WASHINGTON - With the Omicron variant of the coronavirus spreading swiftly across the United States, the White House finds itself on the defensive about the continued scarcity of rapid tests - a shortfall the Biden administration has promised repeatedly to address.
"We're dealing with a once-in-a-lifetime global pandemic that has been very unpredictable," White House press secretary Jen Psaki said on Monday, defending the administration's handling of testing demand that has routinely exceeded supply. The administration, she added, has worked "to increase access, make it affordable and accessible."
Notably, Psaki declined to say whether President Biden would announce any new measures to increase testing capacity in his remarks on the state of the pandemic scheduled for Tuesday evening, even as she attempted to justify what critics say has been an approach lacking urgency and focus.
"We've always said this would always be a building process," Psaki told reporters. "Our objective is to make tests accessible and free for Americans."
For public health officials who have been asking for more rapid testing for months, a shift in strategy can't come soon enough. "We need exponentially more low-cost, AVAILABLE rapid antigen tests," Dr. Megan Ranney of Brown University wrote on Twitter after Rhode Island announced it was sending 100,000 rapid tests to health clinics across the state. Massachusetts has purchased 2.1 million rapid tests which it is sending to disadvantaged areas of the state; Maryland has done the same with 500,000 rapid tests purchased by Gov. Larry Hogan.
But initiative taken by Northeastern governors in states with high vaccination rates only underscores the lack of a coherent testing strategy, recalling the early days of the pandemic, when states competed for medical supplies and personal protective equipment.
Rapid tests can be purchased over the counter, at least in theory. But with case counts soaring and demand responding in kind, rapid at-home tests now appear to be largely sold out at Walmart, unavailable online and nearly impossible to find on pharmacy shelves.
Yet Omicron - and the enormous numbers of breakthrough infections it will generate - is about to make frequent rapid testing for contagiousness more crucial than ever before.
"Rapid testing is a critical tool for bringing the pandemic under control, but we will only see its benefits if we make it accessible and easy for Americans to use. Most American can neither access nor afford rapid tests," Anne Sosin, a public health policy scholar at Dartmouth College, told Yahoo News in a text message.
"Rapid testing can help ensure educational continuity, limit disruptions to businesses and essential services, and keep health systems functioning," Sosin wrote.
It has become increasingly clear that the U.S. is not going to stop the spread of Omicron through mandates, restrictions or social distancing. Largely shielded from severe disease, vaccinated Americans have little appetite to return to the lockdown measures put in place in 2020. Many unvaccinated Americans, meanwhile, have long opposed precautionary measures of any kind.
With politicians equally reluctant to impose new restrictions, that leaves the country's uneven immunization effort as its primary defense.
"Our vaccination and booster coverage is wholly insufficient for the Biden administration to rely on a vaccine-only approach," Sosin wrote.
And so the new, heavily mutated Omicron variant - which the Centers for Disease Control and Prevention said Monday now accounted for 73 percent of U.S. coronavirus cases and which can dodge immunity better than any of its predecessors - will continue to proliferate at an unprecedented pace.
Testing, especially rapid at-home testing, may be the best remaining tool to limit transmission to the vulnerable while also creating a sense of continuity to those who are largely immune to serious illness.
"Expanding access to cheap and accurate rapid tests would help countless people better manage the risk they pose to vulnerable people in their lives," Dr. Jay Bhattacharya, a professor of medicine at Stanford University, told Yahoo News. "That should be a top COVID policy goal, and should have been for a while now."
Yet despite an investment of $3 billion by the Biden administration, that objective appears a long way off. Along with empty shelves at CVS and "out of stock" notices online, lines for PCR tests in major metropolitan centers like New York City and Washington, D.C., over the weekend only underscored the severity of the problem.
Dense and interconnected, such cities are getting slammed by Omicron first - hence the run on tests. In New York City, cases are up 277 percent over the last two weeks. In Honolulu, they're up 828 percent. In Houston, they're up 442 percent. In Miami, they're up 219 percent. In Cleveland, they're up 170 percent.
Soon Omicron will spread beyond major metropolitan areas to every corner of the country - as will the testing shortage, unless the Biden administration somehow shifts gears.
This is dangerous for two reasons. The first is that the more pervasive Omicron becomes, the more effectively it will find and infect the tens of millions of Americans - unvaccinated or otherwise vulnerable - who still lack sufficient immunity.
