Therese Raphael: Why aren’t COVID tests common as aspirin?

Therese Raphael

When the travel ban was lifted recently, Brits visiting the U.S. got a shock. Not only were rapid COVID tests hard to find, prices were at rip-off levels. The Independent newspaper found an antigen test at Orlando International Airport cost $65; it was $75 in San Francisco and $100 in a Washington, D.C., travel clinic.

By contrast, antigen home test kits are provided free of charge from Britain’s National Health Service and come in a box of seven tests that can be picked up at local pharmacies (airport tests are around 35 pounds or $46.88). The tests are useful in areas where the virus is surging. Some schools make antigen tests mandatory before a parent-teacher meeting; they can be required for a hospital or nursing home visit.

And they provide a measure of psychological comfort. If you’re feeling a little off, an antigen test can help rule out the prospect that you might infect people around you.

Why couldn’t the U.S. make it as easy and cheap to do a rapid COVID test? It’s a problem the administration of President Joe Biden must now solve for two reasons. First, Biden’s new “vaccinate or test” rules — currently suspended pending a legal challenge — depend on having enough tests for unvaccinated workers in firms of over 100 employees to test regularly.

Perhaps more importantly, the COVID wonder drugs coming online — including therapies from both Pfizer and Merck — require people having the ability to test themselves quickly and repeatedly so the drugs can be administered soon after infection.

Biden may have campaigned on a promise to expand testing but his administration focused heavily on vaccinations and has only belatedly woke up to the problem of testing shortages.

The U.K. threw the kitchen sink at its rapid testing policy much earlier. That was controversial, in part because of the benefit it brought to a previously obscure company called Innova Medical Group, whose Chinese owner managed to secure an estimated $2.7 billion of government contracts in large part because it had enough supply to deliver quickly. Critics of the Innova and antigen tests say they are far too inaccurate to help with infection control.

A fairer criticism was that the government did a poor job of explaining their use, leading to a backlash when people learned they weren’t as accurate as the polymerase chain reaction (PCR) tests, often referred to as the “gold standard” in testing.

The beef against rapid antigen testing is that their “sensitivity” level — that is, their ability to correctly identify someone with the virus — is much lower than PCR tests. In a pilot study in the city of Liverpool, rapid tests missed 30% of cases where the viral load was high and half of all positive cases detected by PCR tests. And yet as the U.K. and other European countries that rely on these tests have come to recognize, an imperfect test can still play a vital role in cutting transmission so long as it catches the most infectious cases.

PCR tests are great — but they are also expensive, must be processed in a lab and results take from one to a few days. The beauty of antigen tests is that they take minutes to assemble, can be self-administered and the results appear in under 30 minutes.

Harvard immunologist Michael Mina has argued for some time that from a public health perspective, it’s less important for a test be highly accurate in detecting the presence of virus so long as it’s highly accurate in identifying those most likely to transmit it, which the antigen tests are good at.

Regulatory bottlenecks, muddled messaging and now rising global demand has left the U.S. furiously playing catch-up with no easy solution in sight. It has also kept prices of PCR tests far too high. The BinaxNOW test, the cheapest of those available, costs $20 on for a pack of two — only they were unavailable as of this writing. They were more expensive and in short supply at drugstores.

It would be better, of course, if everyone was fully vaccinated and boosted. But COVID hasn’t been vanquished yet, and lockdowns are a policy option no one wants to contemplate again, as recent protests in Europe show. In the meantime, making a rapid test as common as a bottle of aspirin in the medicine cabinet will give people a greater sense of control and help reduce infection rates.

Therese Raphael is a columnist for Bloomberg Opinion. Send comments to [email protected].