A sign posted recently outside the El Arroyo restaurant in Austin, Texas, read, “At-home COVID tests are the new toilet paper.” Two years into this pandemic, it’s extremely troubling that tests and testing capacity are as scarce as toilet paper was in March 2020. While no one could have predicted the specifics of the omicron or delta variants of the coronavirus, we knew that unpredictable variants would arise as long as vaccination in this country and others remained uneven. By the time the delta surge occurred this summer, it was clear our national testing capacity was prematurely reduced.
The Biden administration’s recent announcements that 500 million tests would be mailed to all U.S. residents directly starting this month and that another 500 million would be available in the hopefully near future are good news. However, it is unclear whether those tests will be able to meet the need for testing in the weeks and months to come. One billion tests sound like a lot, but in reality, they would allow each person living in the United States to be tested just three times. Is that enough?
Approximately 2 million laboratory-based tests (with significant wait times for appointments and results) are performed daily, but home testing remains a mystery. Recent reports have suggested that 2 million to 9 million home tests a day may be “available,” but many living in the United States are unable to purchase home testing kits from pharmacy shelves or retailer websites without significant delays. At the same time, private companies appear to be competing with individual consumers for a nationally insufficient supply of home tests.
The United States needs a national target for daily, weekly, and monthly tests that will allow us to resume as much of our pre-pandemic lives as possible. That target may be as low as 9 million daily — or it may be as high as 90 million a day if every person living in the United States were to be tested twice a week. Picking a number is more challenging for testing than it was for vaccines because of the uncertainty about what the next variant may bring and the repeated need for testing. But picking a specific target with transparent assumptions — as was done with vaccines in the first 100 days of the Biden administration — and reporting regularly on progress will be critically important for the foreseeable future, not just to identify and quash outbreaks but also to assure the public that they have access to tests when needed.
The federal government needs to continue to lead by providing a steady supply of tests beyond this initial tranche and by clarifying how many tests the public should expect to have, when we should be using them, how we should report the results, and how the government will ensure a supply of adequate, accessible tests into the summer months and potentially beyond.
The administration recognized the need to secure adequate testing supplies as early as January 2021 in an executive order, though a specific goal has never been clear. While we have — in many phases of this pandemic — hoped that the end was around the corner, new variants are likely to challenge us in the future. We need to ensure testing is available to allow us to safely go about living our daily lives with minimal risk to others. Even more tests will be needed for confirmation of diagnoses as new medications to treat COVID-19 become available.
What’s more, to maximize the impact that at-home COVID-19 tests can have on curbing the spread of the virus, leaders in government, medicine, and public health will need to regularly advise the public on how and when to use and interpret rapid home tests based upon their availability and conditions in local communities.
The federal government needs to continue to lead by providing a steady supply of tests beyond this initial tranche and by clarifying how many tests the public should expect to have, when we should be using them, how we should report the results, and how the government will ensure a supply of adequate, accessible tests into the summer months and potentially beyond. While we may have reached the point in the pandemic where the supply of toilet paper is no longer an issue, our need for COVID-19 tests will remain significant — and overestimating demand is preferable to finding ourselves waiting hours or days for COVID-19 tests as new variants arise.
It’s time for the federal government to more clearly articulate a national testing strategy, including how many daily tests of each type we need, how the public is going to get them, and where the tests and testing supplies are coming from. And then let’s hope we can use them effectively to each do our part to keep ourselves and our communities safe.
Atul Grover, MD, PhD, is the executive director of the AAMC Research and Action Institute.