1. I've written elsewhere about three different roles for COVID testing: https://twitter.com/CT_Bergstrom/status/1274576193333850112

But whether you are testing for individual health, surveillance, or mitigation, speed is of the essence.

2. When testing for individual health, every person with symptoms deserves to be able to be tested in a timely fashion, and to receive results promptly. Any functioning health care system would offer its members as much.

3. When testing for surveillance, we want to know what is happening now, not what was happening last week or the week before. Every day's delay in returning results is a day that we lose in being able to respond to changing prevalences of disease.

4. When proactively testing for mitigation we are trying to identify pre- or asymptomatic individuals and ask them to self-isolate. The infectious period averages only about a week. Every day's delay is another day that an infectious person is walking around transmitting disease.

5. So how are we doing with all of this?

In short, we're failing miserably. While much of the EU and Asia is getting results back in under 48 hours, most parts of the US are reporting 5-10 day turnaround times.

I hadn't seen any hard data, though, until tonight.

6. @DanLarremore, @ddale8, and @jkbren crowd-sourced (my euphemism for conducting a non-scientific survey) information about testing turnaround times across the US and around the world. Their data are striking—and depressing.

Click to expand.

7. This is nothing short of a travesty.

Sick people don't deserve to wait anxiously for a week or more to know if they have the coronavirus. Our public health response should not be a week or more behind the curve. And with a week's delay? Testing for mitigation is useless.

8. No one can claim that the need for testing was unanticipated. Leaders in public heath and beyond have been clamoring for increased testing capacity since at least the start of March.

This was an avoidable catastrophe, plain and simple.

9. The White House has opposed testing every step of the way.

Trump has succumbed to Goodhart's law (via Strathern: "When a measure becomes a target, it ceases to be a good measure.") since March 6 when he wanted to leave passengers on cruise ships to keep US case numbers down.

10. Time and again he has insisted against all reason that we are testing too much, because testing creates cases and makes us look bad. https://twitter.com/realDonaldTrump/status/1275381670561095682

11. The CDC hopelessly botched the original development of COVID tests, and obstructed the efforts of independent labs to develop their own. The FDA ran—and continues to run—interference, slow-walking the process and refusing to grant approval in timely fashion.

12. Under Azar, HHS has refused to spend the fourteen *billion* dollars allocated by congress for COVID testing. https://www.democrats.senate.gov/newsroom/press-releases/on-heels-of-president-trumps-admission-that-he-directed-officials-to-slow-testing-to-keep-case-numbers-low-and-amid-spike-in-covid-19-cases-in-many-states-across-the-country-sens-schumer-and-murray-reveal-that-hhs-has-yet-to-spend-nearly-14-billion-congress-provided-for-testing-and-tracing-call-on-hhs-sec-azar-and-trump-admin-to-immediately-disburse-unspent-funds

13. It goes on and on. Every step of the way, the White House has hindered efforts by states, local health departments, and private companies to provide Americans with testing capacity. And now they're trying cut testing from the upcoming relief bill. https://twitter.com/carlzimmer/status/1284609387739348994

14. And so desperately ill Americans wait ten days or two weeks to get test results that should take a few hours to process.

Epidemiologists are flying blind given the inability to obtain up-to-date surveillance information.

15. And proactive testing for mitigation—one of the most powerful measures we be using to let us all get back to work and play—is entirely out of the question.

This doesn't need to happen. It isn't happening elsewhere. It's a tragic American failure.

And it's not an accident.