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US infectious disease experts largely agree with the Biden administration’s newly announced emphasis on Covid-19 testing in the wake of the emergence of the Omicron variant, but questions remain over whether the president’s plan goes far enough to ensure that testing stops the spread of the virus.
President Joe Biden announced new actions to combat the coronavirus in the US on Thursday, including a nationwide campaign encouraging vaccine boosters; a forthcoming rule requiring private insurance to reimburse the cost of at-home testing; a promise to provide 50m free at-home tests to health centers and rural clinics for those not covered by private insurance; and a requirement that travelers to the United States, regardless of nationality or vaccination status, provide proof of a negative Covid-19 test within one day of boarding flights.
“The bottom line, this winter, you’ll be able to test for free in the comfort of your home and have some peace of mind,” Biden said during a speech Thursday at the National Institutes of Health.
Epidemiologists agreed that the testing should be a point of emphasis at this stage in the pandemic and say they are confident that existing tests will detect Omicron, a novel variant detected in the United States on Wednesday that had already sparked fresh concerns across the world.
“We appreciate and concur with the importance of testing, particularly increasing access to testing through the various different coverage and reimbursement means,” said Dr Nirav Shah, president of the Association of State and Territorial Health Officials.
But the doctors still questioned whether people will have enough access to tests in order to regularly use them and whether testing requirements should also be instituted on domestic travel.
In October, the Biden administration announced that it would buy $1bn worth of tests to address the shortfall.
The new plan calls for private insurers to begin reimbursing people for at-home tests in January. But some infectious diseases experts say that doesn’t go far enough and point to Great Britain, where the at-home kits are free and Germany, where they cost about $3.
The reimbursement plan “is a move in the right direction”, said Dr Celine Gounder, an infectious disease specialist and epidemiologist at New York University. “I think ideally what [the Biden administration] would be doing is providing them for free for everybody. I think anytime you ask somebody to fill out paperwork, it creates a barrier.”
At-home kit manufacturers in the United States also charge significantly more than in other countries. For example, a QuickVue test costs $23.99.
“Reimbursing folks for what these tests retail for just pads the coffers of diagnostic companies, rather than taking a more government-led approach to negotiate the actual cost and provide them for its people,” said Susan Butler-Wu, a clinical microbiologist at the Keck School of Medicine of the University of Southern California.
“I worry that this will end up costing way, way more money than actually contracted and negotiating with manufacturers to provide the tests themselves for free/low-cost.”
The new plan also tightens the requirement for in-bound international travelers to the United States to have a negative Covid test taken with 24 hours of departure, whereas previously it was within 72 hours.
But Gounder said she sees the distinction between domestic travel and international travel, when it comes to testing, as an “artificial line” and thinks the same requirements should be instituted for domestic flights.
“That’s this false idea that virus doesn’t cross the artificial boundaries, and it does, and it really doesn’t matter if it’s an international boundary or a state boundary,” said Gounder.
Another uncertainty surrounding the push for increased testing is whether that effort could cause the same backlash as masking and vaccination recommendations and requirements have faced.
Shah, who also serves as director of the Maine Centers for Disease Control and Prevention, pointed out that testing in schools has not caused widespread resistance.
“The asterisk to that is if we get to a world where the options on the table for employers or schools are vaccinate or test … we could see testing take on a distinctly more political dimension,” said Shah.
If testing becomes a ubiquitous part of life in the United States, that doesn’t necessarily mean the number of Covid cases will significantly decrease, said Butler-Wu.
She pointed to the UK and Germany, which have seen a recent surge in Covid cases despite the widespread testing.
“In order to be impactful, rapid tests must be combined with other measures,” Butler-Wu said. “They are one tool in the toolbox, but they’re often discussed as if they’re the entire toolbox itself.”