In 2022, We Need to Shift Our COVID-19 Focus to Testing

If 2021 was the year of the vaccine, 2022 should be the year of testing. COVID-19 vaccines are essential for controlling the pandemic, but since getting a shot to everyone on the planet is time-consuming and stymied by unequal global distribution; because many who do have access to vaccines refuse to take them; and because the vaccines aren’t 100% able to prevent infections, the world is going to need more in order to stay ahead of SARS-CoV-2.

That extra something should be widespread testing—not just the kind that labs administer to confirm a case of COVID-19, but also the at-home, rapid tests that people can perform themselves. How easily people can learn their COVID-19 status will determine how well the world can control COVID-19. The more people who know if they are positive, the better they can practice mitigation measures like self-isolating and wearing masks so they don’t spread the virus to other people—especially since many infections don’t cause symptoms at all, so people won’t know if they are positive unless they test.

Just before the new year, the U.S. Food and Drug Administration (FDA) authorized the latest at-home rapid antigen test, from Siemens, which—like the other 12 such authorized tests—can be useful either by people who have symptoms and suspect they’ve been infected with SARS-CoV-2, or by those that don’t have symptoms but want to be sure they aren’t infected before or after attending a gathering with others.

U.S. health officials have increasingly stressed the importance of self testing in recent weeks, as more people boarded planes, trains and buses to gather for the holidays. Conducting a self-test, which provides results in about 15 to 20 minutes, is a good way to reduce your chances of spreading the virus to anyone else.

Testing as a practice, however, isn’t as robust in the U.S. as it should be. Since the first days of the pandemic, when Center for Disease Control and Prevention (CDC) labs were the only ones performing tests to verify SARS-CoV-2 cases, the U.S. has lagged behind in making tests for COVID-19 both available and affordable, for many reasons, a number of them scientific, others regulatory and some even cultural.

The CDC initially didn’t allow academic or commercial labs to perform SARS-CoV-2 tests because the agency wanted to ensure that a standard, scientifically validated assay was used to verify all COVID-19 cases and provide an accurate picture of how much virus was in the country, and where it was circulating. The first test kits the CDC sent to state health departments, however, were unfortunately compromised by a lab contaminant and fixing the problem slowed down U.S. testing capacity in early 2020. Even after the FDA began authorizing commercial labs to perform COVID-19 tests in spring 2020, the country was still playing catch up.

The U.S. response then shifted to vaccines—devoting considerable resources, personnel, energy and attention to developing and then distributing the shots. Meanwhile, the public also began to believe that once vaccines were available, they wouldn’t need to get tested as much. That was an intuitive response, but the reality is that SARS-CoV-2 can infect people without causing any symptoms, and those infected—whether symptomatic or not—can still spread the virus to others.

The virus also started to mutate, which meant that while vaccines continued to protect people, that immunity waned in the face of new versions of the virus. So even with vaccines, it remained important for people to know if they were infected or not.

But testing remains out of reach for many Americans. While the National Health Service in the U.K. makes test kits available without charge, sending packs of kits directly to people’s homes, in the U.S., Americans have to purchase them for about $20 to $40 online or at pharmacies. In December, President Joe Biden announced that private insurers, who cover about 150 million Americans, must reimburse people who purchase self-tests; until then many insurers only covered the costs if the self tests were ordered by a medical professional, or if they had symptoms. Such requirements defeat the purpose of using the at-home tests as a way for people to self-police for COVID-19, and isolate themselves or avoid public settings if they are positive.

It didn’t help that health experts were also sending mixed messages about the importance and reliability of testing to the public. The gold standard test for SARS-CoV-2, known as a PCR, or molecular test, looks for genetic traces of the virus. Doctors rely on PCR tests to confirm a COVID-19 diagnosis.

The at-home tests are known as rapid antigen tests, and can provide results in about 15 to 20 minutes. They look for proteins shed by the virus in infected people, and most are more than 90% reliable for identifying a virus infection. These rapid tests are also generally able to detect any variant of SARS-CoV-2, including the latest Omicron variant, although the FDA warned in a statement on Dec. 28 that the rapid tests may not be as sensitivity to Omicron as they are to earlier variants of the virus.

However, some doctors have noted that they’re not as accurate as PCR tests since the PCR tests can take a small amount of virus and amplify it to ensure any SARS-CoV-2 isn’t missed. Still, for surveillance purposes, these self tests can be quite effective. It’s better to be safe than sorry, and encouraging people to test themselves more frequently before or after potentially high-risk behaviors like boarding a plane or attending an indoor public event, could help people avoid spreading the virus to others by self-isolating until they test negative.

That’s why in recent weeks health officials are drawing more attention to testing. CDC director Dr. Rochelle Walensky has been promoting the agency’s Test to Stay program for schools, which encourages students of all ages to get tested frequently. Many parents, however, have struggled to purchase the kits at their local pharmacies, which haven’t been able to keep enough tests in stock to meet demand. Anticipating continued pressure for more tests, Biden announced a plan to purchase 500 million at-home kits that would be distributed free to Americans. The federal government is planning on standing up a website to take requests for shipping the kits directly to people’s homes, but as of Dec. 29, the site has yet to go live.

With Omicron continuing to spread quickly, and political leaders reluctant to resort to lockdowns again, testing, especially home-testing, will be essential to containing the pandemic. That’s the only way Americans will be able to take the proper precautions to prevent spreading the virus, and potentially causing further surges in cases in the coming year. The sooner infected people, whether they are symptomatic or not, isolate themselves so the virus can’t spread to other people, the sooner the pandemic will peter out.