The search for a rapid at-home Covid-19 test now might remind you of what it was like to hunt for toilet paper at the beginning of the pandemic. They’ve been hard to find for months. The tests are in such hight demand, and in such short supply, that CVS has put a limit on how many tests customers can buy. They’re so precious, some people have even started bringing them to dinner parties to give away as hostess gifts, instead of wine or flowers.
On Wednesday, the Biden administration announced that it will spend an additional $1 billion to get more at-home tests into the market, but the shortages could continue for months and, experts say, the additional tests might not be enough to make this tool as effective as it could be to help end the pandemic.
What’s the plan?
Vaccines can protect people from becoming infected, but they are only one tool to can help stop the spread of Covid-19.
The Biden administration has made testing a priority. It’s $1 billion purchase agreement was inked to prompt manufacturers to ramp up production. This follows the $2 billion the administration promised in September that it said would ensure tests are available to those who need them.
The supply will continue to grow with the addition of ACON Laboratories at-home test that the US Food and Drug Administration authorized on Monday. ACON’s at-home test will join Abbott’s and a handful of others. The administration said Wednesday that it also secured a commitment from two other companies to speed up production.
“We’ll continue to pull every lever, as we have throughout the pandemic response on testing, to expand manufacturing production of tests in order to make tests more widely available and drive down the costs per tests,” White House COVID-19 Coordinator Jeff Zients said at Wednesday’s briefing.
The tests should also become more affordable with more competition, Zients said. He added that the ACON self-test should cost less than $10. The Abbott two-pack costs about $23. In September, the administration also got Amazon, Walmart and Kroger to promise to sell at-home rapid test kits at cost for the next three months.
Ultimately, the number of at-home tests should quadruple, the Biden administration said, providing the US with about 200 million at-home tests a month by December, with tens of milions more available in the coming weeks.
Experts say that’s a good start, but it isn’t nearly enough, and they question where the national testing strategy is.
Even 200 million is not enough
While 200 million tests might sound like a lot per month, it’s probably not enough, said testing expert Mara Aspinall.
“It’s a signficant step forward,” said Aspinall, professor of practice at the College of Health Solutions at Arizona State University. “But in order to use testing to eliminate onward transmission, the numbers are closer to testing at least 6 million a day.”
At-home tests can help prevent the spread of disease and also tell someone if they are sick with Covid-19 — even if they don’t have symptoms, so they can go get treatment and also stay home so they don’t spread it to others.
The tests aren’t as sensitive as a PCR test that requires a lab to process, but the advantage is that they can deliver results in less than an hour, unlike the lab tests, which can take days.
The Biden administration said these at-home tests will be distributed to food pantries, community health centers and will also be made available for purchase to companies and to individuals.
Even if cases are slowing down in some regions, with flu season, the country will need more tests to determine if a cough is from the flu or Covid-19. There will also be an increase in demand as more people return to the office. The Biden administration is still working out the details of a new workplace rule that will mandate companies with 100 or more employees either require employees to get the vaccine or test regularly.
With more than 81 million people in this part of the workforce, even if 25% of employees refuse the vaccine, that means the US would need about 4 million rapid tests for those workers alone.
Aspinall thinks to keep the public safe, testing should also include people who are fully vaccinated. That’s not the current guidance from the US Centers for Disease Control and Prevention, but she thinks that’s shortsighted.
“We can’t use testing just as a punishment for the unvaccinated,” Aspinal said. “The vaccines, as great as they are — and they’re 98% plus effective against hospitalizations and deaths — there are breakthrough cases. We need random testing of the vaccinated to protect the unvaccinated.”
“What is the objective of testing? It’s not to punish. It is to stop the spread of disease.”
We need more tests today
Dr. Michael Mina an epidemiology professor at the Harvard T.H. Chan School of Public Health, has looked with envy at countries in Europe that have used cheap rapid tests widely. In the UK, he said, you can get seven mailed to you for free every day. They’re available in other countries just about everywhere and cost about $1.
“To really make testing effective as a public health tool, we need to use them frequently, and that’s the power of rapid tests. Ideally you could have 20 of them in your cupboard and use them anytime you have family over to make sure that you’re not at risk for infecting them, or to use them before you go to work or school,” Mina said.
The Biden administration’s announcement does not allow that level of testing.
“Unless we see real change from the White House that is going to truly enable widespread access to rapid tests – in the form of enabling greater market access and competition from many high quality companies – I will remain skeptical about whether this or similar announcements will lead to a material difference for most Americans,” Mina said in an email. “It’s a start, for sure and if we really can quadruple tests that’s great. But doing so by December most likely means by February. We need the World’s tests available in the US today. We needed them a year ago. We don’t have a moment to waste.”
‘Dumping tools on the market without a strategy’
Asked if 200 million tests a month would be enough, Jennifer Nuzzo, a testing expert at Johns Hopkins Bloomberg School of Public Health and a senior scholar at the Johns Hopkins Center for Health Security, said she doesn’t think so.
“If you hope that most Americans will use tests every other day or so to determine if they are contagious, then the answer to that question is a resounding no,” Nuzzo said in an email. “But if they are to be used in schools to support test-to-stay polices, these tools could have an enormous impact provided they come with personnel to help administer them. If they are simply made available for purchase then they will become a luxury that only a few can afford.”
Nuzzo’s bigger concern is that she doesn’t think there is a national testing strategy — even more than a year into the pandemic.
“Simply increasing the number of tests that are available is not enough,” Nuzzo said. “We urgently need a testing strategy that figures out what are overall testing needs are, optimizes the use of the tests we have and identifies steps for filling in any gaps.”
And even with more rapid tests, the country will still need additional PCR testing, she said. People who get a positive on an at-home test, are encouraged to get a more sensitive PCR test to confirm it. While PCR testing turn around times are much better than at the start of the pandemic, it still can take more than a couple of days to get a result back and that’s not as useful.
“Having more tools is good. But dumping tools on the market without a strategy to optimally guide their use weakens our abilities to ensure that we are getting all that we can out of testing to control the spread of this virus,” Nuzzo said.
‘A little late in the game’
Lori Tremmel Freeman, CEO of the National Association of City and County Health Officials, is also frustrated by what she sees as a lack of national testing strategy. It’s something that should have been managed months ago, she said.
“It’s a little late in the game to be still talking about our lack of a national testing strategy,” Freeman said.
While more home tests can play an important role in disease surveillance, tests results aren’t necessarily reported to health departments like lab tests are.
“I think getting them in the hands of people more easily is a good thing. I don’t want to be negative about it,” Freeman said. “It’s useful for people on an individual basis, but it doesn’t help us with wide scale disease investigation.”
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