Cars form lines at a federally-supported drive-thru testing site for coronavirus disease (COVID-19) at PNC Bank Arts Center in Holmdel, New Jersey, April 4, 2020. K. C. Wilsey | FEMA | via Reuters

As the United States reels from the massive economic fallout of the coronavirus outbreak, there are growing calls by President Donald Trump and others to start to reopen businesses, schools and other public spaces so that the nation can begin to recover financially. On Thursday, Trump tweeted he would be holding a "Major News Conference" that evening to "explain Guidelines for OPENING UP AMERICA AGAIN!" TWEET But health experts and several top business leaders warn that the country — which might not see a coronavirus vaccine for 18 months or more — should not reopen on a broad scale unless there is a huge increase in the relatively small number of tests currently being done for Covid-19 infection. Amazon CEO Jeff Bezos, in a note to shareholders early Thursday, wrote: "Regular testing on a global scale, across all industries, would both help keep people safe and help get the economy back up and running." "For this to work, we as a society would need vastly more testing capacity than is currently available," Bezos noted. NBC News later reported that Democratic lawmakers in calls Thursday with Trump insisted that he wait until there is widespread testing available before he pushes to reopen the nation. But Trump indicated to them that such an economic reopening would have to occur before an expansion of testing levels, Sen. Mike Braun, R-Ind., told NBC News. Health experts also say the country needs a related and equally robust program to trace the people who have had contact with infected people, to avoid seeing those contacts themselves spread the coronavirus to others. There are only about 120,000 samples or so being tested each day for the coronavirus in the United States, according to the federal Centers for Disease Control and Prevention. Experts say that millions of people will have to be tested each day, even as many as 20 million to 30 million people, before the nation can return to a semblance of economic normality. That is much more than the number of tests even projected to be produced by some major manufacturers by June.

"To avoid a second wave of viral spread you have to do what South Korea and other countries, including Germany, have done. You have to have testing in place, and aggressive testing," said Dr. Tom Moore, an infectious disease specialist in Wichita, Kansas. "We don't have to test everybody, but we definitely need to test a significant portion of the community," said Moore, a former board member of the Infectious Diseases Society of America. "This is a Herculean task," he said. "I don't know how it's going to be solved in the immediate future, but it needs to be." Moore and other experts say that a second or third wave of Covid-19 infections could end up killing more people than the first wave, lead to another series of shutdowns of businesses, and ultimately end up doing greater economic damage than has been seen to date from the pandemic.

As of Thursday, there were more than 639,000 cases of coronavirus reported in the U.S., with nearly 31,000 people dead from the disease.

Millions of tests a day

Officials at the Rockefeller Foundation told CNBC they expect to release in coming days a paper outlining the scope of the work that needs to be done to get the U.S. on track to safely returning to work, school and leisure time activities. The philanthropic group is a major donor for efforts related to health, science and other areas. The foundation said that it has been in contact with the Trump administration, national groups of governors and mayors, and leading American corporations as it prepares its recommendations. "It's going to [initially] cost at least $100 billion and upward of $500 billion over the long haul," said Eileen O'Connor, senior vice president for communications, policy and advocacy at the Rockefeller Foundation. The foundation's plan, which will propose that the cost be financed directly and subsidized by the federal government, estimates that 20 million to 30 million tests each day would need to be performed to get many Americans back to a more normal life. But the foundation also estimates that there will ultimately need to be 200 million to 300 million tests each week to have the economy functioning as it was before the outbreak began. That level of testing assumes multiple rescreenings of individual Americans in the absence of a Covid-19 vaccine. The Rockefeller Foundation's plan calls for changes in logistics to optimize the current capacity of testing in the U.S., which by June or July could allow for 2 million to 3 million tests per week, O'Connor said. At the same time, O'Connor said, "We need to invest in the different kinds of tests that can be ramped up even more quickly and as efficiently" as possible. She said a medium-term goal is to ramp up the testing capacity with a "huge investment" that could lead to "up to 10 million tests per week, before we can get certain sectors back to work." Even that number of polymerase chain reaction, or PCR, tests would be a tiny fraction of the U.S. population of 330 million or so.

The first sector to target with a testing capacity of 10 million or so tests per week would be health-care workers, many of whom have contact with coronavirus patients, police and emergency workers, O'Connor said. Then food production workers, including farm workers, and then trucking workers. That target could be reached by this fall, the foundation believes. After that, the goal would be to have tens of millions of tests done every day to have the country fully return to work.

