Good public health policies are welcome, even under prolonged delays. Therefore, we should cheer for the Covid-19 Rapid Result Antigen Test (RAT) announced by the Biden administration earlier this month, which can tell you if you are infected in just 15 minutes and will be covered by private insurance. For Americans without insurance, the government will provide 50 million free tests, which will be distributed through health clinics and other sites in rural and underserved communities. Assuming they can detect the new Omicron variant and its predecessor, these tests will be a key part of our evolving pandemic strategy.
Nevertheless, the plan still faces obstacles. The supply of tests is limited, and even if they can be found, they are expensive: usually, pharmacies cost $10 to $15 each. The government’s plan to provide reimbursement for testing through private insurance is also clumsy, requiring consumers to pay first, submit a receipt, and then wait for reimbursement. In contrast, in Germany and India, tests can be done in stores for just a few dollars, while the UK provides seven free tests a day to anyone in need. Singapore mails test kits to every family.
Widely distributed testing is important, but it alone is not enough. We also need to conduct large-scale public education activities, not to teach people how to use these tests (they are easy to use), but to teach people when to use them. The goal of properly timing the test is simple: to minimize the amount of time contagious individuals spend in front of other people. (This is especially important given the high spread of Omicron variants.) In other words, RAT enables you to determine whether you are infected and can spread the SARS-CoV-2 virus so that you can self-quarantine and consider if you Yes, take one of the oral or intravenous Covid-19 drugs. This requires people to act responsibly at the time and place of their choice—that is, to test frequently. This process is quite painless, just like brushing your teeth or showering before going out.
RAT can identify individuals in the most contagious period of three to five days, mainly before symptoms appear. The test usually involves dropping a nasal swab and some reagents on a test card or test box to quickly show two rows of positive or one row of negatives. Results can be obtained within 10 to 30 minutes, while PCR tests are slightly more accurate. The latter measures viral RNA, but it takes several days to report the results. PCR testing can be used to track the progress of the entire infection process, and once most of the infectious period is over, the RAT loses its sensitivity.
In short, the rapid antigen test enables you to reasonably be sure that you will not pose a risk to others before you leave to attend any parties, movies, indoor sports events, crowded stores, etc. They can prevent or mitigate large super-spreader incidents, such as the one that occurred in the UK in August. Despite some (poorly enforced) vaccination and testing requirements, 4,700 people were infected with the Delta variant at the music festivals they attended. About 50,000 people. After the recent super-spreader incident at a wedding celebration in Wisconsin, more than a dozen "risk-averse" and "super-responsible" wedding participants returned home and contracted SARS-CoV-2, many of them Omicron Variants. Among them were 11 people who were employees of Kaiser Permanente in the San Francisco Bay Area. Some of them went to work before they learned that they were infected. Dozens of other employees and patients in two hospitals may be exposed to the virus.
These tests are also useful for schoolchildren or teachers who are exposed to Covid-19 cases, by converting "test and quarantine" to "test and stay" while waiting for PCR test results, if the result is negative.
This flowchart illustrates the process of a hypothetical dinner party:
Why are we only now starting to take advantage of the benefits of RAT? The first issue is obtaining emergency use regulatory approval (final approval is still a bottleneck). The manufacturer submitted the RAT to the FDA as a medical test, so the agency evaluated the accuracy compared to the PCR test. Since RAT is only accurate during the initial onset and the infectious period, it obviously cannot pass the equivalence comparison test. However, when RAT is used as a public health measure rather than primarily for medical testing and treatment, "equivalence" is not a relevant benchmark. In addition, there is confusion as to whether medical insurance can or should pay for RATs. Unraveling this bureaucratic knot leads to delays in entering the market. Therefore, low (unreimbursed) usage means that efforts to reduce costs have slowed, and testing has not (and is) not used optimally.
No matter what we choose to do, we need to pass a large number of these RATs into the hands of the public through a well-communicated action plan so that we can finally end the pandemic.
Henry I. Miller is a doctor and molecular biologist, and a senior researcher at the Pacific Research Institute. Andrew I. Fillat has spent his career in technology venture capital and information technology companies. He is also the co-inventor of relational databases. Miller and Filat are undergraduates at MIT
Photograph by Yogendra Kumar/Hindustan Times via Getty Images
The Quarterly Journal of Urban Affairs, published by the Manhattan Institute, edited by Brian C. Anderson.
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