Standing up testing

ABSTRACT

Public health systems in the U.S. were not adequately prepared for the demands placed on laboratory systems, equipment, staffing, or information technology by the COVID-19 pandemic. Limited capacity early in the pandemic was a critical barrier to effective surveillance testing for COVID-19 infections, which allowed the virus to spread undetected through many communities, in part due to the proportion of cases that were asymptomatic. As the availability of testing increased, sensitivity (the ability of a test to correctly identify positive cases) and specificity (the ability of a test to correctly identify negative cases) of various testing approaches remained a concern. Members of racial and ethnic minority groups often had unequal access to testing, while at the same time being disproportionately affected by COVID-19 infections, hospitalizations, and deaths. The rise of the Delta variant in summer 2021 and the subsequent reopening of schools and workplaces in many parts of the U.S. raised additional questions about COVID testing capacity and the effectiveness of screening programs, which were further challenged by the Omicron variant surge in early 2022. Major investments in laboratory systems and information technologies are needed to address gaps identified during the COVID-19 response to ensure preparedness for future public health threats.