More tracking

The Rockefeller Foundation's plan also will call for "data aggregation" platforms that will track where tests and testing-related supplies such as swabs and chemical reagents are located and where they should be allocated. "We then have to also marry that with testing results and contact tracing ... so that we can know where the disease is going next," O'Connor said. The contact tracing could be aided by digital apps and geolocators to identify where infected people have been, she said. New York Gov. Andrew Cuomo on Wednesday said the state, which is currently ground zero for the Covid-19 pandemic in the U.S., will need an "army" of contact tracers to identify people who have been with infected individuals. He called on the federal government to fund that effort. Tweet Thomas Frieden, a former director of the Centers for Disease Control and Prevention, told the news site STAT this week that "We need an army of 300,000 people" to do contact tracing nationwide. O'Connor said, "There is no doubt we need to get the economy back and running, and if we don't the damage will be long lasting." "Everybody is focused on the safest return to work possible, but the only way you do that is testing," she added.

A long road ahead

The Rockefeller Foundation's plan does not estimate that the U.S. workforce will be back to normal anytime soon. And while the foundation's projections for the number of needed tests might seem high to some people, it comes on the heels of projections published by the Edmond Jr. Safra Center for Ethics last week. "These [projections] suggest that, depending on what tracing technology is used in conjunction with testing, at least millions and possibly hundreds of millions of tests per day will be needed," that analysis said. "While we estimate that such capacity is possible by late spring or early summer," the authors wrote, "we must invest much more aggressively if we are to allow a return to work." Dr. Scott Gottlieb, the former head of the Food and Drug Administration, and a CNBC contributor, has called for a plan that would test anyone who visits a doctor, which would be nearly 4 million people per week. But Gottlieb also said in a Vox interview this week that getting to the point where the United States has the capacity to perform 2 million to 3 million tests each week "is going to be very hard." He said it would be possible to reach that level by September but added that Congress would need to support that effort. Former Vice President Joe Biden, the presumptive Democratic nominee for president, said Thursday, "I say we should not send you back to work till it's safe to send you back." Choosing between the economy and health "is a false choice," he said. "The way you revive the economy is you defeat the disease," said Biden, who argued that widespread testing will be needed to determine who can return to work and which workplaces and public spaces can be opened again. BlackRock CEO and co-founder Larry Fink said during an interview on CNBC's "Squawk Box" on Thursday: "We're going to still see elements of the disease increasing in other parts of the world and until we have adequate testing, rapid testing, it's very hard to see how we're going to reboot in the next 30 days." Fink said he expects that treatments for Covid-19 could be improved to speed up that economic rebooting, "But it may not be in June or July. It may be in August." He noted that a number of business leaders told Trump during conference calls on Wednesday that "we need to have adequate" testing "to make sure we have a secured environment." Trump himself this week said, "Our country has to get open, and it will get open, and it will get open safely and hopefully quickly. Some areas quicker than other areas." The president, who is running for reelection this fall, also claimed "there's tremendous testing, and the governors will use whatever testing is necessary, and if they're not satisfied with their testing, they shouldn't open." But Trump's own leading infectious disease advisor, Dr. Anthony Fauci, told the Associated Press in an interview Tuesday that the U.S. is "not there yet" in having enough testing capability or contact tracing systems in place to rely on for reopening the economy.

Equipment shortage

Complicating the effort to increase the number of tests performed in the U.S. is a shortage in equipment needed to conduct those screenings. This week, the American Academy of Medical Colleges wrote Dr. Deborah Birx, coordinator of the White House's Coronavirus Task Force, and said the group appreciated the fact that the U.S. Food and Drug Administration had taken steps "to reduce regulatory barriers to developing, validating, and deploying" coronavirus tests. But the group added that while those tests hold the promise for increased numbers of Covid-19 screenings, "we have come to learn over the past several weeks, despite the best efforts of all parties, not one of these components [needed to run those tests] is readily available in sufficient quantities to each and every lab that needs them." "Widespread but uneven shortages in one or more of the essential components for testing have resulted in a situation where few labs are able to maximize the testing capacity of any one machine, platform, or test," the letter said. Qiagen, a major manufacturer of the RNA extraction kits used to detect the coronavirus for tests, told CNBC on Thursday that it "produced enough kits in March to purify RNA for coronavirus testing of about 3.3 million patient samples, up from about 1 million in February and an average of 400,000 a month during 2019." The company added that it "aims to double production to about 7 million in April and ramp up to about 20 million a month by October 2020 — well ahead of our original plan that we announced on March 17." That level of production would still, for Qiagen at least, be far short of the levels of testing the Rockefeller Foundation plans to call for.

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