Editor’s note: Dr. Megan Ranney is associate dean of Brown University’s School of Public Health and professor of emergency medicine at the university’s Warren Alpert Medical School. The opinions expressed in this commentary are his own. Read more reviews on CNN.
On Thursday, President Joe Biden announcement that the United States Postal Service will again send four free Covid-19 tests to every household that orders them through covidtests.gov.
But we are in the middle of a terrible, not good, horrible season of several respiratory viruses. More than 10% of deaths in the United States last week were due to influenza, Covid-19 or pneumonia (both bacterial and viral), well above expected levels at this time of year. We lack essential medicines in some places. We continue to face severe shortages of health workers and hospital overcrowding. Covid-19 masking and bivalent boosters remain underutilized.
All of this raises the question: are four tests just a facade in the face of this winter surge?
It’s true that four tests per family is not a lot. But they illustrate a larger group of ongoing victories against Covid-19 – outside of vaccination – that should be celebrated and then looked at closely to learn from.
The first underestimated fact is that frequent and easily accessible antigen testing for all remains a key part of Covid-19 mitigation – and rapid home tests for Covid-19 are now available to (almost) everyone. between us. Testing at home before going to a holiday party, a few days after being exposed to the virus, or when you feel sick reduces the risk of unintentionally spreading the virus.
It might be hard to remember now, but it wasn’t until the spring of 2021 that at-home testing even became available to the public. Then they were expensive and hard to find. Unsurprisingly, huge disparities in usage were observed during these first months. Minorities, older people and low-income people were less likely to use them.
But thanks to the flexibility that a public health emergency declaration provided the U.S. Food and Drug Administration (FDA) in early 2020, as well as the federal government’s connections and purchasing power, hundreds of home Covid-19 tests have now received emergency use. authorization, and there is wide availability.
Insurers, including Medicare, reimburse consumers for up to eight tests per month per person. ICATT, or the Increasing Community Access to Testing Program, was developed to provide free community testing at more than 15,000 locations (including pharmacies, libraries, and grocery stores) across the United States. United. According to a government official, more than 50% tests carried out under this program are intended for uninsured persons. Similar programs have been set up with food banks, schools, federally approved health centers and residences for low-income seniors.
Of course, for testing to make a difference, people need to act on positive Covid diagnoses. For the elderly, pregnant or at high risk of poor outcomes, therapeutics like Paxlovid are an important part of this action. Recent real-world data shows that during the Omicron wave, Paxlovid recipients had approximately 50% lower hospitalization rates than those who did not – even controlling for age, previous vaccination and infection, co-existing diseases, etc. Laboratory studies confirm efficacy against newer variants.
Unfortunately, at least 60% of people who could benefit from Paxlovid do not receive a prescription and, as with testing, stubborn disparities remain in access to these life-saving treatments. For example, blacks, Hispanics, Native Americans, and people living in areas of high social vulnerability — the very people who are at the greatest risk of death — are less likely to receive a prescription for Paxlovid. Also, many people may get a prescription but be unable to fill it.
This brings us to the second piece of good news to pay attention to: between December 2021, when the FDA authorized emergency use of Paxlovid, and now, the proportion of eligible patients treated with oral antivirals after a diagnosis of Covid-19 has risen from less than 1% to around 40%. The improvements likely reflect the dramatic expansion of test-to-treat programs in recent months. Led by the federal government, in-person, telehealth, and pharmacist-led programs have shortened the time and effort from diagnosis to issuing a prescription. Private companies, such as eMed, also provide these services.
Even better, last week a new partnership was announced between Walgreens, Uber Health and DoorDash to make it easier to deliver Paxlovid quickly to those who can’t get to the pharmacy. According to Walgreens, this program can reach 92% of Americans. Combined with existing prescription delivery services from CVS and RiteAid, this new partnership can reduce the risk that a sick person will have to go out and expose others in order to get their Paxlovid prescription. It also offers immense benefits to those who cannot get transportation or child care or who are disabled.
And that brings us to the last important point. These lessons are extendable far beyond the Covid-19 pandemic.
As an emergency physician and mother, I wish all Americans could access home testing — and treatment — for a wider variety of common illnesses, such as influenza, RSV, and strep throat. For now, rapid FDA approval of new diagnostics is only possible for tests and pharmaceuticals related to Covid-19.
Partly because of bureaucracy, there remain no FDA-approved rapid or molecular home antigen tests for influenza or RSV. Also, oseltamivir (commonly known as Tamiflu) is not as effective as Paxlovid and there are no good treatments for RSV. Moreover, telehealth has already been shown to increase the overprescription – and unnecessary prescription – of certain treatments, such as antibiotics; any testing program to treat on a larger scale should be careful to ensure that it does not further exacerbate the overuse of antivirals and antibiotics. And unlike paying for Covid-19 tests and treatment, access to other types of telehealth and medication largely depends on one’s insurance — or ability to pay out of pocket.
But these barriers are not immutable. If we’ve learned anything during Covid-19, it’s that change is possible when we collectively push for it to happen. Indeed, personal experiences with Covid-19 have increased Americans’ commitment to changing structural barriers to equitable care – such as ICATT and Test-to-Treat programs.
Yes, more people need to be vaccinated. Yes, we should hide in crowded places right now. Yes, hospitals are overflowing.
At the same time, we also have developments to celebrate this holiday season. We now have amazing new tools that reduce illnesses and serious illnesses, and they really are available to everyone.
Maybe, just maybe, the failures and small successes we’ve seen in the midst of Covid-19 can lead us to a space where even more public health innovation can happen.
It would be a great silver lining of the past three years.
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