The nation’s coronavirus testing capacity, already straining to keep up with demand, is facing enormous new pressure, with holiday travelers waiting in long lines to be tested, overworked laboratories struggling to keep up, and rapid at-home diagnostics flying off pharmacy shelves as the omicron variant fuels a rapid spike in COVID-19 cases.
Two years into the pandemic, the surging desire for tests in the face of limited supply threatens to thwart President Joe Biden’s response, but it is hardly a new problem. The United States has bungled testing from the outset of the pandemic, experts say, and matching supply with demand has been a persistent challenge for both the Trump and Biden administrations.
Biden came into office vowing to make testing for the virus cheap and easily accessible, and there have been some improvements since he was sworn in. Laboratory tests are more plentiful now, and more than a dozen at-home tests are available, up from zero in January. The Food and Drug Administration has sped up its approval process, and the supply of at-home tests has increased steadily since August; last month, it was expected to double by March.
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But the United States remains a far cry from Europe, where more than three dozen types of at-home tests are available for as little as $1 to $2 per test. Americans can pay as much as $25 for a box of two, and Biden’s plan to have insurers reimburse for those purchases will not take effect until mid-January at the earliest.
In Miami, cars lined up bumper to bumper this week at a drive-thru test site. In Providence, Rhode Island, there were no testing appointments available at a local CVS; those looking to be tested were instructed to buy over-the-counter at-home tests.
In the Brooklyn borough of New York City, people waited in line for two hours Thursday to be tested at a medical clinic in Park Slope. New York state, an early epicenter of the pandemic, recorded 21,027 positive coronavirus cases Friday, the highest number reported on a single day during the entire pandemic.
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Around the country, retailers — both online and brick-and-mortar — are having trouble keeping over-the-counter tests in stock. Walmart was selling Abbott’s rapid antigen test online Friday, but many stores in Washington, D.C., and its Maryland and Virginia suburbs were sold out. In Houston, the pharmacist at a local Walgreens, Hanh Ho, said shipments of at-home tests arrive every Wednesday and sell out the same day.
“They’re a hot item,” Ho said. “One guy came in and took all of them.”
The difference between the United States and Europe is rooted partly in their differing health care systems but also stems from a critical decision that the Biden administration made months ago: not to subsidize tests in the same way it subsidizes vaccines. Some Western countries decided early on to shoulder much, if not all, of the testing costs, guaranteeing demand and, some argue, lowering prices through purchasing agreements with major manufacturers.
The Biden White House only recently — in back-to-back announcements in September and October — committed to spending a total of $3 billion to buy tests. More than half has been spent on over-the-counter tests, senior administration officials said.
“It’s been a dreadful situation from Day One of the pandemic, and I would say it’s still botched,” said Eric Topol, a professor of molecular medicine at Scripps Research. “We should have an ample supply of rapid tests freely available,” as in Britain, Israel and some other countries, he added.
Earlier this month, Biden announced that at-home tests would be reimbursed by insurers for the 150 million Americans who have private insurance and that the administration would distribute an additional 25 million tests to community health centers and rural clinics, which tend to treat lower-income patients.
But the announcement drew immediate complaints from public health experts, including Topol, who objected to requiring that people go through the process of seeking reimbursement. Topol said the notion that consumers would routinely front such costs in the hope of reimbursement was “a nonstarter.”
White House officials say they are working to further expand production of at-home tests, which would in turn create market competition and, presumably, drive down the cost.
Demand is only expected to grow after the Centers for Disease Control and Prevention endorsed a new approach Friday for allowing children exposed to the coronavirus to stay in school, testing at least twice over the course of a week, instead of requiring them to quarantine.
“We are continuing to do everything we can to continue to grow that supply,” Carole Johnson, testing coordinator for the White House coronavirus response team, said in an interview Friday.
The testing push received a boost Friday when a federal appeals court reinstated the Biden administration’s rule requiring that many companies mandate that their workers be vaccinated against the coronavirus or face weekly testing.
During any infectious disease outbreak, there are two major reasons to use tests, experts say: to determine if someone is infected and to protect others from getting infected. To diagnose COVID, doctors generally rely on polymerase chain reaction, or PCR, tests — highly sensitive tests that are performed in laboratories.
But with omicron spreading quickly, experts foresee a jump in demand for rapid antigen tests, the quick version that are sold over the counter, which many people use for peace of mind.
During a White House briefing Friday, Dr. Rochelle Walensky, the CDC director, advised people to “do a test and make sure that you’re negative before you mix and gather in different households” over the holidays, “for that extra reassurance.”
Reassurance is what Stan Smith, 67, was seeking Friday at a busy testing site in Orlando, Florida. He said he had no symptoms and was vaccinated, yet he had already waited nearly 90 minutes for a test.
“We’ve got to look out for each other,” he said. “I don’t know if I’m going to be around anybody who could contaminate me, but I don’t want to be that person either. Christmas is only a week away.”
