To test or not to test — that is the question

President Biden is being tested by a pandemic that won’t quit. In his latest remarks to the nation, the president provided an update on the coronavirus and warned about a continued rise in cases. He reiterated the need for people to get vaccinations and boosters to avoid serious illness, saying there is plenty of supply available. “We have in hand all the vaccines we need to get every American fully vaccinated, including the booster shot,” he said.

But can the same be said of testing?

There remains a gap between what Biden is saying about COVID-19 test availability and what people are experiencing around the country right now. In Orlando, Fla., the lines get longer and longer to the point where people are being sent home without a test.

In New York City, home to Broadway and 24-hour-a-day life, people waited for over five hours for tests and were turned away. The Biden administration had to launch federally run COVID-19 testing sites in New York City and other areas overwhelmed by demand as the omicron variant causes record numbers of new coronavirus cases.

Parts of Massachusetts have car lines that look reminiscent of the early days of vaccinations as frustrated drivers crawled through traffic only to wait again at testing sites. 

The good news from Biden is that insurance companies will provide reimbursement for tests (if you can find them), and he is promising that we will soon see more home tests on drugstore shelves. The U.S. government is launching a site later this month to get tests shipped to homes for free. 

The most accurate tests available are polymerase chain reaction, or PCR, tests, which detect tiny fragments of the virus’s genetic material. Because the tests require specialized lab equipment, people have to wait for days to get their results, particularly when there are surges, as there are now, and as demand grows and logjams are created. 

Rapid tests, on the other hand, find molecules that are found on the virus’s surface, called antigens. They’re not as accurate, but they can be run at home and provide results in as little as 15 minutes. 

What is not available right now are home tests that distinguish between the delta and omicron variants, and the distinction is important for both transmissibility and treatment.

Another source of debate is around whether people coming out of isolation need to be tested, and how asymptomatic people should approach tests if they need them to travel or to access a public venue. Some states may decide to recommend that only high-risk people seek tests. 

Ultimately, the right questions to ask are: How did we get into this testing mess? And how do we get out of it?

First, we must encourage citizens to learn how to respond to a problem before it is a crisis. Tests were available months ago and sat idle on drugstore shelves. We knew variants were around the corner, but it took a blizzard before we all purchased salt and shovels.

Secondly, government must be more responsive to its own predictions. If you foresee a need for an item that could be potentially out of stock, then stock up. The Biden administration has worked to increase production and has provided 50 million rapid tests to community health centers. Schools have received state allocations of resources that presumably are being used, in part, for tests.

But government can’t do everything. We have a private sector. Abbott Labs, which produces the BinaxNOW at-home tests, says that is will increase its production of 50 million test kits per month to 70 million in January. We need corporate America to keep supply up and prices down.

Lastly, we need solid data on the effectiveness of home tests. The Food and Drug Administration (FDA) says it is monitoring and evaluating antigen tests on the market for their sensitivity to the omicron variant. Dr. Fauci, director of the National Institute of Allergy and Infectious Diseases, clarified at a  White House briefing Wednesday that rapid tests are still essential and that the FDA released its initial findings suggesting diminished receptivity to be fully transparent. The FDA has not said which test kit brands it had evaluated.

And are we sure everyone is reporting test results correctly? 

With guidelines constantly changing, the public needs confidence in science and government. We are only going to get out of this crisis with team effort. When it comes to public health, the public is the most important variant. 

Tara D. Sonenshine is a former U.S. under-secretary of state for public diplomacy and public affairs.