As President Donald Trump spoke at the Rose Garden on Tuesday about coronavirus testing, a banner behind him made a bold claim: “AMERICA LEADS THE WORLD IN TESTING.”
That claim, however, is very misleading.
It’s true that the US leads the world in total number of tests, in large part because it’s a big country and has the most confirmed Covid-19 cases and deaths globally. But when controlling for population, America is behind several countries in terms of Covid-19 testing: As of May 9, the US testing rate is roughly 26 per 1,000 people, according to Our World in Data; in comparison, Denmark’s rate is 53, Italy’s is 42, New Zealand’s is 39, Germany’s is 33 (as of May 3), and Canada’s is 28.
Testing is crucial to controlling the coronavirus pandemic. When paired with contact tracing, testing lets officials track the scale of an outbreak, isolate the sick, quarantine those with whom the sick came in contact, and deploy community-wide efforts as necessary. Aggressive testing and tracing is how other countries, including South Korea and Germany, got their outbreaks under control, allowing them to start reopening in the past couple of weeks (though even they have scaled back their reopenings after new spikes in Covid-19 cases).
“The whole point of this social distancing is to buy us time to build up capacity to do the types of public health interventions we know work,” Natalie Dean, a biostatistics professor at the University of Florida, told me. “If we’re not using this time to scale up testing to the level that we need it to be … we don’t have an exit strategy. And then when we lift things, we’re no better equipped than we were before.”
The US still falls short on testing overall
There’s no widely accepted standard for this, but experts generally agree that the US needs to be doing much more testing. Some have called for conducting as little as 500,000 tests a day, while others have called for up to tens of millions.
Nationwide, the US is not hitting the proposed minimum. Based on data from the Covid Tracking Project, America averaged roughly 276,000 tests a day during the week of May 3. That’s up from an average of 150,000 a day in the first half of April, but only a little more than half of the bare minimum experts recommend.
At the state level, the Times estimated that the daily minimum of 500,000 tests amounts to about 152 tests per 100,000 people. Only two states, Rhode Island and North Dakota, met this standard as of May 7. Again, this is the proposed minimum; some experts argue the US needs multiple times that number of tests.
Still, there are some signs of things getting a bit better. Not only has the number of daily new tests nationwide increased in recent weeks, but states have also seen an improvement in another important metric: the positive rate.
This standard measures what percent of people test positive for the coronavirus among all tests done. If the positive rate is high, it’s likely not enough people are being tested, since it suggests that only people with a high chance of infection are getting tested, potentially missing a lot of people without significant symptoms. Experts recommend a positive rate no higher than 10 percent — and preferably much lower.
In recent weeks, the nationwide positive rate has fallen below 10 percent — hitting 9 percent the week of May 3, based on Covid Tracking Project data. Most states have seen their positive rates fall below that threshold, too. It’s a sign that states are now getting enough testing capacity to match their outbreaks.
As promising as that might be, experts caution that improvements in the positive rate have to be matched with adequate numbers of tests and sustained decreases in Covid-19 cases to safely reopen parts of the economy. Testing also has to be paired with contact tracing — which might require hiring 100,000-plus “disease detectives” — to truly control outbreaks.
When all those other factors are taken into account, the US is still playing catch-up to other countries.