Some will be hospitalized. Some will die. All of this will put further strain on a health care system that's already struggling to keep up with an huge, ongoing Delta wave.
The second reason Omicron's explosive growth is dangerous concerns the even greater number of Americans who face less risk of serious illness themselves: the boosted most of all, but also the double-vaccinated and the previously infected.
Encouraging data out of South Africa, Denmark and elsewhere suggests that the vast majority of these people have little to fear, personally, from an Omicron infection. Yet their lives could be upended all the same. They may fall ill. They'll have to miss work or school. And they should quarantine to avoid transmitting the virus to others who might be more susceptible.
Multiply those disruptions by hundreds of thousands, or even a million new cases each day, and they start to have a serious impact on schools, hospitals, families and businesses, regardless of how mild each individual infection might be.
The good news is that in the age of Omicron, experts say testing - especially rapid at-home testing - can safely minimize that impact. But only if Americans can actually find and take these tests.
The Biden administration has already endorsed a new strategy called "Test to Stay," intended to prevent students from having to undergo lengthy quarantines at home if they've been exposed to the coronavirus in the classroom. Instead, students can keep going to school, provided that they are tested for COVID-19 regularly and don't show any signs of illness.
"Test to Stay is an encouraging public health practice to help keep our children in school," CDC Director Rochelle Walensky said during a Friday briefing of the White House pandemic response team. "That testing needs to be at least twice during the seven-day period after exposure."
A similar principle, meanwhile, should now apply to any vaccinated person experiencing a breakthrough infection, experts say. "Asking boosted people with [a] 'breakthrough' infection to isolate for 10 days seems excessive to me," Ashish Jha, dean of the Brown University School of Public Heath, tweeted Monday. "Want 100% assurance? Sure, do 10 days. But I've told friends: Get a rapid antigen at 5 days. If neg[ative], [it's] reasonable to assume you aren't contagious."
"Levels of the coronavirus decline rapidly in vaccinated people who are infected, [so] people with breakthrough infections [should] be able to return to their daily lives faster," added physician and epidemiologist Jay Varma, former COVID-19 adviser to New York Mayor Bill de Blasio.
PCR tests can detect even the tiniest traces of pathogen in the body, but increasingly long wait times - for both the tests and the results - will render them almost useless to combat the Omicron surge. Rapid antigen tests are much handier because they immediately identify whether someone has enough virus in their system to be infectious. For this reason they're also a far superior way to screen for COVID before gathering indoors with friends and family, as Harvard epidemiologist Michael Mina has long noted.
"We continue to think about testing as a medical device," Mina said in a CNN appearance on Monday. "We continue to regulate it in a very slow, arduous fashion. And that has left the United States far behind our peer nations in terms of getting Americans access to these tests."
Rapid tests were not available until early 2021, and when the U.S. pandemic appeared to subside over the spring and summer, so did interest in their public health potential. Abbott Laboratories, maker of the popular BinaxNOW brand of tests, simply stopped making kits.
The day after Thanksgiving, however, the World Health Organization announced that a new "variant of concern" - Omicron - was spreading in southern Africa. The variant's imminent arrival in the United States heightened the demand for rapid testing.
Several days later, President Biden released his "winter plan" to battle the Omicron variant. The plan allowed for Americans with private insurance to seek reimbursement for rapid test purchases from their insurers, a potentially cumbersome process that could discourage some people from purchasing rapid tests in the first place. Nor did the provision have anything to offer Americans lacking insurance or receiving insurance from the government.
Some wondered why the United States didn't simply distribute rapid tests to all Americans or make them readily available at little or no cost, the way other nations have.
The White House bristled at the suggestion. On Dec. 6, Psaki defended the White House approach. "Should we just send one to every American?" she wondered sarcastically. "Then what happens if you, if every American, has one test? How much does that cost?"
Last weekend, social media channels were inundated with videos and reports of prolonged waits for coronavirus tests. The Biden administration has opened thousands of testing sites across the country, but these can involve hours-long waits. And many of the sites offer only molecular tests, which can still take several days to return results.
The ideal remains a test that can be administered at home, as a person prepares to travel - or experiences tell-tale symptoms like a sore throat. But even with the pandemic about to enter its third year, that idea remains very much unrealized.
"So far, testing has largely been just sort of a free-for-all," said Mina in his CNN appearance. "The message from the federal government continues to be, 'We're going to.'"