Rapid testing, a key to controlling pandemic, faces gaps

No rapid over-the-counter tests sold at Atlanta airport
In this photo, Delta Air Lines employees assist customers in the Domestic Terminal at Hartsfield-Jackson Atlanta International Airport in Atlanta on Tuesday, October 5, 2021.  (PHOTO by Hyosub Shin / Hyosub.Shin@ajc.com)



In this photo, Delta Air Lines employees assist customers in the Domestic Terminal at Hartsfield-Jackson Atlanta International Airport in Atlanta on Tuesday, October 5, 2021. (PHOTO by Hyosub Shin / Hyosub.Shin@ajc.com)

As hundreds of thousands of Georgians are traveling to meet friends and family, some experts say that the pandemic response has neglected a crucial tool for preventing another surge: over-the-counter rapid tests.

Rapid tests, also called rapid antigen tests, do something that the “gold standard” laboratory tests can’t: they tell you right away if you’re infectious that day. They are key to guiding in-the-moment decisions like whether to meet up for dinner or get on a plane if you didn’t manage to get a lab test done and wait a day or two for results.

But the U.S. has been slow to mobilize rapid over-the-counter tests. Since the pandemic began, public health officials have prioritized laboratory tests, usually called PCR tests. Typically obtained through a doctor’s office or drive-through clinic, the PCR tests take longer, cost more and results are used by public health agencies to track case numbers.

With PCR tests, even small amounts of virus can be detected, even if a person isn’t infectious.

“One of the greatest failures of thinking by our agencies,” Michael Mina, an infectious disease researcher and advocate for rapid over-the-counter testing said on Twitter of the disdain for rapid antigen tests. He argues the lack of emphasis on rapid tests is responsible for hundreds of thousands of COVID-19 deaths.

Over-the-counter tests are even more important with the spread of the omicron variant of the virus, said Stephen Kissler, a research fellow in the department of immunology and infectious diseases at Harvard’s T.H. Chan School of Public Health. Omicron appears better able to infect vaccinated people than other variants have been.

“I think the rapid tests provide some of the best protection we have against the spread of disease, especially as we now have a variant on hand that’s going to be able to cause an awful lot of breakthrough infections,” Kissler said.

And yet the over-the-counter rapid tests sold in drugstores cost more than $10, making frequent testing expensive for middle-class Georgians. And the supplies have been thin.

“Germany pays $1 for this test,” said Dr. Carlos del Rio, a distinguished professor of infectious diseases at Emory University. “In the U.K., they get them for free. I mean, why are we paying $23 (for a pack of two)?”

At Hartsfield-Jackson International Airport, the nation’s busiest airport and a hub of holiday travel, there is nowhere in the domestic terminal to buy a rapid antigen test, according to the airport.

In one of the concourses, Concourse E, people can have a rapid test administered for $250. It’s actually a laboratory test, but the company works fast to deliver results on the spot. The concession is run by the company XpresCheck, which also tests people in the international terminal.

People are now being tested for free in the international terminal as part of a federal effort to identify COVID-19 cases and surveil for the omicron variant.

The Biden administration announced this fall it planned to put $1 billion toward buying new at-home tests, and that it would also work to lower the cost of the tests.

“The bottom line,” President Biden said in announcing the plan: “This winter, you’ll be able to test for free in the comfort of your home and have some peace of mind.”

The White House said Biden would demand that insurance companies eliminate co-pays for patients, and reimburse policyholders who bought over-the counter tests. It also planned to send tests for free distribution at federally funded clinics.

But some public health scientists said that was still too complicated. It requires people to seek reimbursement or, if they have no insurance, to seek out and get to the limited clinics that carry the tests.

A coalition of the federally funded clinics in Georgia, the Georgia Primary Care Association, reported Friday that the clinics still have no take-home tests to give out. “Other than the President mentioning it in his recent speech, we have received no information or instructions as to when to expect them,” said Duane Kavka, the association’s executive director.

And while Biden’s promised investment in tests was supposed to lead to the country buying 200 million tests per month, that is still not enough to test every American once.

A spokeswoman for the state Department of Public Health, Nancy Nydam, could not say how many tests were available in Georgia.

“DPH has received limited information about the federal program,” she said. “What we have heard is that some tests are beginning to roll out to (health centers) but beyond that, there are still many unknowns.”