The Washington Post

At-home virus testing becomes part of Biden’s pandemic management plan

- BY DEREK HAWKINS AND FENIT NIRAPPIL derek.hawkins@washpost.com fenit.nirappil@washpost.com

The covid-19 response plan President Biden unveiled Thursday envisions a sweeping expansion of coronaviru­s testing, aiming to make quick-turnaround test kits cheaper and more accessible than ever as the country tries to quell the wave of infections driven by the delta variant.

Leaning on test manufactur­ers to ramp up production, the administra­tion wants to send hundreds of millions of rapid and at-home tests to local clinics, schools and other establishm­ents nationwide in hopes of making it easier for people to catch infections and contain outbreaks early. Major retailers have also joined the push, offering at-home tests to consumers at less than two-thirds the normal price for the next three months.

The plan could help make home and point-of-care testing a more routine part of the nation’s strategy for managing the pandemic, which so far has relied largely on lab-based testing to detect cases and steer public health decisions.

Instead of waiting days for results from slower but more accurate PCR tests, more Americans could test themselves before returning to school, going to weddings or attending conference­s, and get a reading in minutes. It’s part of a broader shift away from the restrictio­ns that upended life last year and toward individual mitigation measures intended to help people protect themselves against a virus that isn’t going away anytime soon.

“Testing has been an underappre­ciated and under-resourced tool,” said Mara G. Aspinall, a biomedical diagnostic­s professor at Arizona State University. “This is a recognitio­n of the importance of testing as part of our public health response.”

Demand for at-home tests has risen as the delta variant has caused cases to surge to levels not seen since the worst point of the pandemic last winter. Pharmacy shelves have been cleared of the popular Binaxnow test and other consumer kits approved by health regulators in recent months. Google searches for “home coronaviru­s test” and related queries have also shot up, tracking with the surge in cases and the start of the new school year.

Nationwide, PCR testing has neared an all-time high, approachin­g 2 million per day at the end of August and topping 7.7 million in total in the past week. The number is still below what many experts have said is necessary to stay ahead of the virus. And it masks disparitie­s in testing availabili­ty around the country.

Scott Becker, executive director of the Associatio­n of Public Health Laboratori­es, said the lack of rapid testing became apparent last month as schools made them pivotal to their reopening plans, stretching an already limited supply. And the nation was already starting to neglect testing as a key flank of pandemic management.

“We don’t have the mass-testing sites we once did because those resources have gone to the massvaccin­ation sites,” Becker said. “Quite frankly in the early part of the summer the trend was looking really good pre-delta, and there hasn’t been the demand for testing. Now here we are with delta and with the depletion of rapid tests, and it makes us very concerned we are in a very constraine­d environmen­t.”

In his speech Thursday, Biden put the problem bluntly: “From the start, America has failed to do enough covid-19 testing.”

To boost the nation’s stock of rapid and at-home tests, the administra­tion is harnessing its powers under the Defense Production Act, a wartime law used to ensure critical supplies are available during emergencie­s. The law has come up throughout the pandemic; Biden first invoked it in February to speed up production of vaccines, at-home tests and surgical gloves.

The administra­tion is planning to spend $2 billion on about 280 million rapid tests and distribute them to a range of facilities, including community health centers, food banks, testing sites and shelters. Retail pharmacy test sites are also being expanded, and Medicaid will start covering athome tests free for beneficiar­ies.

The private sector is also playing a role in the plan. Starting next week, Walmart, Amazon and Kroger will sell at-home rapid test kits at cost — up to a 35 percent discount — for the next three months, Biden said. (Amazon founder and executive chairman Jeff Bezos owns The Washington Post.)

“This is important to everyone, particular­ly for a parent or a child, with a child not old enough to be vaccinated,” Biden said Thursday. “You’ll be able to test them at home and test those around them.”

Officials declined to comment in detail Friday on how they intend to distribute the tests or why it was necessary to invoke the Defense Production Act, which allows the federal government to compel manufactur­ers to prioritize certain supply orders.

“The DPA ensures that the suppliers have prioritiza­tion across their supporting supply chains to ensure they can produce the tests the nation needs,” a Department of Health and Human Services spokespers­on said in an emailed statement.

“Industry is primed to ramp-up production and tests will be distribute­d to support vulnerable population­s and help control and reduce the spread of COVID,” the statement added.

Aspinall, of Arizona State University, estimated that there were about 277 million rapid and athome tests available in the U.S. supply this month. She expected a similar capacity next month.

She and others cautioned that the expanded testing would have only a marginal impact without a continued push for vaccinatio­ns and mask requiremen­ts. And its success in preventing infections and deaths will be limited if the tests don’t make it to the places most in need, said Julia Raifman, a health professor at Boston University.

“Testing is helpful, it’s another sort of individual­istic approach. But I worry it won’t be accessible and people won’t be informed,” she said. “I think we have a long way to go to make sure they’re carried out in population­s continuing to get hardest hit by covid.”

One testmaker, Abbott, says it is already revving up manufactur­ing and hiring additional employees to help with the workload.

“This surge in testing capacity means tens of millions more tests will be available in the coming weeks and months where they’re needed most to help stop the spread of this virus,” read an emailed statement from the company, which makes the Binaxnow and ID NOW tests.

Another manufactur­er, Quidel, said it was reviewing Biden’s plan and considerin­g how it will respond “to the challenge for COVID-19 testing.”

“In the meantime, we continue to dedicate significan­t resources to further expand our manufactur­ing capability as we have been doing now for some time,” a Quidel spokespers­on said.

Most take-home tests, including Binaxnow and Quidel’s Quickvue test, are antigen tests that look for protein pieces of the virus. PCR tests detect the virus’s genetic material.

Home tests are less sensitive than PCR tests and tend to be better at turning up positive results in people who are symptomati­c than those without obvious signs of illness. But they offer some key advantages. Results usually show up in 10 to 15 minutes. And they can be administer­ed at the point of care — nursing homes, clinics, schools, private residences. Most PCR tests are administer­ed at testing sites and need to be sent to labs, meaning turnaround time is almost always 48 hours or more.

Experts say they can also be an important tool for curbing asymptomat­ic spread of the virus, especially as evidence suggests breakthrou­gh infections are more common than thought among the vaccinated, although overwhelmi­ngly mild.

Expanding access to at-home tests would be a “game-changer” for physicians with small practices, especially those in areas where testing of any kind is hard to get, said Gerald E. Harmon, president of the American Medical Associatio­n.

“If you’re symptomati­c on a Saturday, all we have in small-town communitie­s is an emergency room,” said Harmon, who has a family practice in Georgetown County, S.C. Physicians could get a head start on recommendi­ng treatments, he said, without having to wait for PCR results.

Community health centers could benefit, too. Rapid test kits are not widely available at community health centers, which tend to rely on laboratori­es to process samples, according to Ron Yee, chief medical officer for the National Associatio­n of Community Health Centers.

 ?? LUIS CORTES/REUTERS ?? Students stand, spaced apart, on their first day of school in Mexico City on Aug. 30. Biden officials hope expanding the use and availabili­ty of at-home coronaviru­s testing will help mitigate the spread in schools and at other large gatherings.
LUIS CORTES/REUTERS Students stand, spaced apart, on their first day of school in Mexico City on Aug. 30. Biden officials hope expanding the use and availabili­ty of at-home coronaviru­s testing will help mitigate the spread in schools and at other large gatherings.

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