WASHINGTON — The Biden administration Tuesday formally began allowing Americans who had ordered free coronavirus tests this winter to request a second round of four tests per household, through the same U.S. Postal Service program that President Joe Biden unveiled in January.
The move, which Biden had promised last week during his State of the Union address, followed a crush of interest in the program when it debuted in January. At the time, case rates had skyrocketed because of the omicron variant, and tens of millions of households scrambled to obtain the free tests.
Now, with supply outpacing demand and virus cases on a steep decline, White House officials and public health experts say it will require significant effort to sustain interest in testing — and ensure that manufacturers keep producing tests.
“People were able to sell tests like hotcakes over omicron,” said Gigi Gronvall, a testing expert at Johns Hopkins University. “They were able to gouge prices. It’s now, when the libraries can’t give them away, that the government needs to make sure that the manufacturers don’t pull out, like what happened before delta.”
The supply of rapid at-home tests has ballooned in recent weeks. Federally authorized manufacturers had the ability to make an estimated 535 million tests last month and 462 million this month, said Mara Aspinall, an expert in biomedical diagnostics at Arizona State University who is also on the board of OraSure, which makes rapid COVID-19 tests.
Tests are now easier to find in pharmacies and at many community sites. And the majority of U.S. households ordered free tests from the Postal Service website over the past seven weeks, said Dr. Tom Inglesby, the White House’s testing coordinator. More than 275 million tests have been delivered to nearly 70 million households, with more than 5,000 Postal Service employees in fulfillment centers packing and shipping them.
But federal funding for at-home tests is now lapsing, Inglesby said, meaning that lawmakers would have to commit more to prepare for possible outbreaks. As part of its new coronavirus response strategy, the administration requested $22.5 billion from Congress, including funds for testing.
“Testing does not just happen on its own. We’ve seen that a couple of times now, that when testing demand goes down, industry also reduces its output,” Inglesby said. “We saw with omicron that we have very little time to react to a surge. We had a matter of weeks to scale manufacturing again. And that is not possible without industry being prepared.”
The Biden administration is still working to secure enough tests to fulfill Biden’s pledge during the omicron surge to purchase 1 billion of them for free distribution, not all of which may be allocated to the Postal Service program, White House officials said. The federal government has begun adding to a stockpile of tests, Inglesby said.
The administration recently sent test manufacturers a “request for information,” essentially asking what it will take for them to sustain manufacturing during a quieter phase of the pandemic.
“We are fully committed to supporting the testing infrastructure in a way that does not let it lapse or diminish in times of quiet,” Inglesby said.
Public health experts and lawmakers roundly criticized the White House late last year for not buying more at-home tests sooner, which they said could have helped meet demand when the omicron variant arrived late last year.
When omicron began spreading, long lines formed around the country as grocery and pharmacy shelves emptied of tests.
The Biden administration has since purchased hundreds of millions of them from a cluster of large manufacturers, while more manufacturers have won authorization for their tests.
While some Americans received tests within days of the Postal Service website going live in January, many got them weeks after placing orders, long after the peak of the omicron wave. The timing, which some experts said diminished their value, was the result of manufacturers having to scale up to deliver the tests, Inglesby said.
The next tranche of tests should be available with a “pretty rapid turnaround,” he added.
Public health experts said the tests, however late they arrived, had important purposes beyond diagnosing infections. Lindsey Dawson, a policy analyst at the Kaiser Family Foundation who has studied rapid test availability, said the mail program had helped shift the perception of rapid tests from a scarce luxury to a normal, accessible resource.
“Just making somebody familiar, like, ‘Oh, this isn’t so intimidating. I can have these at home. I can use them for myself. I can use them on my child and move about the world in a way that feels more secure,’” she said of the mass distribution.
The Centers for Disease Control and Prevention still recommends using at-home tests after being exposed to the virus, when experiencing COVID-19 symptoms or before indoor gatherings with vulnerable people.
Other components of the Biden administration’s pandemic response will rely on testing, such as the “test to treat” initiative, which allows Americans to get tested at pharmacies, community health centers and long-term care facilities, and to receive antiviral drugs on the spot if they test positive.
Some public health experts, meanwhile, have warned that after the CDC recently relaxed mask recommendations for much of the country, people might take more risks that could expose them to the virus, even when there is less of it around.
Millions of Americans have immune deficiencies, and the youngest children are still ineligible for vaccination.
Christina Rondinone, a stay-at-home mother in Jupiter, Florida, has maintained a small stockpile of tests in recent months, from a nearby pharmacy and the Postal Service program. She plans to order four more tests from the government, which she can use before visiting her father, who has lung and kidney disease and requires dialysis, putting him at risk of severe COVID-19.
Rondinone, 35, said the tests were akin to a first-aid kit in her home; she would like to start using them after attending crowded indoor events without a mask, she added.
Aspinall, the manufacturing expert, said rapid tests were used as much as seven times more often than PCR tests on a weekly basis during the omicron wave — a big change. But she warned that without as much demand in the coming weeks and months, manufacturers would likely produce fewer of them.
Companies would have to continue committing substantial manpower to the effort to sustain production levels, she said, coming off a period when they worked “24/7” to meet demand.
“No one wants to be caught out where they were a year ago,” she said. “Companies are more aggressive in managing their supply chain than they ever have been.”
The federal government in January also began requiring private health insurers to cover the costs of at-home tests for their members. Dr. Mark McClellan, a Duke University health policy professor who has studied the rollout of the reimbursement program, said it showed signs of promise but that at this quieter point in the pandemic, it is unclear how long the program would remain in place.
Gronvall, the Johns Hopkins testing expert, said she hoped the high demand for COVID-19 tests in recent months encouraged manufacturers and policymakers to see “that there’s a real utility to having these at-home tests, and not just for COVID.”
She added, “I would really love to see more tests, so that people can test if they have the flu.”