Diagnostic testing is central to detecting the virus in symptomatic and asymptomatic persons, or those identified as contacts exposed to COVID-19 cases, to guide community interventions that are predicted to contain ongoing transmission. The pandemic has resulted in unprecedented demand for the RT-PCR testing capacity of all countries. Demand for testing has been coupled with a global shortage of commercial kits, reagents, consumables, disruptions in the global transport networks, and exacerbated by international competition for testing resources. Accordingly, even many high-income countries have inadequate RT-PCR testing capacity to effectively suppress ongoing transmission, and most low and middle-income countries (LMICs) are unlikely to be able to establish even minimally needed RT-PCR capacity in the immediate future.