Rare as gems and almost as expensive

January 10, 2022 – In early December, Sascha Schweiri noticed rapid tests for COVID at her local pharmacy at home. There were so many, she thought she might come back a few later. At the time she did, her son was considered close contact with a positive case at school, but the tests were sold out. That night her husband had symptoms.

“I called all the pharmacies nearby. and no one had, ”says the mother of three children from Easton, MA. “CVS online said it has one of my local stores, so I ran over. No, sold out. I called a little more. CVS in a neighboring town said they had just received notice that CVS in Rhode Island has something. I had just enough time to drive there as fast as I could, 45 minutes in both directions, buy a two-box limit and fly back to pick up my youngest at school. ”

Schweiri’s story is far from unusual. Thanks to the rise of Omicron, finding a quick test at home can feel like a rush of gold under a four-leaf clover held by a unicorn at the end of a rainbow.

Lack of test

With many schools and offices requiring a negative test before you are allowed to enter, just finding the test has become a big challenge. Two main types are used for COVID-19. Molecular PCR tests, which must be evaluated in the laboratory, are more sensitive and will detect COVID sooner. Because Omicron is spreading so fast, you could wait in line for hours to get a PCR test, and since the labs that process the samples also have a backup, wait a week or more for the results. Antigen tests, which give results in minutes, can be done at home – but can give you a false negative result until the virus reaches a certain threshold.

“There are still supply chain problems and problems with clinical laboratories that can monitor PCR testing,” says Amy Karger, MD, chair of the College of American Pathologists ’Point of Care Examination Committee. “And here in Minnesota we don’t have enough people to collect.”

This is true elsewhere as well. For example, in the New York metropolitan area, the CityMD emergency chain temporarily closed dozens of locations due to staffing problems.

All of this means that for many people, quick tests at home seem like a better option – if they could find them. Website NowInStock.net, which tracks popular product offerings, displays tests coming and going in places like Walmart.com and Walgreens.com in just 6 minutes.

“Three months ago, if you wanted antigen tests, you could go to any CVS to get as much as you wanted,” says Dr. Omai Garner, director of clinical microbiology for UCLA Health. “Now I can’t find him in all of LA”

Why is it so hard to find tests?

In some European countries, antigen tests at home are as easy as milk. But here we face two main problems.

First, “there are a lot more regulatory rings to skip in the United States than in other countries,” Karger says.

While the FDA recently introduced a faster review process focused on tests that can be produced in large numbers, only 13 over-the-counter antigen tests are now allowed in the U.S.

And second, the federal government has taken an approach to production testing. “A few months ago, we needed federal support to produce and produce these tests,” Karger says. “It’s done in European countries, which give them away for free. It was up to the whims of the companies to decide. ”

The problem with leaving it to for-profit companies, Garner points out, is that COVID is cyclical, with unpredictable lulls and bumps.

“It’s hard for a manufacturer to produce enough of the tests needed for a wave in the middle of a time when we’re not growing,” he says.

For example, Abbott Labs, the manufacturer of BinaxNOW, closed the factory and laid off workers after falling demand last spring. As of September 2021, all manufacturers together have conducted less than 50 million tests each month. That monthly number is now over 200 million – but with a U.S. population of 330 million, that still means less than one test per person per month. And most of us will have to do more tests at home after each exposure.

“With Omicron, you quickly switch from negative to positive,” says Dr. Sc. Blythe Adamson, epidemiologist and infectious disease economist. Works with companies to develop secure test protocols to reopen and stay open. “The delta lasted about 4 days. Now I see people getting contagious 12 to 24 hours after being exposed. You have to be able to find out so quickly. ”

This means, ideally, testing daily after exposure.

The cost of testing at home

Since the beginning pandemic, laboratory tests are free. But since tests at home are made and sold in the private sector, people have to pay out of pocket. In September, the Biden administration announced an agreement with several major retailers to sell test kits at a price – but the agreement expired in December and prices rose.

For many people, even if they can find a home test, buying enough to test their family has become too expensive.

“If our family of three were to test daily (which would be the current reality if we tested each time close contact occurred), that would be $ 16,425 a year,” says Bethany Gladhill of St. Louis. Paula, MN. “This is more than we pay for our health insurance or mortgage.”

Accuracy problem

If you are lucky enough to find a test kit at home, but it is too early after exposing the Omicron variant, you may not be able to believe the negative result.

This was recently experienced by Garner’s own family.

“The first day, the second day of symptoms, we had false negative antigen tests. We were symptomatic – mild runny nose, nasal congestion, “he says.” And then on the third day I managed to do a PCR test, which was positive. I was also antigen positive that day. “

Adamson was the lead author in a new preprint study (which did not pass the review) that seems to confirm the problem. The study analyzed the results of 30 people with the Omicron variant who did PCR and rapid tests at the same time.

“We knew that PCR tests were positive before antigen testing, but most people assumed that a negative antigen test meant you weren’t contagious,” she says. “This study showed that most people were contagious while being antigen negative. ”

What to do now

If you are looking for tests at home, here’s what you can do:

• If you see a test, don’t worry about which brand it is. Buy. Every test you find on sale in the U.S. has received FDA approval for emergency use. “Don’t talk too much about brands now, given how few tests there are,” says Karger. But if you have a choice, some tests are easier to use than others. Consumer Safety Organization ECRI recently published a report showing which rapid tests are most appropriate for consumers.
• Shopping services like NowInStock.net, ZooLert.com, i HotStock.io monitor a number of websites and provide information on available tests.
• on Twitter, SupplyNinja and Wario64, two accounts known for helping players find the latest PlayStation, tweeted about quick tests.
• For the first few days after exposure to Omicron, antigen tests may not detect the virus. Even if you have a negative result, experts recommend that you assume that you are positive, especially if you have symptoms of COVID. If you can do a PCR test right away, great. But if not, wait and repeat the antigen test 2 or 3 days later. “If both tests are negative, it gives you confidence that you’re really negative,” says Karger.
• If you have only one antigen test available, wait until 5 days after exposure, Karger recommends. This should provide enough time for the virus to develop to levels you can detect.
• If you are positive for antigen or PCR, the CDC recommends isolation for 5 days and wearing a well-equipped mask if you are near others at home.