Nearly two years into a global pandemic that’s provided every one of us with a crash course in epidemiology, it’s a simple task to rattle off all of the problems with America’s coronavirus response. The government slashed pandemic preparedness funding before the pathogen even existed and mobilized far too late once it did. It lagged behind on critical masking recommendations and failed to fund vaccination programs until months after the first shots rolled out. These are just some memorable highlights on a long list of snafus. But even if we’ve grown forcibly—and maddeningly—accustomed to government failure in the face of SARS-CoV-2, one persistent example of foot dragging still stands out: It remains incomprehensibly inconvenient for ordinary people to figure out whether they have Covid-19.
As the world braces itself for the proliferation of the omicron variant and winter looms, this shortfall matters immensely. Universal and easy access to rapid, reliable testing for Covid-19 will be a key tool for driving down cases moving forward, and the Biden administration’s efforts toward making this happen have been laughably inadequate. The best time to kick off the process of making free, at-home antigen tests ubiquitous and easy to obtain was this time last year; the second-best time is right this very second.
Testing infrastructure has never been our strong suit: in February and March 2020, the United States scrambled to catch up with peer countries in scaling up tests for the virus. It was months before polymerease chain reaction, or PCR, tests were anything close to widely available; once they were, your access to them depended heavily on where you lived. Even worse, one recent study showed that test results took an average of six days to come back and could indicate a positive result for weeks after a case was transmissible—long after the information was actually useful. Eventually, the development of at-home rapid antigen tests promised to change these dynamics. Besides offering the enticing possibility of allowing everyone to perform the test at their kitchen table instead of via a professional lab, they yield highly accurate results within minutes. And because they’re less sensitive than PCRs, they tend to pick up only infectious cases—making them a far more useful public health tool.
If all of us had the ability to get near-instantaneous answers about our infectiousness, it would change the course of the pandemic. Just imagine how useful it would be if you could test yourself before heading out to gather with family or friends—to be more or less confident that you could avoid transmitting the virus. More importantly, these rapid antigen tests provide everyone with the best possible chance of detecting their positive status and getting started on a course of soon-to-be-rolled-out antiviral treatments or monoclonal antibodies within the early window necessary to render them effective. Imagine having the upper hand against the pandemic for a change!
Well, this future is only possible if the rapid tests are all over the place, and—to snatch the parlance of the tech bros I ordinarily revile—frictionless to get. At-home antigen testing will only have an impact if it’s not a pain in the ass to obtain. At the moment, however, that’s exactly what it is.
While other countries were making early bets on the very foreseeable infection mitigation strategy I just described—an editorial in The New England Journal of Medicine called for as much over a year ago!—the richest country on earth did nothing to plan for it, even after Biden took office. In the United Kingdom, anyone can order seven free home tests per day for home delivery, whether or not they’re legal residents. In the United States, a pack of two can cost well over $20—if you’re even able to find them in stock.
That daunting retail hunt and eyebrow-raising price point will bar millions of people from considering rapid tests as an option at all: A bus ride and several hours’ wages constitutes a pain in the ass by any measure! It also leads to natural rationing: “Should I really waste a $10 test on dinner with one other couple?” “I’d better save my last test for an emergency, in case I can’t find another when I need it.” “I didn’t push the swab back far enough in my nose and got inconclusive results—why should I bother wasting any more money on these dumb things?!” Multiply these perfectly rational hesitations by tens of millions of people, and the potential for at-home antigen testing to deliver much of anything subsides considerably.
Last week, the Biden administration offered a solution to this: Private insurers must reimburse enrollees for the costs of over-the-counter tests. Anyone who has ever bought something that came with a mail-in-rebate that never made it to the mailbox can easily tell you why this plan won’t work: This method both requires you to pony up cash up front and also imposes administrative burdens onto patients who may not be keen to sit around on hold with insurance companies to wrangle their reimbursements back, months after the fact.
You may also recall that uninsured people and people on Medicaid and Medicare—you know, the poor and elderly!—are at the highest risk of serious disease and don’t benefit from mandates placed upon private insurers. For them, the Biden administration has allocated 50 million free tests to community health centers. By means of comparison, over 80 million people are on Medicaid, and around 30 million are uninsured. So 50 million isn’t nearly enough and won’t satisfy the need simply to put these tests everywhere, in easy reach of wherever people are. We should be joining Ohio and Colorado in giving these things out at public libraries! There should be rapid-test kiosks at the farmers market and high school football games! We should send them far and wide through the public health service!
These tests, so critical to curbing the disease, were so slow in becoming available in the first place because the government apparently hoped the invisible hands of the free market would eventually make them cheaper and more plentiful. If the global pandemic has clarified anything, it’s that the market can’t be trusted to deliver when it comes to public health. Only the public sector can scale up and deliver these resources universally. We need direct public provisioning of rapid at-home tests and collective subsidization of a process so smooth that it’s undetectable. Keeping people safe can’t be achieved with market logic—not when anyone might ask, “Is it worth it for me to blow money on this test today?” Instead, we need to use every policy lever possible to make them say, “Hey, why not? It’s free, and there are plenty.”