Rapid tests remain elusive in the fight against COVID-19 – The Durango Herald

Colorado lost an important resource as community sites phased out tests

Olivia Cates, a tester at COVIDCheck Colorado, conducts a COVID-19 PCR test Wednesday at the La Plata County Fairgrounds testing site. The testing sites in La Plata County and Archuleta County rely on slower and more expensive PCR testing rather than rapid antigen testing. (Jerry McBride/Durango Herald)

Jerry McBride

At this point in the pandemic, rapid antigen and molecular testing would be ubiquitous and inexpensive.

Almost from the start, federal officials, including former President Donald Trump, touted the benefits of rapid tests, such as those from medical giant Abbott Laboratories.

dr. Michael Mina, an epidemiologist, immunologist and former professor at the Harvard TH Chan School of Public Health, has argued for months that rapid antigen testing is the way out of the country’s pandemic.

But at community testing sites across Colorado, test contractor COVIDCheck Colorado and the state Department of Health and Environment have phased out rapid molecular CUE testing.

Instead, testing sites have reverted to just free PCR testing.

COVIDCheck Colorado and the Colorado Department of Public Health and Environment stopped using rapid CUE tests in La Plata and Archuleta counties in late September and early October. “COVIDCheck Colorado, in consultation with CDPHE, has decided to discontinue offering the CUE COVID-19 tests in an effort to reduce significant logistical and operational challenges for the workforce,” San Juan Basin Public Health said in a press release. the change was announced. (Jerry McBride/Durango Herald)

Jerry McBride

With the phasing out of rapid testing at community sites, public health officials have lost an important resource as the state experiences a crushing increase in COVID-19 cases.

“As we head into a significant winter wave here in Colorado, we’re still in a position where we simply don’t have widespread access to rapid testing,” said Liane Jollon, executive director of San Juan Basin Public Health.

“We think[rapid testing]would add to the toolbox of ways we can control disease,” she said.

The promise of low-cost, accessible testing

In May 2020, the US Food and Drug Administration announced it had approved the first antigen test, which could help public health officials monitor the spread of the coronavirus.

“Antigen tests are also important in the overall response to COVID-19 because they can generally be produced at a lower cost than PCR tests, and once multiple manufacturers hit the market, they could potentially scale to test millions of Americans per day. because of their simpler design, which allows our country to better identify infection rates in real time,” said former FDA Commissioner Dr. Stephen Hahn and Dr. Jeffrey Shuren, director of the FDA’s Center for Devices and Radiological Health, said in a press release.

As of May 2020, the FDA has approved 40 antigen tests, which detect proteins from the virus rather than genetic material, about a quarter of which are over-the-counter at-home tests.

Home diagnostics has been a particular focus of federal and state testing efforts, with the logic that inexpensive, accessible testing will help Americans regularly screen themselves and limit transmission.

The Biden Administration Has Made Free, Rapid Home Testing a Pillar of the President COVID-19 action plan. and the state announced in September that CDPHE would launch a free, rapid home testing program in which Coloradans could request tests and the state would send them to their home.

But while the FDA has approved a number of rapid at-home tests and governments have intervened in public health tools, they have remained scarce and hard to find across the country.

PCR tests can be performed with a nasal swab or saliva, but they must be sent to a lab and processed with specialized and expensive equipment. PCR tests take about 24 to 72 hours, according to San Juan Basin Public Health, while rapid antigen tests can take as little as 15 minutes. (Jerry McBride/Durango Herald)

Jerry McBride

Obstacles to Widespread Availability

A recent study by the Kaiser Family Foundation finds that the FDA’s regulatory framework, the lack of initial investment from the federal government, evolving messaging and guidance, the cost of over-the-counter at-home rapid tests, and the unpredictability of supply chains and demand have all limited availability and access to quick tests.

Some have argued that economics and profits have played an inordinate role in quickly testing deficits.

The New York Times reported in August that Abbott Laboratories told a manufacturing plant to destroy tests after demand slumped by lowercase.

