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Testing for the coronavirus in the United States is dropping even as infections remain high and the death toll rises by more than 1,000 a day.
An Associated Press analysis found that the number of tests per day slid 3.6 percent over the past two weeks to 750,000, with the count falling in nearly half - 22 - of the states. They include Iowa, where the testing rate peaked in mid-July but dropped 20 percent in the last two weeks.
Amid the crisis, some health experts are calling for the introduction of a different type of test that would yield results in minutes and would be cheap and simple enough for millions of Americans to test themselves - but also would be much less accurate.
'There's a sense of desperation that we need to do something else,” said Dr. Ashish Jha, director of Harvard's Global Health Institute.
Widespread testing is considered essential to managing the outbreak as the United States approaches a mammoth 5 million confirmed infections and more than 157,000 deaths out of over 700,000 worldwide.
Testing demand is expected to surge again this fall when schools reopen and flu season hits, perhaps outstripping supplies and leading to new delays and bottlenecks.
Some of the decline in testing over the past few weeks was expected after backlogged commercial labs urged doctors to concentrate on their highest-risk patients. But some health and government officials are seeing another reason for the drop - a growing public frustration with waiting in line and then not learning results for days.
In Iowa, state officials are reporting less interest in testing, despite ample supplies.
'We have the capacity; Iowans just need to test,” Gov. Kim Reynolds said last week.
According to state data as of Wednesday, more than 977,000 people had completed an assessment at TestIowa.com, but only about half that - about 499,000 - have actually been tested.
Reynolds announced the $26 million Test Iowa Initiative on April 21 to greatly expand the state's testing capacity.
But the program got off to a chaotic start and the testing process using equipment provided under the contract was not validated until more than two weeks later.
Once that hurdle was cleared, Reynolds announced May 14 the state now had the capacity to run 5,000 tests a day.
But even with that capacity, that level has not often been reached. Since May 14, the 5,000-tests-a-day mark has been hit in Iowa only 38 percent of the time, an analysis by The Gazette found.
The number of confirmed infections in the United States has topped 4.7 million, with new cases running at nearly 60,000 a day on average, down from more than 70,000 a day in the second half of July.
U.S. testing is built primarily on highly sensitive molecular tests that detect the genetic code of the coronavirus. Although the test is considered the gold standard for accuracy, experts increasingly say the country's overburdened lab system is incapable of keeping pace and producing results within two or three days - the time frame considered crucial to isolating patients and containing the virus.
'They're doing as good a job as they possibly can do, but the current system will not allow them to keep up with the demand,” said Mara Aspinall of Arizona State University's College of Health Solutions.
Testing delays have led researchers at Harvard and elsewhere to propose a new approach using antigen tests - rapid technology already used to screen for flu, strep throat and other common infections.
Instead of detecting the virus itself, such tests look for viral proteins, or antigens, which generally are considered a less accurate measure.
A number of companies are studying COVID-19 antigen tests in which people spit on a specially coated strip of paper. If the person is infected, it changes color. Experts say the speed and widespread availability of such tests would make up for their lower precision.
While no such tests for the coronavirus are on the U.S. market, experts say the technology is simple and the hurdles are more regulatory than technical. The Harvard researchers say production could quickly be scaled into the millions.
A proposal from the Harvard researchers calls for the federal government to distribute $1 saliva-based antigen tests to all Americans so they could rest themselves regularly, perhaps even daily.
Even with accuracy as low as 50 percent, researchers estimate, the paper strip tests would uncover five times more COVID-19 cases than the current laboratory-based approach, which federal officials estimate catches just 1 in 10 of the infections in society.
But the approach faces resistance in Washington, where federal regulators have required at least 80 percent accuracy for new COVID-19 tests.
To date, the Food and Drug Administration has allowed only two COVID-19 antigen tests to enter the market. Those require a nasal swab supervised by a health professional and can be run only on specialized machines found at hospitals, doctor's offices, nursing homes and clinics.
Also, because of the risk of false negatives, doctors may need to confirm a negative result with a genetic test when patients have possible symptoms of COVID-19.
On Tuesday, the governors of six states announced an agreement with the Rockefeller Foundation to purchase more than 3 million of the FDA-cleared antigen tests, underscoring a growing interest.