CVS chief medical officer: How coronavirus testing needs to change

Editor’s Note: Dr. Troyen Brennan is chief medical officer and executive vice president of CVS Health. The opinions expressed in this commentary are his own.

Social distancing has blunted the spread of Covid-19 and different parts of the country are starting to see a decrease in new cases. We have largely avoided overwhelming our health care system, and everyone is looking for ways to responsibly restart the economy.

But every health professional and most of the nation, it seems, understands that if we do not take precautions, we will be back to square one.

We must get those with viral infection to remain at home even if they are asymptomatic, provide appropriate treatment for those early in infection and use hospital settings primarily for those with more severe symptoms. Broadly expanded, accurate and rapid testing is the only way to do that. This approach will bridge us to the time when we have a viable vaccine ready for mass distribution.

Fortunately, the elements necessary to build this program are coming together rather quickly. States and the federal government will have to facilitate and integrate careful public health measures into testing protocols, but private companies have a significant role to play.

We recently announced plans to offer self-swab tests in parking lots or at drive-thru windows at up to 1,000 CVS Pharmacy locations, with the goal of processing up to 1.5 million tests per month. We are also developing mobile solutions that will allow our health care professionals to serve businesses and community health centers and provide real-time results. Over time, we will move entirely to rapid testing, which allows for faster treatment and prevention of spread.

But we will still need to dramatically increase capacity.

Estimates on testing needs vary – one report from a Harvard panel of experts suggests up to 20 million per day. This will likely cost billions, but in the context of keeping the economy moving, avoiding long-term unemployment and ensuring the health care system is not compromised once again by rising viral infections, it would be a bargain. Lawmakers are starting to focus on how to fund a much-needed surge in testing.

Large-scale test sites like the ones CVS Health and other retailers are operating are serving a critical purpose, but we must move to more local solutions. We need a new approach to testing, which must include:

Community-based testing

Covid-19 disproportionately affects African-Americans and other minorities, which should be an important consideration in any testing solution going forward. Parking lot test sites are working well for now, but as we move into this new phase we need testing to be distributed throughout the community for ease of access and for equitable access. This includes tapping into retail networks that have scale and a high level of familiarity.

Highly accurate testing

Tests that identify Covid-19 genetic material using mucus or saliva in large, central labs are the mainstay of testing, and very accurate. Going forward, we will also need to rely on both viral antigen tests via nose and throat secretions to identify infection and serology tests via blood to identify antibodies. In addition, tests should be able to identify both Covid-19 and influenza infections so we know which virus we are dealing with, especially in the fall.

Rapid results

While sending tests to labs and awaiting results will continue to be part of some testing solutions in the short term, rapid results should be standard practice by the fall, subject to availability of supplies. Getting results where you have been tested makes next steps clear.

Reliable tracing

Results should be shared with public health authorities immediately so they can engage in contact tracing and added to electronic medical records so a patient’s physician can be involved in care. Results should also be transmitted to the federal government to develop a central clearinghouse for positive results.

Treatment

Many medications are being tested to understand if they can be used to ameliorate symptoms early in the infection, forestalling more serious complications. For patients with more severe symptoms, Gilead’s remdesivirhas shown promise. Until a vaccine becomes available, having viable treatmentson handwill be critical.

We are all hopeful for a vaccine that could be universally administered before Covid-19 makes a potential return later this year. But we need to be realistic and prepared. We need to start planning now for rapid testing, fast treatment and contact tracing to ensure we can maintain public health and restart our economy as we move toward the beginning of this pandemic’s end.