How to fight COVID, again and again: Rapid tests

Celina Chang, the vice president of business operations and technology at LabCentral, prepared a COVID-19 rapid test kit in Cambridge.Nathan Klima for The Boston Globe

The Big Idea is a regular column exploring research that can change how you live your life — and how you think about the world.

Omicron almost certainly isn’t the last variant we’re going to face. And that’s crucial to keep in mind.

So how do we fight off wave after wave of COVID, while somehow adjusting back toward normal life?

One important piece of the answer may be to avail ourselves of a scientific tool we’ve mostly neglected. A tool that many other wealthy countries have made good use of: rapid tests.

As part of a broader pandemic plan, President Biden announced Thursday that private insurers will soon begin doing some reimbursement of at-home, rapid-test costs, and the administration will distribute free tests to clinics that serve low-income residents.

But that’s likely not going to be enough to turn a potentially blockbuster tool into a pandemic game-changer.

About a year ago, Michael Mina — then an assistant professor of epidemiology at Harvard T. H. Chan School of Public Health and a physician in the Department of Pathology at Brigham and Women’s Hospital — teamed up with biochemists, computer scientists, and others to crunch the numbers and model how America might look different if we had greater access to rapid tests, which you can do yourself using a nasal swab (results take about 15 minutes).

Their answer?

We’d crush the amount of virus circulating in the population.

Even if only some Americans tested just once a week, rapid tests would catch lots of infectious people. And if those people didn’t go out on the days when they were most infectious, spread of the virus could be radically slowed.

Recognizing this benefit to public health, the UK, Germany, and lots of other countries have, at various times, provided free rapid tests to their populations. And when the tests weren’t free, they were generally cheap and easily available.

Which makes complete sense.

Flooding the zone with rapid tests allows schools to reopen quickly (or never close at all), work meetings to happen in-person, family gatherings to take place more safely.

Rapid tests could be a super-affordable way for the government to keep the economy humming and weather successive waves of the virus. The question is why the United States has been so slow to approve them.

Johannes Fruehauf, the CEO of LabCentral in Cambridge and cofounder of Mission BioCapital, told me he recently visited Germany and bought a rapid test for about 80 cents.

By contrast, when I did some poking around this week, I found that both of my local pharmacies offered two-packs of tests for $23.99 (though one pharmacy was out of stock).

Fruehauf, who’s also a medical doctor, argues that you should be able to give your child a COVID test when they brush their teeth.

Doing that three times a week in Germany — at 80 cents a test — would set you back less than $10 a month per child. Doing that three times a week in the United States — at $12 a test — would set you back more than $140 per child.

And remember: Germany has given lots of tests away for free.

In the United States, with a population of about 330 million people, that would mean having hundreds of millions — or billions — of tests floating around.

So how did we get here? Why are we staring down Omicron, unable to quickly and cheaply identify highly infectious people?

Last year, Mina — who’s now the chief science officer at eMed Digital Healthcare, which assists with at-home COVID testing — told me that the FDA just hadn’t adjusted to the fact that we were facing a novel coronavirus.

A year later, he says, not much has changed. “To this day, the FDA, I would say, has barely adjusted.”

Mina believes that “the FDA should have recognized: ‘Hey, there’s an urgency here, and time is of the essence.’”

Indeed, that urgency quickly became clear in Europe. Early in the pandemic, Mina served as an adviser to the prime minister’s office in the UK, but he wasn’t able to do much to move the needle at home.

Instead, the United States has leaned heavily on super-precise PCR tests, which frequently involve a multiple-day wait, thereby rendering the results worthless, albeit expensive: What if you tested negative, but got infected while waiting for results? What if you tested positive, but don’t have COVID anymore?

School districts often rely on such tests, forcing children to stay at home for days (sometimes weeks), even though 15-minute tests are available.

That, in turn, deals a massive blow to kids’ ability to learn and parents’ — often moms’ — ability to truly return to work (or compete equally in the workplace).

Mina believes that the tools we’re using to keep COVID out of school often pale in efficacy to rapid tests.

“What would you rather do: Wear a mask for 10 hours today — or 12, depending on what you’re doing? Or spend 30 seconds to use a test? And if everyone spent 30 seconds to use a test, it would massively, massively cut down on transmission.”

He says that when it comes to rapid tests, the public is sometimes worried that a test could miss 5 percent of cases.

“But then you say a mask used for the same purpose misses 70 or 80 percent of people. Or a PCR test takes two or three days to return and effectively misses 40 or 50 percent of infectious days. I just don’t know how to get people to understand that a 90 or 95 percent sensitive test used at the beginning of every day is just massively powerful to limit spread.”

The efficacy of masks is also limited by the fact that they are generally shed in crowded restaurants, bars, and school lunchrooms. (Harvard undergraduate Rebecca Cadenhead wryly noted in a recent Harvard Magazine piece, “The coronavirus must know not to come into the [dining] hall.”)

Fruehauf — whose colleagues at LabCentral have spent more than a year working on rapid tests and have long used them to monitor themselves — says his Cambridge team has detected several cases of COVID during their twice-a-week tests. And their findings — published in the Journal of the American Medical Association — underscore one of the trickiest parts about this novel coronavirus: People are often asymptomatic.

He noted that most of the employees who came in with COVID had no idea they had it. But, with a rapid test, they were able to avoid spreading it to others.

“Unfortunately, the FDA is holding these tests and these companies who are developing these tests to a very high standard, which are very hard and sometimes impossible to meet, with the outcome that we as a population in the US are deprived of what would otherwise be a fantastic tool at a population level to help control this disease, to get us back to normal society and business and clubs and things,” Fruehauf said.

He wishes offices and schools had the same rapid tests that his colleagues do. “I want a test that basically we can take every student, every morning, before they go to school,” Fruehauf said. “Swab it. Done. A few cents.”

Instead, the FDA has approved rapid tests from the few manufacturers who were able to surmount a raft of regulations, turning the tests into a rare and costly commodity. The government could have stepped in — as governments have in other countries — to either cover the costs of tests or to churn out piles of them as an emergency measure — but it hasn’t.

Mina believes that we’ll continue to see variants for a while — something like Omicron was an inevitability, he believes — but that “with each new variant, the implications of that variant are going to diminish.”

He says that after almost two years, the tide may be turning on rapid tests. But, in the meantime, he’s deeply frustrated.

In October, before this week’s news about reimbursement, Biden did push for a major ramp-up of rapid tests. But “the reality,” Mina argues, “is we’re not going to see this massive infusion of tests that he’s talking about unless we authorize many more companies. So we have a few additional companies, and each will bring millions more tests. But that won’t really be ramping up till February or March, at the very time we’re going to see cases from this wave come down again. So I don’t want to say ‘too little, too late,’ but we’re 750,000 deaths too late.”

You can follow Kara Miller on Twitter @karaemiller.

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Follow Kara Miller on Twitter @karaemiller.