The advent of the Omicron variant and the rise in cases across the US is a grim reminder that we will only control this virus through a combination of public health measures and medical interventions, including vaccines, drugs, and easily accessible diagnostic tests. Yet well over a year since the first rapid antigen test was approved, despite desperate pleas from many epidemiologists and public health experts, the US is yet to embrace the power of mass rapid testing.
Rapid at-home tests are becoming less scarce on our pharmacy shelves in recent months due to investment by the Biden Administration but their price is still prohibitive for most Americans to use them in the most effective way. At a typical cost of $25 for a pack of 2, many individuals are conflicted about when to use rapid tests. If the tests were cheaper or free, individuals could engage in a twice-weekly testing regime or test whenever they knew they were entering a high-risk, poorly ventilated, or unmasked venue, office, home, or other location.
The demand for rapid tests is clear with a recent trial in New Hampshire exhausting their supply of 1 million free tests when 100,000 households signed up within 24 hours. The barrier that remains is cost and supply.
Widespread accessibility to rapid tests in the US is presently hampered by a cumbersome F.D.A. process intended for high-tech medical devices. To be approved, the rapid tests must demonstrate that they are nearly as sensitive as the gold standard PCR. tests. But rapid tests are the “public health gold standard”, they deliver the most important public health metric by detecting when someone is infectious and is likely to transmit the virus. Therefore they should be regulated as a Public Health Good. President Biden could accomplish this with a simple Executive Order, increasing competition among manufacturers and flooding the market with inexpensive, high-quality rapid tests.
As the pandemic shows no sign of receding well into its second year, governments around the world are less willing to instigate lockdowns as they weigh the economic impact. Rigorous testing followed by supported isolation can prevent the need for city-wide lockdown and rapid community transmission as proven in a recent Hong Kong study.
Industry and institutions could also play a role in promoting the use of regular rapid testing, which would be beneficial both to their bottom line and to the health of their stakeholders. A new preprint study from the University of Bristol has found that both high levels of vaccination and rapid twice-weekly asymptomatic testing are needed to keep infections rates low on university campuses. The researchers adapted an existing mathematical model of Covid-19 transmission in universities, to determine two scenarios. With low-level interventions (no asymptomatic testing, 30% vaccinated), 53-71% of students become infected during the first term; with high interventions (90% using asymptomatic testing, 90% vaccinated) the incidence of infections is just 7-9%, with approximately 80% of these cases estimated to be asymptomatic. Workplaces could adopt similar interventions. Some have already implemented vaccine mandates, but adopting a twice-weekly rapid testing policy particularly in high-risk settings would keep employees safe and transmission low.
This is also a critical time to start requiring rapid tests for domestic travel within the US. The Biden administration is currently preparing stricter testing requirements for all international travelers entering the United States, but with the Omicron variant likely already seeded in multiple states, we need to focus on all travel. As we have learned from bitter experience, no population is safe until we all are. I can only hope that the Omicron variant is the warning we need to embrace mass testing.