Testing Well

An Interview with Paul Romer

Octavian Report: What kinds of testing do we need to defeat COVID, how much of it do we need, and how quickly do we need it?

Paul Romer: We have a very serious health crisis, and an even more serious economic crisis. To make our way out of those two crises, I think we need testing on the scale of 20 to 30 million tests per day. Full stop.

This is way more tests than others were talking about when I started saying this. It ruffled a lot of feathers. People raised eyebrows. Others have now been kind of moving up in the direction that I've been pointing to, because I think I made some safe space to think about this with a little bit more of an open mind. But the reality is we should be willing to spend $100 billion dollars to get to this level of testing. We need a response at this kind of scale, and at this level of seriousness, to deal with the challenges that we're facing.

OR: What are the tracks along which action to get us to that scale would move?

Romer: There's two parts to that. One is: how do we get up to that scale of testing? The second is what else will we need besides testing to keep this pandemic in check. On the second one, the point of testing is to identify who's infectious and to get those people into isolation. So we need to anticipate: are we just going to rely on self-isolation and voluntary measures? Will the government provide some support for people who go into isolation? Will we use measures that address the fundamental problem with isolation, which is that if people isolate at home, they will infect family members, and then the family members will go out and infect others. So if we're going to allow isolation at home, we may need to adopt policies where we say: well, that really means the whole family has to be isolated. Or we could give people the option of saying you can go be isolated in a dormitory where your family won't be at risk and their movement won't be constrained in any way. So it's test and isolate to keep this virus under control, to keep us on a path where the number of new infections, every two weeks, is smaller than the number that we had before.

To get to that level of testing we need to implement this program. The most important thing is to commit the revenue stream that will pay for the tests. I'm assuming about $10 per test. If we're testing at the scale of 20 to 25 million people a day, so everybody could be tested every two weeks, then you're going to need about $90 billion a year. So we need to commit the funds to pay for this right now during a depression. And this is not just a recession, this is a depression. This is worse than the Great Depression of the Thirties. During a recession or a depression states do not have revenue to take on new responsibilities. They have more spending demands, they have less tax revenue coming in. So the only option for providing the revenue stream for these tests is the federal government that can borrow. And relative to other things that government is doing, where it's borrowing and spending trillions of dollars, $100 billion a year is certainly a feasible level of resources that it could provide.

To carry this out, I think those funds should be passed through to the states. Governors and state public health departments should be responsible for designing the specifics of the test program for the state. And they should be free to purchase the tests from new entrants into this testing business, new university labs that have experience in genomics, and they should be free to avoid, to cut through the very rigorous process that the FDA uses when it certifies a test for use as part of clinical care for patients in our medical system. These tests for deciding is it safe for you to go back to work don't have to be the same as the ones we use for clinical care, and they could be provided from a whole new set of providers that we need to encourage to enter into this activity.

OR: Does America have the political will to stay focused on this problem? And do you think the kind of testing you describe is compatible with America’s culture?

Romer: Part of what you're pointing to is that the United States is different from Iceland. It's not a small Island with a relatively small number of people who move in and out. We have a culture which is very different from South Korea. So it's a good point to remember so that when somebody presents a plan which boils down to “Let's wait until we get the number of infections way down to the level of South Korea had, and then let's just do South Korea,” the United States is probably not going to do South Korea. We're different. We're not going to respond in the same way. So instead of just blindly pointing to, "Well, let's do what they did," we do need to think about what's actually feasible, what's credible, what's possible in the U.S.. And this again is why I'm pushing towards universal, population-scale testing. I think that's the approach that is most consistent with the culture that prevails here in the United States.

As for the first part of the question, I have a different take on this than most people. I do not think that the fundamental challenge here is a partisan divide. Everything in the United States ends up getting processed through a partisan filter, but I just think that's just noise right now. I think there are two things that are going on. One is that many people are simply in denial and it's totally understandable. This is an extraordinary shock. And let me try and illustrate it using myself as an example. If Paul Romer of 2020 spoke to Paul Romer of 2019 and said, "We need to initiate a $100 billion dollar a year program of population scale testing to deal with threats posed by viral pathogens," Paul Romer of 2019 would have said, "Oh, come on. That's overkill. That's way too much money. It's expensive. You won't be able to scale up to that level anyway. I don't buy any part of it." So why does Paul Romer of 2020 you think this is like easy and obvious and cheap?