, Ray.

Ray: Good morning, Brian. Good morning, doctor. I'm glad you addressed the Abbott test that came out just recently, and it's got very good ratings so far as accuracy and sensitivity. That is a type of test that you mentioned that controls need to be run. They need to be run only occasionally with that Abbott test if I'm not mistaken. The control doesn't need to be run before each test as far as the accuracy as compared to the amount of time that it takes for laboratories to give you the results. I've heard patients that come into our pharmacy, it ranges anywhere from 3 to 10 days, and that's a lot of time between the infection--

Brian: That's an unacceptable amount of time. If it's longer than three days, you might as well not have had the test.

Ray: Sure. So far as the Abbott test, I think there were two other tests that have EUAs, emergency use authorization. Pharmacies are a great way to get to the people. Now, in pharmacy that I own in The Bronx, we have a LSL, limited service laboratory, and we're able to do the type of testing. We're licensed to do that low-level intensity testing. I think that's a way that you can reach many, many more people.

Dr. Gawande: Yes.

Brian: Ray, thank you. Doctor?

Dr. Gawande: The pharmacies have actually been an important mechanism and channel for people to obtain testing. You've seen a number of the national pharmacies as well as independent pharmacies offering capacity for testing, the turnaround times from the big national laboratories, Quest, LabCorp, have come down from that period of time. I still had a family member just tell me this week that they had a week-long turnaround time on getting result back on a test, which is completely useless.

The Abbott test is less accurate than a PCR test, no question about it, but it has a faster turnaround. It's 15 minutes. You can get retested in a couple of days if you still have symptoms or there are persistent concerns. There are ways to use them as this screening tool. They're actually only approved right now for using in symptomatic people because the accuracy is higher in symptomatic people. They're just now entering distribution, but the government has bought 150 million of those tests to distribute, then, they will push them out various channels. I think pharmacies will likely be one of them.

Brian: I want to ask you about a couple of other things in the news before you go, Dr. Gawande, if you don't mind.

Dr. Gawande: Yes.

Brian: One of them is, AstraZeneca halted its clinical trials of a vaccine candidate because of some kind of serious illness in one of the subjects, how clear is it to you whether that was a side effect of the vaccine, and what this news means for the picture of vaccine development?

Dr. Gawande: My infectious disease colleagues tell me is that this is the typical part to be expected in a vaccine trial. You're going to have tens of thousands of people who are getting the vaccine, some of them are going to have a rare event. They're going to have a rare condition that gets diagnosed. You have to pause the vaccine trial long enough to investigate, is this indeed an isolated rare, suddenly, they have an onset of a new condition that's unrelated and appears to be unrelated, or could this be related to the vaccine trial? Typically, you're able to clear it and then continue onward with the trial. We'll just have to wait and see what they find in this trial.

It won't be the last time that these trials will have these kinds of events and need to pause. For me, it gives me confidence that they are running it the proper scientific way. It's also an indication that these aren't just going to run like clockwork. If they have to pause for a week to sort these things out, that's just what's going to happen. There's a chance, but it's highly unlikely that we're going to see results out of any of these trials, let alone, really positive and fantastic results before the election.

Brian: I thought as soon as early voting starts, they're going to announce a vaccine. Never mind. Another question that I have, based on the news, is about what you might call gray areas, various controversies arising that might be in gray areas. Here in New York, restaurants are clamoring to reopen for in-person dining in New York City with the city's low infection rate, but the governor says, "Experience elsewhere shows us that's likely to light a match." Some politicians in Big Ten football states are asking them to reinstate college football this fall, but the conference says, no. Some other conferences are playing college football. My question is, do you have an opinion about when or if indoor dining and when or if college football, and how do we know?

Dr. Gawande: Yes, I love that you call this the gray zone cases because these are the hard cases about exactly when, exactly how big, but it's all about being able to experiment and doing it in the right places. The places like in the northeast, where you have really low infection rates, are the ones where you can begin to try and learn and see what's possible. In Massachusetts, we've opened up dining including indoor dining but at much-reduced capacity. We've had generally a positive experience, but moving to expand that capacity has been paused because we've had an uptick in some outbreaks of cases and some have been tied to people really violating the basic rules around that.

We had cases of more than 100 people turning up in a basement bar and places that are packing in with no masks, not doing the social distancing, and violating the basic rules. We're navigating this space. I do think that it is the appropriate thing when infections are low to begin testing out whether you're able to get people to follow the basic rules. Can we maintain some distance? Will we wear the masks? Can we test out the process of, "Okay, while we're eating, we're going to take off the mask, but when you get up from your table, you're going to put the mask back on again"? Can we get the ventilation at an appropriate level that we can keep the outbreak from happening? You need testing as part of that because you need to be able to monitor and know whether conditions are getting worse or staying safe.

