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Where Testing And Contact Tracing Have To Be Before Distance Restrictions Are Lifted

ARI SHAPIRO, HOST:

Unemployment numbers are a large part of why President Trump wants to start reopening parts of the country as soon as possible. Many health experts, including Dr. Anthony Fauci, have expressed concern that doing so without wider testing across the country could be counterproductive.

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ANTHONY FAUCI: If you start pulling back on mitigation, physical separations, there will be infections. The real proof of the pudding of the success of this reentry is how quickly and effectively you identify them, you get them out of circulation, you give them care where needed and you do contact tracing so that you don't have a beginning of a peak.

SHAPIRO: To talk about where testing fits into the conversation about reopening the country, Margaret Hamburg joins us now. She was New York City health commissioner and head of the Food and Drug Administration. Good to have you back here.

MARGARET HAMBURG: Thank you. Appreciate being here.

SHAPIRO: How much higher do testing levels need to be before it's responsible for leaders to start reopening parts of the country?

HAMBURG: Well, we really do have to have a very significant increase in testing. This is absolutely fundamental to a thoughtful, safe and data-driven reopening. We all want to get back to life that resembles, in some way, what we knew before. But until we have better testing to detect the path and penetration of this novel coronavirus in our communities and across the country - until we can really understand the contours of the epidemic - until we can really identify those who need to be isolated because they're infected, do the contact tracing, as Dr. Fauci was saying, and quarantine, we cannot safely do this.

SHAPIRO: I know you say we need more testing and it's going to vary from one part of the country to another. But are we, like, 50% of the way there, 90% of the way there? How much more are we talking about?

HAMBURG: Well, we're talking about a lot. Some people have said, you know, we need between 750,000, maybe a million tests a week. And we have - you know, we've done, you know, maybe 3.2 million or something to date. So we need a lot more.

SHAPIRO: Yeah. So given that this disease is being spread in part by people who don't show symptoms and may never show symptoms, how widespread should testing be? Should everybody get a test? I mean, how do you make sure you're catching all the cases that are out there?

HAMBURG: Well, I think that while we have limited testing, obviously, we need to target it to those who have symptoms.

SHAPIRO: Sure.

HAMBURG: But I think we need testing for a couple of different reasons. We need testing so that we can really understand where the epidemic is and where it's going. And we need broader-based testing for that. And we need to understand background levels of community spread, including asymptomatic infections that have occurred. But we also really need to be very serious about the public health measures necessary to contain and manage this spread. And that means testing, isolation, contact tracing and quarantine.

SHAPIRO: Yeah. We've been hearing for more than a month that there aren't enough supplies to do the number of tests we're talking about. At this point, how could state and federal leaders jumpstart the supply of tests?

HAMBURG: Well, I - you know, it's, I have to say, a little baffling to me why we still haven't been able to get over the hump of, you know, really getting more testing out there. You know, first, we had shortages in the number of tests available. Quickly, we began to see shortages in the swabs needed to do those tests and the reagents needed. We have to really mobilize. We are behind. It's going to take some time. But you know, this has to be an absolutely critical priority.

SHAPIRO: Is it a problem of manufacturing or distribution or importation? Like, where's the roadblock?

HAMBURG: Well, I think it is a problem of manufacturing at this point. Some of it is distribution. There are resources in places that don't need them and not where they need to be. We need, I think, to have a system in place that's really looking at - where are we, what do we need, what are the different components necessary, and how can we make sure that all of this is aligned so that we can do the public health disease management and control activities necessary?

SHAPIRO: So you're laying out all of the distance between where we are and where we need to be. Meanwhile, President Trump said yesterday that he thinks we might be able to open some parts of the country even before May 1, in the next couple of weeks. Based on what you're seeing, do you agree?

HAMBURG: Well, I am concerned. I think we really need to, you know, take a careful, considered look at where we are and what still needs to be done. You know, we talked about shortages in testing, but we also have not ramped up what's needed in terms of the public health tools necessary to undertake the other critical steps for ongoing management and control as we start to move away from the current social distancing practices. We need many more people to help with the case identification and contact tracing activities. We have an already overstretched public health workforce. We're going to have to add to that with some trained community workers and maybe digital apps.

SHAPIRO: All right. Margaret Hamburg, thank you very much for speaking with us today.

HAMBURG: Thank you.

SHAPIRO: She was New York City health commissioner and head of the FDA. And she is now chair of the board of the American Association for the Advancement of Science.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.

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