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WASHINGTON — With the Omicron variant of the coronavirus speeding across the United States, President Biden will reportedly announce a new plan Tuesday to buy 500 million at-home rapid tests to distribute free to the public — the administration’s biggest investment in rapid testing to date, but one that experts say still won’t make such tests ubiquitous enough to slow the new variant.
The tests will not start to be available until January, according to the New York Times, at which point Americans will be able to order them for home delivery from a government website.
“We’re dealing with a once-in-a-lifetime global pandemic that has been very unpredictable,” White House press secretary Jen Psaki said Monday, defending the administration’s handling of testing demand that has routinely exceeded supply as she previewed Biden’s remarks on the state of the pandemic scheduled for Tuesday afternoon. The administration, Psaki added, has worked “to increase access [and] make [tests] affordable and accessible.”
According to public health officials who have been demanding more rapid testing for months, invoking the Defense Production Act to distribute 500 million free tests is a step in the right direction. But some fear it may be too little, too late.
“500 million #covid19 tests sound like a lot,” Leana Wen, a former Baltimore health commissioner who now serves as a professor of public health at George Washington University, tweeted Tuesday. “But: 330 million Americans. If half want tests = 165 million. That’s only 3 tests TOTAL per person. Not nearly enough for testing to become the norm before school/work, and friends getting together. We need a plan for far more.”
“A start (finally),” added Eric Topol, director of Scripps Research Translational Institute, “but billions are needed to help prevent spread.”
The problem, Topol and others say, is that Omicron — and the enormous numbers of breakthrough infections it will generate — is about to make frequent rapid testing for contagiousness more crucial than ever before.
Yet with case counts soaring and demand responding in kind, rapid at-home tests now appear to be largely sold out at Walmart, unavailable online and nearly impossible to find on pharmacy shelves. Where they can be found, they remain too expensive for many Americans to use with any regularity.
Biden's new plan is an acknowledgement of how the testing landscape has shifted — and how America's testing strategy needs to shift in response.
It has become increasingly clear that the U.S. is not going to stop the spread of Omicron through mandates, restrictions or social distancing. Largely shielded from severe disease, vaccinated Americans have little appetite to return to the lockdown measures put in place in 2020. Many unvaccinated Americans, meanwhile, have long opposed precautionary measures of any kind.
With politicians equally reluctant to impose new restrictions, that leaves the country’s uneven immunization effort as its primary defense.
Yet “our vaccination and booster coverage is wholly insufficient for the Biden administration to rely on a vaccine-only approach,” Anne Sosin, a public health policy scholar at Dartmouth College, told Yahoo News in a text message.
And so the new, heavily mutated Omicron variant — which the Centers for Disease Control and Prevention said Monday now accounted for 73 percent of U.S. coronavirus cases and which can dodge immunity better than any of its predecessors — will continue to proliferate at an unprecedented pace.
Testing, especially rapid at-home testing, may be the best remaining tool to limit transmission to the vulnerable while also limiting disruptions to lives of those who are largely immune to serious illness — as well as to school, work and the economy as a whole.
“Expanding access to cheap and accurate rapid tests would help countless people better manage the risk they pose to vulnerable people in their lives,” Dr. Jay Bhattacharya, a professor of medicine at Stanford University, told Yahoo News. “That should be a top COVID policy goal, and should have been for a while now.”
Yet despite an previous investment of $3 billion by the Biden administration, that objective hasn't been meet. Along with empty shelves at CVS and “out of stock” notices online, lines for PCR tests in major metropolitan centers like New York City and Washington, D.C., over the weekend only underscored the severity of the problem.
Dense and interconnected, such cities are getting slammed by Omicron first — hence the run on tests. In New York City, cases are up 277 percent over the last two weeks. In Honolulu, they’re up 828 percent. In Houston, they’re up 442 percent. In Miami, they’re up 219 percent. In Cleveland, they’re up 170 percent.
Soon Omicron will spread beyond major metropolitan areas to every corner of the country — as will the testing crunch.
This is dangerous for two reasons. The first is that the more pervasive Omicron becomes, the more effectively it will find and infect the tens of millions of Americans — unvaccinated or otherwise vulnerable — who still lack sufficient immunity.
Some will be hospitalized. Some will die. All of this will put further strain on a health care system that’s already struggling to keep up with an huge, ongoing Delta wave.
The second reason Omicron’s explosive growth is dangerous concerns the even greater number of Americans who face less risk of serious illness themselves: the boosted most of all, but also the double-vaccinated and the previously infected.