Brian: Let me take one more test and trace question for you from a listener. John in Teaneck, you're on WNYC with Dr. Atul Gawande. Hi, John.

John: Hi. This question actually I'm not sure doctor you can answer this. When the setup at the beginning of the segment was talking about technology, my first thought went to the tracing part of it because I live in a household full of professional musicians sidelined by this. One of them has just started training actually two weeks ago to be a tracer in the Philadelphia area. What she's telling me is that there's a problem whether it's the software or the network system, and it's related to HIPAA issues. They haven't been able to iron out how to actually get some of the information-

Brian: Privacy issues.

John: Right, exactly. They haven't been able to get some of the information that's required to be able to speak to people into the hands of the tracers. For them to be able to ask a question, they need to ask the people that they're contacting. They don't even have birth dates. It's like, "You were born in a month that starts with a letter. Can you confirm if I ask you?" It's like that. Anyway, I don't know if you can speak to issues with that or not.

Brian: Yes, that's such a great question because we can have all the testing capacity that we can develop as you were optimistically and encouragingly laying out at the beginning of the segment, but then, people have to be willing to be traced and people have to be willing to be quarantined once we know they've come in contact.

Dr. Gawande: Completely. This is partly an operational issue. As we're getting experience with contact tracing, you have to learn the protocols so that you're not-- You often have wrong information and lots of people will be upset if you pass along that so and so has coronavirus and it turns out you're telling the wrong person on the other end of the phone. We're getting better at being able to get those confirmations and walk the right balance of providing that information.

The trust issue has been the biggest issue. A, I got to be able to know who are your 5 or 10 closest contacts that you spend the most time with you so that I can contact them and follow up, and willingness of people to hand that information over to someone from the government is low. What you need are lots of people who are linked together arm and arm saying, "We're in this together, and we're going to be willing to do it."

When you have, at a national level, such a division of whether to take this virus even seriously, willingness, for Trump to describe half of this as conspiracy theory talk and not really back among his own supporters that this is something that is important, that we're going to hold hands and do this all together, and this is how we're going to fight and get this under control, but it is going to require sharing information, safeguarding that information, not using it in ways that are going to attack people. At this moment in time, that is very difficult to persuade people to trust. You can understand that people might be concerned that you're going to investigate their immigration status or you're going to use this to go after them or their relatives or their family and friends. That is a challenge when we are riven over the basics of whether we're even trying to fight this virus or not.

Brian: Last question. It builds off this one because it's a whole other national model of approaching, getting our way out of the coronavirus. We had a guest yesterday who was parsing different countries' methods of dealing with the virus, including arguably the most controversial, Sweden, which has done relatively little except banning big group gatherings, aiming for herd immunity, as they call it, through the spread of the virus, leading to a dying out of the virus.

The stats that we were discussing seem to show that Sweden had a slightly higher death rate than other Scandinavian countries at first but lower than the UK. By now, it's no worse than anywhere else in Europe where they're taking all these stringent measures. Yet, intuitively, it seems so cruel and immoral to just let the virus spread because presumably a lot of, especially older people, are going to die. Have you looked at Sweden, and is there anything to learn from their model?

Dr. Gawande: Yes, the reality is it's not herding immunity that is driving down their spread of infection. They have at best 6% of their population who have currently been infected. They do have the highest per capita death rate in all of Europe, and it's been particularly bad because of the failure to protect the elderly. I think the bottom line here is that although the government did not impose lockdowns, that it was an important part of the lack of spread, that they've had very good testing, and been able to trace people where testing is positive. They've had people generally, substantially, reducing gatherings, avoiding social contacts, things like that. Masks have become something that people are using. The common practices really do matter.

Also, Sweden is a small country, and what we don't have is the same level of health care, testing, and cohesiveness that that country has. You can easily point to Norway, next door, which has had a far lower death rate and much more success in containing the cases without hammering their economy either. The economy mainly follows your infection rate. With a couple of basic steps, we don't need to, at this point, drive a lockdown. We've learned over the last six months or more that if we can get people to wear their masks and we can drive mask use up over 80% in public places where people can't socially distance, that will dramatically reduce the likelihood of spread.

Our problem is places where people are having large gatherings, disdain for masks, and unwillingness to follow some of the basic aspects partly because there is no cohesive commitment among leaders to encourage this to happen in big parts of the country. That alone will drive it forward. I don't think there's a debate about lockdowns, at this point. At this point, it's mainly, "Can we follow those practices and bring our testing up to at least European standards?"

Brian: Dr. Atul Gawande, staff writer for The New Yorker, a surgeon at Brigham and Women's Hospital in Boston and professor at the Harvard TH Chan School of Public Health. His latest New Yorker article is called We Can Solve the Coronavirus-Test Mess Now, If We Want.

 

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