In Germany, you can buy a rapid Covid-19 test at the grocery store for one euro (a little more than a dollar). In Britain, any household can obtain a pack of seven rapid tests every day for free. In Singapore, you can get a free rapid test from a vending machine. Families in Israel receive at-home rapid tests for their children to use before school. Rapid testing is commonplace in many parts of the world because policymakers recognized early on that the tests could blunt the pandemic by stopping chains of transmission. By letting people know they are infectious, rapid tests are useful even in areas with high vaccination rates and can allow for a safer return to in-person activity.
But in the United States, if you’re lucky enough to find tests on a pharmacy shelf, they can cost between $7 to $50. The United States has not prioritized these tests, and it is only recently that Americans have recognized their unique benefits. To end the coronavirus’s grip on American society, the United States must embrace rapid testing in a more substantial way by making it easier and cheaper for people to frequently use them.
At-home rapid tests — which are usually antigen tests — can tell people within minutes whether they are contagious with Covid-19. Many Americans are more familiar with laboratory P.C.R. tests, which tell users if there’s any amount of virus in their system and can often take 24 hours or longer to return results. (Dr. Mina advises a diagnostics company working on a rapid molecular test for Covid-19, which is different from the rapid antigen tests discussed here.)
People can buy rapid tests at the local pharmacy, swab the front of their nose or throat at home, and based on the results, either isolate or continue about their day. Regular use of rapid tests can make schools and workplaces safer and erase the need for quarantines through test-to-stay programs, in which students who have been exposed to the virus can stay in school as long as they take frequent Covid tests. The rapid tests can also make everyday activities — including indoor ones, such as dinner parties, play dates, weddings and visits with grandparents — less risky.
The Delta variant is highly contagious, which is why knowing your Covid status in real time, on a frequent basis, is more important than ever. While the vaccines are effective against severe disease, concern over breakthrough infections remain, and many people live or interact with unvaccinated people, such as children under 12 who are back in school.
The Biden administration has recently increased efforts to make rapid tests more affordable, accessible and convenient, acknowledging that “from the start, America has failed to do enough Covid-19 testing.” This is a welcome change. In recent months, test manufacturers have pulled back supply and laid off workers because of declining demand. But Americans should be using them much more often. For rapid tests to be most effective — and to alleviate any user concerns about false negatives — people should take them frequently.
With schools back in session and many private and public sector employees now trying to comply with Mr. Biden’s new policy to either get vaccinated or test weekly, demand is increasing. But this important public health tool remains in short supply. The lack of rapid testing is driving wait times for some P.C.R. labs back up again to three or more days, making lab-based testing effectively useless at stopping transmission.
The problem is that rapid-test makers who want to sell in the United States need to comply with the Food and Drug Administration’s medical device authorization process, which requires rapid tests to meet the same standards as laboratory-based medical diagnostic tools. (The agency has given emergency use authorization to some tests.) These standards are necessary for tests used by doctors with their patients. But for public health purposes, we need fast, accessible tests that answer the question, “Am I infectious now?” Rapid tests can help prevent spread to your child, spouse, friend, colleague, classmate or the stranger sitting next to you at dinner. If the primary beneficiaries of a test are other people, the test is not a medical tool, but a public health one.
Other nations appreciate this critical nuance. When it became clear that Covid-19 was spreading too fast for laboratory testing to be effective in stopping transmission, countries like Britain and Germany created separate evaluation processes to determine which rapid tests had the highest accuracy for detecting infectious levels of virus. They created a special pathway to analyze the best tests in weeks and granted authorization to dozens of test manufacturers, opening the market and driving down the cost of rapid tests.
There is a similar solution that can significantly increase America’s supply of accurate rapid tests. Using executive action, President Biden should redefine rapid Covid-19 tests as public health tools rather than medical devices. The president has already declared these tests a public health priority, and an executive action making rapid tests official public health tools would be the natural next step.
An executive action that redefines rapid tests as public health tools could enable a new pathway for federal authorities to conduct their own evaluations of which rapid tests most accurately identify infectious levels of virus. This could also allow global manufacturers with tests already approved for use in other countries to more easily enter the U.S. market, increasing supply significantly.
While step one is breaking the logjam to scale up production and use of these tests, the White House should also treat rapid testing with the same urgency and private sector partnership approach that Operation Warp Speed pioneered for vaccines. For such a program to succeed, there needs to be close collaboration across government agencies, so that everyone involved in the process — in regulation, supply chain, distribution channels, public health protocols, results verification and reporting and public education and marketing — are all working together toward the same goal, to make rapid testing accessible and available to all Americans at little to no cost.
The U.S. government should provide rapid tests to every American household, business and organization for free to complement the vaccination campaign and make abiding by the vaccine mandate more feasible. The investment could yield significant health and economic benefits. Past economic analyses predicted that a major government-funded rapid testing program that reached every American could add as much as $50 billion to the gross domestic product and save tens of thousands of lives or more.
There is bipartisan support for making rapid testing free and widely available. Changing the regulatory structure to bring more rapid tests into the U.S. market would make this possible, and there are successful national rapid test case studies from Britain and Germany that leaders can learn from.
Before rapid tests, people had to assume they could be contagious from Covid-19. That’s why people isolated themselves, and businesses and schools closed. It is why people missed holidays with their families. But by embracing rapid testing alongside vaccination, people can live with the virus. Workplaces can sustainably reopen. Children can stay in school. The United States should use rapid testing as a complement to the vaccine to put forward a multifaceted defense against Covid-19. Our leaders must work quickly to make this a reality.
Michael Mina is an associate medical director in clinical microbiology at Brigham and Women’s Hospital/Harvard Medical School. He advises Detect, Inc., a diagnostics company working on a rapid molecular test for Covid-19 (this is different from the rapid antigen tests discussed in this essay). Steven Phillips is a fellow of the American College of Epidemiology and of the American College of Occupational and Environmental Medicine.
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