Photo: Andrew Kelly/REUTERS

The Great American Testing Crunch

How it happened, what we can do about it, and when it might end.

Photo: Andrew Kelly/REUTERS

When Lex Perez-Gonzalez left work on Monday, he joined a long line of people waiting to get a rapid COVID test on 125th Street in Harlem. Perez-Gonzalez, 32, planned to join a friend’s Christmas gathering in Connecticut later this week, and he wanted to make sure he was negative well in advance of traveling. But 45 minutes after arriving, he still hadn’t moved. When he walked up to the front of the line, a woman told him she’d been waiting for three hours. Perez-Gonzalez abandoned the line, figuring he could get a test on Tuesday. But he had no such luck.

“I went to three testing sites on the Upper West Side, and they were all either closed or only accepting appointments, and in order to get an appointment, you had to show up at 7:30 or 8 a.m.,” Perez-Gonzalez said. After giving up on testing sites, Perez-Gonzalez checked a CVS to see if it had any at-home test kits available, but it was sold out. “We were coming off such a chill summer thinking this was behind us. It’s frustrating,” he added, wondering if he might have to ditch his Christmas plans altogether.

Perez-Gonzalez could be forgiven for thinking it would be easier to get swabbed as the country enters its second pandemic holiday season. Despite a new administration in Washington, America’s testing program was unprepared for a surge in demand for tests this week. Practically overnight, New Yorkers, hit hard by the highly transmissible Omicron variant, have pushed the city’s testing capabilities to the breaking point, a sign of what’s likely to happen to the rest of the country in the coming days if cases skyrocket nationally. Over the past week, the city has administered more than a half-million tests and demand has kept climbing.

As for the rapid at-home tests, they’re rarer than a subway seat at rush hour. Walgreens, CVS, and Walmart on Tuesday responded to bare shelves by capping the number of at-home tests consumers could buy. If you can find one, it will set you back about $24 — or $100 for a family of four. Meanwhile, in the U.K., the government has been mailing free tests to anyone who requests them online. Nearly every pharmacy is well stocked.

It looks as if COVID is here to stay, so will the United States ever get out of testing hell?

“I certainly hope so. And I believe so,” said Mara Aspinall, a biomedical diagnostics expert at Arizona State University’s College of Health Solutions. “The test technology for antigen tests needs to be very precise, but it’s not very complicated. Pregnancy tests are exactly the same technology, except they use urine as opposed to a nasal swab. Those tests are available at the Dollar Store. Ultimately, when we have enough manufacturers, and enough demand, which has now materially changed, there’s no reason that the cost of these cannot be reduced.”

European governments subsidized the mass production and distribution of rapid tests, but the Biden administration threw money at vaccines instead. The White House had been hesitant to distribute free tests widely — Press Secretary Jen Psaki notoriously panned the idea earlier this month — but on Tuesday the president announced a plan to do just that: purchase and distribute 500 million at-home rapid tests to Americans for free. Though the White House hasn’t provided details about how the plan will be implemented, it has said that tests will start being shipped next month.

“It’s at least a good start. The downside of this announcement is that they aren’t going to be available before the holidays, and it would be nice if it were a higher number so that families and people could have more on hand,” said Dr. Amy Karger, associate professor of laboratory medicine and pathology at the University of Minnesota Medical School.

Both Krager and Aspinall recommended anyone who can find at-home rapid antigen tests to use them in advance of holiday gatherings to screen for COVID, especially if they will be near someone who is vulnerable to severe illness, such as the unvaccinated. In short, smoke ’em if you got ’em.

In the meantime, Biden will try to meet demand by opening federal testing sites across the country, the first of which will be in the city, and New York City officials announced their own plan to open 23 additional testing sites this week and distribute free tests.

Since the earliest days of the pandemic, when tests were desperately rare, public-health experts have strongly advocated for a nationwide program that made at-home tests accessible and affordable. Yet a range of complicating factors — supply-chain issues, more transmissible variants, the apparent hope of the Biden administration that vaccines would snuff out the pandemic — have hamstrung efforts to ramp up testing nationwide. For some public-health experts, the spike in demand is an indication that many Americans finally understand the power of testing.

“Since the over-the-counter tests became available in March, there has been little interest in them. The fact that Americans now want an answer in real time, that is a significant cultural shift,” said Aspinall. “Information from tests is power. Everybody wants to take the power away from the virus and put it in their own hands. That’s what testing enables us to do.”

Affordable at-home testing was a key component to a plan Biden implemented in September. The White House partnered with three of the country’s largest retailers — Walmart, Kroger, and Amazon — to offer tests at cost to consumers, bringing down the price to $14. Those partnerships have expired, and the most widely used at-home kits now retail for twice as much. (Each of the two tests in a kit are meant to be used consecutively.)

“It’s really hard to create a culture where every time people get together, they spend $24 to get an at-home test, using one test before and one test after,” said Nikhil Bhojwani, founder and managing partner of Recon Strategy, a boutique health-consulting firm. “There’s probably a number, maybe $1 a test, at which point it becomes a no-brainer, it becomes unacceptable to show up somewhere without doing a test.”

Last year, Bhojwani outlined a path to scaling up testing in a series of articles for Harvard Business Review. His initial vision, co-written with Atul Gawande, included a call for local, state, and federal governments to buy tests en masse. While Bhojwani’s plan was never fully realized, he’s hopeful that the federal government’s purchase of half a billion tests will lead to lower production costs, which will in turn lead to greater availability of cheaper tests.

“It’s really hard to make an economic case to invest in manufacturing and putting these tests on shelves. The manufacturing cost is not that high, but it’s the shipping and packaging that goes with it. That’s where this sort of government purchase can create the incentives to manufacture. Five hundred million tests being bought by the government — you can imagine a supply of a much greater amount being created because scales would drive down costs. Ultimately, it will lead to many more rapid tests becoming available at a much lower cost.”

If the scarcity of rapid tests weren’t enough, people reported testing negative at home only to subsequently stand in line for hours and come back positive after a PCR laboratory test, which is more sensitive. All of the major at-home-test manufacturers have released statements standing by their products’ ability to identify Omicron. While Karger and Aspinall, who sits on the board of one such company, acknowledged that it is possible the rapid tests may not be as accurate with Omicron as they were with prior variants, they were both adamant about the value of using them.

“While vaccination is useful on an individual basis, it’s not going to make a difference on a public-health level. Too many people have dug in and are not going to get vaccinated, and Omicron, to a larger degree than anything before, evades vaccines. Masking is universally despised and social distancing probably never worked,” said Aspinall. “Testing is the only exit strategy we have now.”

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The Great American Testing Crunch