Encouraging data out of South Africa, Denmark and elsewhere suggests that the vast majority of these people have little to fear, personally, from an Omicron infection. Yet their lives could be upended all the same. They may fall ill. They’ll have to miss work or school. And they should quarantine to avoid transmitting the virus to others who might be more susceptible.
Multiply those disruptions by hundreds of thousands, or even a million new cases each day, and they start to have a serious impact on schools, hospitals, families and businesses, regardless of how mild each individual infection might be.
The good news is that in the age of Omicron, experts say testing — especially rapid at-home testing — can safely minimize that impact. But only if Americans can actually find and take these tests.
“Rapid testing is a critical tool for bringing the pandemic under control, but we will only see its benefits if we make it accessible and easy for Americans to use. Most American can neither access nor afford rapid tests," Sosin told Yahoo News. “Rapid testing can help ensure educational continuity, limit disruptions to businesses and essential services, and keep health systems functioning."
To that end, the Biden administration has already endorsed a new strategy called “Test to Stay,” intended to prevent students from having to undergo lengthy quarantines at home if they’ve been exposed to the coronavirus in the classroom. Instead, students can keep going to school, provided that they are tested for COVID-19 regularly and don’t show any signs of illness.
“Test to Stay is an encouraging public health practice to help keep our children in school,” CDC Director Rochelle Walensky said during a Friday briefing of the White House pandemic response team. “That testing needs to be at least twice during the seven-day period after exposure.”
A similar principle, meanwhile, should now apply to any vaccinated person experiencing a breakthrough infection, experts say. “Asking boosted people with [a] ‘breakthrough’ infection to isolate for 10 days seems excessive to me,” Ashish Jha, dean of the Brown University School of Public Heath, tweeted Monday. “Want 100% assurance? Sure, do 10 days. But I’ve told friends: Get a rapid antigen at 5 days. If neg[ative], [it’s] reasonable to assume you aren’t contagious.”
“Levels of the coronavirus decline rapidly in vaccinated people who are infected, [so] people with breakthrough infections [should] be able to return to their daily lives faster,” added physician and epidemiologist Jay Varma, former COVID-19 adviser to New York Mayor Bill de Blasio.
PCR tests can detect even the tiniest traces of pathogen in the body, but increasingly long wait times — for both the tests and the results — will render them almost useless to combat the Omicron surge. Rapid antigen tests are much handier because they immediately identify whether someone has enough virus in their system to be infectious. For this reason they’re also a far superior way to screen for COVID before gathering indoors with friends and family, as Harvard epidemiologist Michael Mina has long noted.
“We continue to think about testing as a medical device,” Mina said in a CNN appearance on Monday. “We continue to regulate it in a very slow, arduous fashion. And that has left the United States far behind our peer nations in terms of getting Americans access to these tests.”
Rapid tests were not available until early 2021, and when the U.S. pandemic appeared to subside over the spring and summer, so did interest in their public health potential. Abbott Laboratories, maker of the popular BinaxNOW brand of tests, started to wind down manufacturing.
The day after Thanksgiving, however, the World Health Organization announced that a new “variant of concern” — Omicron — was spreading in southern Africa. The variant’s imminent arrival in the United States heightened the demand for rapid testing.
Several days later, President Biden released his “winter plan” to battle the Omicron variant. The plan allowed for Americans with private insurance to seek reimbursement for rapid test purchases from their insurers, a potentially cumbersome process that could discourage some people from purchasing rapid tests in the first place. Nor did the provision have anything to offer Americans lacking insurance or receiving insurance from the government.
Some wondered why the United States didn’t simply distribute rapid tests to all Americans or make them readily available at little or no cost, the way other nations have.
At the time, the White House bristled at the suggestion. “Should we just send one to every American?” Psaki wondered sarcastically Dec. 6. “Then what happens if you, if every American, has one test? How much does that cost?”
Last weekend, social media channels were inundated with videos and reports of prolonged waits for coronavirus tests. The Biden administration has opened thousands of testing sites across the country, but these can involve hours-long waits. And many of the sites offer only PCR tests, which can still take several days to return results.
And so the White House appears to have reconsidered. Yet while the ideal remains abundant, free tests that can be administered at home, as a person prepares to travel or socialize— or experiences tell-tale symptoms like a sore throat — that vision will remain largely unrealized unless the administration keeps its foot on the gas.
"I am excited about this development," Mina tweeted Tuesday. "I think this is very good for start for [the] US and although 500 million across 350 million is not massive per person, this has the ability ensure that this process is in place and the US will have tests when needed beyond Omicron."