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Our Eyes on the Virus: Why We Still Need Widespread Rapid Testing Even With Vaccines

6 minute read
Mina, MD, PhD, is the Chief Science Officer of eMed. He was previously assistant professor of epidemiology and immunology/infectious diseases at the Harvard T.H. Chan School of Public Health, Center for Communicable Disease Dynamics; and associate medical director in clinical microbiology at the Brigham and Women’s Hospital.

The vaccines are here. Why do we still need testing? Testing is our eye on the virus. Without testing, we can’t see where it is or where it is going. As fall and winter set in, outbreaks will again occur, sparked by the unvaccinated. And most people become infectious before they know they are infected.

Frequent and accessible rapid testing is a tool that if deployed last summer and fall would have saved 100,000 lives. The U.S. missed the opportunity to use frequent rapid testing to stop individuals from unintentionally spreading the lethal SARS-CoV-2 virus to our most vulnerable and avert the horrific winter surge.

By rapid tests, I mean the tests that an individual can conduct without a laboratory (ideally in the privacy of their own home) with results given in real-time. There are two types: rapid antigen tests, which look for the virus’s proteins and detect infectious levels of virus. The other lets you know you’ve been infected: rapid molecular tests accurately detect the virus’s RNA and amplify it to confirm infection—sometimes days before the individual shows any symptoms.

Despite bipartisan, national support and a call to action from more than 50 leading scientists, the U.S. government has failed to adopt a robust at-home rapid testing strategy that could make these types of tests available to all Americans at little to no cost (similar to what the United Kingdom has done).

But the vaccines are here, why do we still need testing?

With growing cases around the world particularly due to more transmissible variants, we should be utilizing testing to prevent and control cases and outbreaks when they arise. The new guidance by the CDC, allowing vaccinated individuals to stop social distancing and remove their masks in a wide variety of settings, should have been introduced with complementary at-home rapid testing for all. We’ve seen examples of unvaccinated individuals transmitting to vaccinated residents in nursing homes. We also know that according to the CDC, although a majority of all adult Americans have received at least one dose of the vaccine, the rate of uptake isn’t consistent across the country. In Mississippi, for example, only 31% of the population has received at least one dose. We should be doing everything we can to expand access to the vaccine and convince more people to get vaccinated, but we should also be smarter about testing.

We have already seen new variants that spread more quickly and there’s the potential for others to develop increased ability to evade vaccine—derived immunity that could threaten the gains that vaccines have made. When this happens, the virus could find its way into senior centers and nursing homes. Compared to younger individuals, seniors and elderly have somewhat more limited capacity to retain over time highly effective immune protection. By late fall and winter, after almost a year since vaccination, many elderly might again have partially renewed susceptibility.

As we navigate the next chapter of the pandemic and work our way closer to normalcy, it is essential that we leverage accurate and highly accessible rapid testing to keep schools, workplaces and travel open in the safest way possible.

We know with certainty that individuals don’t need to have symptoms to infect others with COVID-19. The virus presents itself differently in everyone and most individuals are infectious for a number of days before showing any symptoms (if ever). After infection, the virus gets itself situated, before beginning to grow very rapidly. Once it hits its stride, in a single day the virus grows from hundreds of virus particles in the nose, to billions. At that point, transmission can hit its peak, before the person has any recognition that they might be spewing out millions of virus particles with every breath. Symptoms are most frequently a result of the immune response to the virus, rather than from the virus infection itself, and the immune system doesn’t get into full stride and yield fevers until after this peak in virus transmission is achieved. This is a major reason why SARS-CoV-2 has been so difficult to contain—because maximum transmission is often occurring before the body’s sensors kick in to let people know they may be infected. Regular rapid testing can allow contagious individuals to know they are infected and isolate quickly to keep from spreading to others.

The White House has focused on vaccines over testing, but why not give each household a box of 20 free rapid at-home tests after a family member gets vaccinated? Surveys show that Americans want accessible, inexpensive (or free) rapid testing. Dr. Fauci has offered his strong support for a robust level of rapid testing many times. In a recent U.S. House Energy and Commerce Hearing, he said, “We should be literally flooding the system with easily accessible, cheap, not needing a prescription, point of care, highly sensitive and highly specific (tests).” At another point, he commented that we as a country have done things “infinitely more complicated” than scaling up rapid tests and getting them into to every household.

There are a handful of FDA authorized at-home rapid antigen and molecular tests available for over-the-counter use, but the price point is high and the supply isn’t anywhere near what it should be if we want the majority of Americans to have these tests in their homes. Exactly like we’ve done with the vaccine, the U.S. government should be subsidizing test manufacturing and assisting in the distribution.

We know that the combination of vaccines and rapid tests will drive down community transmission to a point where we can effectively eliminate the virus. The time to “flood the system” with rapid tests was 12 months ago. But now is still better than never. We should be investing today in widespread rapid testing to fully reopen the economy, schools and travel safely. Without doing so may well cause more hospitalization and death, and continue to prolong the pandemic.

(Mina is a medical advisor to Detect.)

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