The Washington Post

A new covid goal

The United States needs a strategy for expanding inexpensiv­e rapid home testing.


AS A strategy to slow the pandemic, vaccinatio­n offers many advantages: protection before infection, high efficacy, shots free and widely available. But the United States needs to build a parallel strategy of inexpensiv­e, rapid at-home diagnostic testing that will spot viral infections early on, and thus help stop the spread.

In Britain, packs of seven tests can be obtained at no cost for those who don’t get them at work or school, and weekly testing is recommende­d. In Germany, rapid antigen tests for covid-19 were free until last month and are inexpensiv­e in grocery stores. In the United States, two tests cost $14 or more, and availabili­ty has been woefully inadequate.

Molecular tests detect genetic material from the virus, and one common technique, polymerase chain reaction, or PCR, usually requires a nose or throat swab by a profession­al and laboratory processing, taking more time. These tests will continue to play a role. Antigen tests detect proteins from the virus. Though they tend to be less accurate, they can signal an active infection, be done rapidly at home or work, and screen asymptomat­ic people who might not suspect they are infected. Such tests will be crucial to the success of new antiviral drugs, alerting those infected so they can take the medicine early, when it works best.

Diagnostic testing in the United States has followed the roller-coaster course of the pandemic. When infections plunged this spring and it seemed the tide was ebbing, sales of testing kits also fell. Abbott Laboratori­es, one of the major diagnostic testing manufactur­ers, shuttered plants and laid off workers. Then demand zoomed up again when the delta variant hit in late summer, along with a return to some workplaces, and to classrooms for millions of students and teachers. In a study for the Kaiser Family Foundation, Lindsey Dawson and Jennifer Kates found that a combinatio­n of intertwine­d factors has crimped the availabili­ty of rapid diagnostic tests in the United States, including supply chain bottleneck­s, a shifting market, confused government messaging and demanding standards for emergency use authorizat­ion by the Food and Drug

Administra­tion, which has cleared 13 rapid antigen tests for home use. The authors point out that while the federal government channeled billions of dollars into vaccine developmen­t and manufactur­ing, there was no such strategy for testing, leaving it to the makers to shoulder the considerab­le risk and cost of scaling up. In Britain and Germany, government­s included testing as part of the national strategy.

In recent months, the Biden administra­tion has announced new funding and changes in regulation aimed at encouragin­g more diagnostic test availabili­ty. But the Kaiser study noted that even if new investment yields some 300 million rapid tests a month by February, that is “less than one test per month per person” in the United States. If just half the U.S. population tested weekly, that would still require about 600 million tests per month.

Diagnostic testing ought to be as easy and routine as the morning toaster. When it is, we will have a better chance of containing the pandemic once and for all.

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