Yes, Americans Should Be Mailed Free Tests

The White House press secretary, Jen Psaki, responded with exasperation this week to a question about distributing at-home tests to Americans: “Should we just send one to every American?,” she said.

Yes, we should, and many more than one. Tests should be sent out week after week, free of charge.

Ms. Psaki’s weariness is understandable. Everyone is tired and frustrated. But the United States should consider something new. Leaders have tried to get all eligible Americans vaccinated; the nation has fallen woefully short. Mandates, one of the most effective ways to get large groups of people vaccinated, are haphazardly applied in some areas and outright banned in others. Fears of Omicron have increased uptake of vaccines a bit, but there’s still not enough coverage to avoid surges in many areas of the country.

Other measures, like masking, which help prevent some cases, aren’t enough, since they are also applied unevenly and many Americans don’t want to wear them.

In the meantime, damaging school absences persist. When one child is infected, often an entire class is declared a close contact and told to stay home. This affects not only the children’s education, but also the routines and work of their parents, who often need to stay at home with their children. This happens to masked and unmasked classrooms alike.

What might make a difference is testing. If people could check whether they are infectious, and check often, spread could be prevented in many cases. For tests to be useful, though, they have to be ubiquitous and simple.

Other than widespread vaccination, no silver bullet exists to end the pandemic, rapid at-home antigen tests included. But plentiful free tests could help keep schools and businesses open at full capacity more easily. Test-to-stay strategies involve regularly testing children or adults who have been exposed to the coronavirus, allowing them to continue to attend school or work so long as they stay negative. These strategies can be used in lieu of 10-day or two-week quarantines, permitting life to go on more normally.

New antiviral drugs will also need to be taken early when a person is sick to be most effective, and testing can help that (and those drugs need to be cheap or free, as well).

The Biden administration’s announcement that it is making at-home tests reimbursable by insurance is insufficient. People who want their insurance to cover the tests must first go to a pharmacy (where hopefully tests are available), pay for them out-of-pocket and then submit documentation to get reimbursed. Anyone who has dealt with insurance before knows that this is likely to be cumbersome.

Free tests will be available at some community centers and rural clinics for those without insurance, but this still requires people to go out and get them. Not everyone owns a car. Not everyone has the time or freedom to run to the store. Having plentiful tests available already in their homes could make the difference between people testing or not.

Testing lots of Americans, and testing them often, would require billions of tests. The country would need to increase production. The United States would also need to pay for them. But even if it cost tens of billions of dollars, it might generate far more than that in productivity. The economic losses during the pandemic are in the trillions of dollars.

Free tests for all would also allow far more people to more safely live a normal life. If done correctly, widespread testing could also avoid the polarizing fights over vaccination and masking. At-home testing has not yet been politicized, as these other measures have been.

In Britain, tests are available to many people through work and schools. If you can’t get them there, you can order them from the National Health Service. You can regularly get a pack of several tests delivered to your home free of charge. Germany paused free antigen testing for unvaccinated people a few months ago, in part because it thought this might spur more to vaccinate, but reinstated it recently because of surges. Residents can get at least one free rapid test a week. In many other European countries they are available for just a few dollars.

There are challenges to wide-spreading at-home testing plans. When more people test at home, positive cases can become harder to track because they may not be reported to health authorities, making it harder for contact tracers to follow up. These cases may also be less likely to undergo genomic sequencing, which is helpful for understanding variants and spread. Countries where at-home tests are widely available still experience surges.

But at this late date, why isn’t the United States using every option available to end the pandemic? If Omicron will lead to more cases among both the unvaccinated and vaccinated, people need to be able to learn much faster whether they are contagious.

The Biden plan to reimburse for tests doesn’t go into effect until mid-January. In Indiana, where I live, we’re already in what might be our worst surge. Americans need quick, reliable tests and the ability to frequently use them. They should be available at home, where people make decisions about whether it’s safe to socialize, and the tests need to be free.

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