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Biden's Covid test plan isn't enough

The president's plan for free at-home Covid tests and other testing policies could be far more ambitious.
Image: A person receives a nasal swab during a test for Covid-19.
A person is swabbed for Covid-19 at a street-side testing booth in New York on Friday.Ed Jones / AFP via Getty Images

The startling explosion in omicron cases across the country has made one thing clear: America needs to get a lot more serious about testing.

Vaccines, masks and judicious use of social distancing remain vital tools in the arsenal against the spread of Covid-19. And vaccination with the Moderna and Pfizer vaccines — particularly with a booster dose — so far seems to remain effective at protecting people from serious illness. But experts say the omicron variant of the coronavirus appears to be exceptionally contagious and more likely to cause breakthrough cases — a phenomenon that’s causing stress and uncertainty for millions of people unsure of how to navigate the holiday season as we wait for more data about the nature of the threat it poses.

A clear part of the solution is to make testing as cheap and simple as possible.

Put simply, it’s a policy that’s acutely vulnerable to death by paperwork.

It’s good news that the Biden administration is taking steps in that direction. Weeks after White House press secretary Jen Psaki snarked at a reporter about the impracticality of providing free Covid test kits, the White House is doing just that: On Tuesday, the administration announced that it would make half a billion test kits available to the public through home deliveries in January. And the administration announced this month that insurance companies are obligated to reimburse people for the full cost of at-home tests.

President Joe Biden also announced Tuesday that the federal government will set up new federal testing sites across the country, the first of which is scheduled to be up in New York City before Christmas. In addition, the administration has said it plans to continue using the Defense Production Act to ramp up production of tests.

More robust testing capacity, through testing sites and at-home test kits, could dramatically reshape our ability to slow the spread of omicron — and any future variant that could prove even more effective at circumventing the vaccines’ protection against infection. It will allow more people to get tested before travel and large social gatherings, and increase the speed at which infected people can alert those they’ve exposed to the virus.

But right now we’re far from where we need to be — more needs to be done, and fast. The deliverable free kits from the government are a good first step and may nudge people to buy more kits on their own, but unless the initial supply is replenished they would on their own provide a fraction of what would be needed for the testing protocol that the National Institutes of Health has recommended. (According to Quartz, the NIH recommends testing Americans twice a week to prevent outbreaks, but "testing just half of the US population each week would still require more than what’s been pledged, around 600 million tests a month.")

And my colleague Hayes Brown has persuasively made the case that getting insurance companies to reimburse people for at-home test kits is a terrible way to roll out a plan that’s advertised as free testing. First, there’s the glaringly obvious issue of overlooking the tens of millions of Americans who aren’t insured. Moreover, asking people to file for refunds with insurance companies — entities that are famous for Byzantine administrative channels which discourage policy holders from getting fully compensated — will inevitably mean that some people won’t get their tests covered or that some will be discouraged from buying tests altogether. It’s also unclear whether there will be restrictions on the kinds of tests or the number of tests insurance companies will be required to pay for. Lastly, there's the problem of spreading the information that this policy even exists. Put simply, it’s a policy that’s acutely vulnerable to death by paperwork.

As Brown explained, peer nations have already rolled out far more comprehensive at-home testing options:

Brits can order a pack of seven tests every day at zero cost. If they’re presenting even mild symptoms, they can also order a free PCR test, which takes longer but is more reliable.

In Germany, a program that provided free weekly tests was phased out in October, aiming to encourage more Germans to get vaccinated. But tests are still readily available and are cheap: roughly $1 versus the nearly $20 you might pay for the Abbott Laboratories BinaxNOW two-pack in the U.S. — if you find it on sale, that is.

And right now even finding at-home test kits is a crisis unto itself, as supplies have sold out across the country. In New York, where omicron has spread at breakneck speed, there are many reports of price gouging — some stores are dramatically (and illegally) marking up the prices of the few kits they have.

Recode’s Rebecca Heilweil has reported that this crunch has been months in the making: “Limited federal investment, a sluggish regulatory approval process, and ongoing shortages of raw materials and workers have all hampered test manufacturing,” she wrote recently. The reality is this testing crisis was preventable to the extent that we always knew that extra contagious new variants could emerge, and that investment in testing could've been ramped up long ago.

If people want to try to carry on without restrictions, making testing a bigger part of our lives seems essential.

In addition to policy, the U.S. pivot toward more aggressive testing also requires a shift within our culture. As testing becomes more accessible, we need to normalize more routine testing before travel and substantial social gatherings, and encourage people to err on the side of caution by regularly getting tested if they’re experiencing Covid-related symptoms. Theoretically, even many vaccine-skeptical people should be able to embrace routine testing, although of course the kind of worldview that makes one skeptical of vaccines would likely also mean shunning testing for many in that set.

There doesn’t seem to be much appetite for lockdowns among policymakers or the public (yet). If people want to try to carry on without restrictions, making testing a bigger part of our lives seems essential. If you test positive and you're vaccinated, you’ll probably be fine. But we can all do our part to minimize the spread to those who are most vulnerable among us, and to shield our economic recovery and badly strained health system from crashing under the weight of social recklessness.