In mid-September, San Juan Basin Public Health announced that community testing sites operated by COVIDCheck Colorado and CDPHE will phase out their use of CUE rapid tests in mid-October.

“COVIDCheck Colorado, in consultation with CDPHE, has decided to discontinue offering the CUE COVID-19 tests in an effort to reduce significant logistical and operational challenges for staff,” the press release said.

A few days later, Governor Jared Polis announced that the state would be sending residents home rapid tests for free.

A CDPHE spokeswoman said in an email that the state, which purchased 2 million Abbott BinaxNOW rapid antigen tests in September and another 500,000 earlier this month had no delivery problems with its home testing program.

Testers with COVIDCheck Colorado perform PCR nasal swabs on Wednesday at the La Plata County Fairgrounds COVID-19 testing site. The Colorado Department of Public Health and Environment is conducting a rapid home testing program to complement community testing. According to a CDPHE spokeswoman, the state receives 97,768 rapid antigen tests per week and had shipped 907,470 over-the-counter tests as of Monday. (Jerry McBride/Durango Herald)

Jerry McBride

The state receives 97,768 per week and has shipped 907,470 over-the-counter tests as of Monday, the spokeswoman said.

According to Jollon, people should ideally test multiple times a week to better monitor transmission.

“That’s a strategy that we’re seeing developing in other countries and talked about in the US, but we’re not there yet,” she said. “We generally rely on a more expensive diagnostic test to guide our disease management strategies.

“If we had a wider availability of rapid tests, we could develop disease control strategies where everyone in school or the workplace is tested regularly,” she said. “That would require a huge amount of inexpensive, widely available rapid testing.”

By these standards, CDPHE’s testing program, while successful, falls short.

The total of 907,470 sent BinaxNOW tests, including two per box, wouldn’t even allow all Coloradans to test themselves once.

At testing sites in the Colorado community, PCR testing remains the only tool, leaving local public health officials questioning whether rapid testing will be available anytime soon.

“The faster the results come in, the better it is for us,” Jollon said. “We would like to see faster tests available.”

Why fast testing is important

Traditional PCR tests are diagnostic tools that confirm disease and allow doctors to treat patients.

“That’s the test you can take to the bank, which we’re sure you’ve had,” says Dr. May Chu, a clinical professor at the Colorado School of Public Health.

Public health experts ideally use rapid tests as surveillance tools to understand transmission in communities. With that data, experts and government officials can make critical decisions about quarantines and other precautions that could save lives. (Jerry McBride/Durango Herald)

Jerry McBride

“The PCR test is a really important diagnostic test,” she said. “We identify a patient and whether that patient needs treatment.”

But PCR testing requires labs and specialized and expensive equipment to process samples, often taking between 24 and 72 hours.

The tests themselves are expensive, costing $100 or more, she said.

In comparison, Abbott’s BinaxNOW COVID-19 tests cost $23.99 and can be taken at home and provide near-instantaneous results.

Rapid antigen and molecular testing has an essential function for epidemiologists and public health experts: surveillance.

“Public health testing is different from diagnostic testing,” Chu said. ‘… You look at risk mitigation.

“If you’re doing surveillance, it’s important to know how high the infection rate is in that community,” she said.

While rapid antigen tests are about 15% to 25% or more less accurate than PCR tests, the lower cost, faster turnaround and easier production allow for broader and more frequent screening.

Public health experts can then use that data to understand transmission and make critical decisions about quarantines and other precautions that could save lives.

“(Surveillance testing) gives you an idea of ​​the burden or burden of disease in the community,” Chu said. “The public health perspective is that the success is in keeping that burden as low as possible.”

“Ideally, we would like to have access to both[PCR tests and]a rapid-acting screening tool that we can deploy on a large scale for people, whether they are symptomatic or not,” Jollon said. “You could take a test several times a week if you go to school or work in a critical service. Taking a screening test multiple times would correct for the lower accuracy.

“Having cheap, widely available rapid tests, even if they’re not 100% accurate, gives you another way to quickly identify individuals that are positive and get them out of conditions where they could spread infection,” Jollon said. .

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