State and Local Testing Strategies for Responding to Covid-19 Outbreaks in Communities: Considerations for Equitable Distribution

As vaccination efforts slowly ramp up across the U.S. and more states and communities start to reopen, testing remains a critical proactive strategy to controlling local outbreaks, monitoring for variants, and ending the pandemic. Yet, vulnerable communities at greatest risk for Covid-19 often have limited to no access to pharmacies and health systems that provide the foundation for testing and vaccination networks. This new report by The Duke-Margolis Center for Health Policy, with support from The Rockefeller Foundation, provides critical considerations for equitably prioritizing testing resources to communities at greatest risk as states and local governments face shortages of testing and ancillary supplies. It also includes longer-term strategies for controlling Covid-19 after the surge in cases subsides to stop emerging outbreaks and identify new variants.

Testing is and will continue to be a critical component of responding to Covid-19 outbreaks in the short term and managing the pandemic in the long term. Current vaccines are still effective against the known Covid-19 variants, but like all viruses, SARS-CoV-2 is constantly changing. The only way to identify those genetic variations quickly enough to get in front of this growing threat is frequent testing and increasing genetic sequencing of those positive tests. Close coordination and engagement with communities are crucial to reducing barriers to testing and the inequities of who is being tested.

This is the fourth report in a series of Covid-19 testing protocols and guidelines led by Duke-Margolis and supported by The Rockefeller Foundation. Released in September 2020, the Covid-19 testing framework outlined a pathway toward operating safely even for higher-risk populations and with continuing community spread. Building off the framework, the Duke-Margolis team released Risk Assessment and Testing Considerations for Reducing SARS-CoV-2 Transmission in K-12 Schools in October 2020, which formed the basis for the testing protocols implemented in six pilot projects, and Risk Assessment and Testing Considerations for SARS-CoV-2 Transmission in Congregate Care in January 2021.