 People wait for at-home coronavirus test kits in a long line that snakes around the Shaw Library in Washington on Dec. 22. (Andrew Harnik/AP) | Scaled-up coronavirus testing, at a level some countries have already achieved, can't come soon enough for pandemic-weary Americans seeking to celebrate the holidays safely with loved ones, amid the rapid spread of the omicron variant. As many governments impose fresh restrictions to curb omicron, the Biden administration is making rapid testing a pillar of its response. President Biden announced a raft of new measures Tuesday to broaden access to coronavirus tests, including the delivery of a half-billion free rapid tests to homes next month and the establishment of testing sites across the country. Earlier this month, Biden also announced a reimbursement scheme for at-home antigen tests. Since the start of the pandemic, the United States' testing infrastructure has been widely criticized as inadequate — hampered by supply issues, high costs and what critics describe as an inflexible, pricey and convoluted process for test makers to obtain government authorization. Biden pledged during his campaign to address the problem and took some steps to do so this fall. But images this week of Americans waiting outside in lengthy testing lines as at-home test kits sold out at pharmacies underscored the challenges to mass testing that remain. People lucky enough to get their hands on an at-home test kit often pay $25 for two tests. Public health experts praised the measures announced Tuesday, but many described them as too little, too late to curb a highly infectious variant that is proving frustratingly adept at sidestepping antibodies from vaccines or prior infections. Pressed on Tuesday about why Americans were struggling to access tests, Biden became defensive. "What happened was the omicron virus spread even more rapidly than anybody thought," he told reporters. But experts had sounded the alarm for more than a year that such a variant could emerge, especially in the vast swaths of the world that remain largely unvaccinated, coming back to bite wealthy countries accused of hoarding doses. Some had repeatedly urged the U.S. government to accelerate the authorization and distribution of rapid tests, pointing to other wealthy nations that have done just that. In the United Kingdom — perhaps the poster child for mass rapid testing — people can order at-home test packs from the government to their doorsteps or pick them up at the pharmacy or other locations for free. Taking a rapid test before attending a wedding, sports event or private dinner party became the norm for many people. The German government bought hundreds of millions of rapid tests for an ambitious free testing program from March through October. (Free tests have since resumed after cases rose). Singapore has also distributed free antigen tests to households. In France and Belgium, meanwhile, rapid at-home tests can be purchased from pharmacies for just a few euros. The common denominator in many places: sustained public funding for self-administered tests of a kind the United States has not provided. "Without it, manufacturers have lacked confidence that going through the FDA's process would be financially worth the trouble," ProPublica reported last month. Instead, the Biden administration emphasized vaccinations over testing in the spring, leading test manufacturers to scale back production. Just two weeks ago, White House press secretary Jen Psaki appeared to dismiss the idea of sending at-home tests to every American household as ludicrous. Meanwhile, new confirmed infections and hospitalizations in the United States have roughly doubled since early November. Omicron's speed in making people sick heightens the urgency of improving access to rapid at-home tests. The variant's incubation period — the time between exposure and the development of symptoms — appears to be faster than those of the delta and alpha variants. "With Omicron, people who think they've been exposed may need to test themselves sooner, and more often, to catch a virus on the upswing," Katherine J. Wu wrote in the Atlantic. This detection capacity will be key to the test-to-stay strategy that the Biden administration is now pushing for schools in the United States. Israel and other countries have already used such systems to minimize disruptions to normal life for healthy residents. A study of a citywide rapid antigen testing program in Liverpool, England, released this week found a 32 percent reduction in covid-19 hospitalizations — and that daily contact testing among workers "saved 8,292 key worker workdays." For those who do fall ill, new oral coronavirus treatments could help blunt the impact on individuals and health systems across the world. In order for the pills to work, though, they have to be taken within a few days of a person developing symptoms — a tight time frame that depends heavily on access to quick and accurate testing. "In general, testing capacity needs to be strengthened so that we can take advantage of these pills, which might keep people out of the hospital," Nahid Bhadelia, director of Boston University's Center for Emerging Infectious Diseases Policy and Research, told Today's WorldView. The United States isn't the only wealthy country facing pressure to improve access to rapid testing. Canadians are also venting frustration about test shortages and long lines, while Australian business groups are urging the government to bankroll free or subsidized rapid tests. For low- and middle-income countries, greater access to rapid, at-home testing could be even more important. With significantly lower vaccination rates than wealthier nations, their populations are more vulnerable to omicron — and their economies suffer more from blunt virus-control measures such as lockdowns, Bhadelia said. While rapid tests can provide real-time data to inform individuals' and governments' decisions, experts emphasize that they are Band-Aids at best. As Benjamin Mazer noted in the Atlantic, even before the arrival of omicron, countries that had been lauded as models of rapid-testing success faced major virus surges. With omicron, infections are multiplying so fast that countries that were awash in rapid tests just weeks ago — including Britain and France — have experienced shortages. "Until now, tests offered only a porous safety net; in the era of Omicron, the holes are even wider," Wu wrote in the Atlantic. "We'll need to close the gaps by doubling down further on preventive measures," including mask-wearing and cutbacks on socializing. The key to turning the virus from a Grinch that incites worldwide panic to something more manageable, experts and many policymakers concur, lies in vaccinating hesitant pockets of wealthy countries and the vast majority of many poorer ones. Wednesday brought two sources of tentative hope: South Africa's huge wave of omicron cases appears to be subsiding as quickly as it grew, my colleague Max Bearak reported, while researchers in the United Kingdom said omicron appears to be less severe than the delta variant. As long as so much of world remains unvaccinated, though, another, more pernicious variant could crop up. With some countries planning to offer fourth doses to their citizens, the World Health Organization doubled down Wednesday on calls for countries with abundant vaccine supply to help get first and second shots into arms in poorer countries first. "No country can boost its way out of the pandemic," WHO Director General Tedros Adhanom Ghebreyesus told reporters Wednesday. No country can test its way out of the pandemic, either. | 
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