Today, Explained - Why it's hard to find rapid tests in the US

Episode Date: November 18, 2021

And why they're easy to find in Europe (though they don't seem to be helping much at the moment). Today’s show was produced by Miles Bryan with help from Will Reid, edited by Matt Collette, engineered by Efim Shapiro, fact-checked by Laura Bullard and hosted by Sean Rameswaram. Transcript at vox.com/todayexplained Support Today, Explained by making a financial contribution to Vox! bit.ly/givepodcasts Learn more about your ad choices. Visit podcastchoices.com/adchoices

Get groceries delivered across the GTA from Real Canadian Superstore with PC Express. Shop online for super prices and super savings. Try it today and get up to $75 in PC Optimum Points. Visit superstore.ca to get started. I was talking to a buddy in Canada about COVID recently, and he told me one thing that's pretty distinct north of the border. He said rapid COVID-19 tests are everywhere in Toronto. You know, the ones where you swab your own nostrils for like 30 seconds or so and then stick them in a solution and wait 15 minutes. It's kind of like a pregnancy test. He said in Toronto, people are taking these rapid tests

before heading out to a restaurant, before going to a bar, before getting together at a friend's house for a dinner party. He said there's a guy on his block who just has dozens of them in case anyone needs them. He hands them out for free.

No such guy exists on my block. In fact, all I ever hear about is how hard they are to find here in the United States. And of course, if you're lucky enough to find them at your local pharmacy, a pack of two costs something like 25 bucks, which isn't nearly as cheap as free. ProPublica's Lydia DePillis says it didn't have to be this way.

She didn't point to Canada, though. She pointed to the UK. so the uk has probably the most sophisticated testing system in the western world at least they had decided early on to go really big on testing and they spent i think they allocated 37 billion pounds over a two-year period to do testing and contact tracing. And so that was signing gigantic contracts with test manufacturers and distributing them for free at central communal access points and also even sending them to you at your house. Starting this Friday, everyone in England will be offered two free COVID tests a week at home or at work and in schools and colleges.

There's variations of that across the rest of Europe, right? So in many other countries, they had a free testing program with both PCR and antigen tests. Even if it's not paid for by the government, there are enough tests on the market that you can pick one up at your grocery store or pharmacy, cost about as much as a cup of coffee, and it's just as ubiquitous as gum. And in the United States, we have a lot of gum, but we don't have a lot of testing. That's right. We got our priorities slightly mixed up. This is actually the question I really want to ask you, Lydia. Why is it so hard to find rapid tests in the United States right now? So a lot of reasons that sort of fall into two buckets. The first bucket is limited supply, and that's mostly the FDA's problem.

And the other is limited demand or money for tests that is consistent. And that's mostly a higher level White House, HHS, Congress problem. Huh. Okay. Well, let's talk about each of those starting with the FDA. What is up with the FDA? Why are they so cautious around rapid testing? Right. So there's actually a pretty longstanding caution at the FDA about antigen tests in particular. And if you don't know, these are the tests that pick up the proteins on the virus, not the virus itself. I recently took one for the first time. Yeah. Fancy. Excellent. Well, so you should know that they are good at picking up really high viral loads. Like if you actually have enough of the virus in your nose to pass it along to people. They're not as good at picking it up just as you contract the virus. And also, they don't

pick it up, which is a good thing, after the virus is kind of dead and passed in your system, which a PCR test will pick up. So the FDA is really leery of false negatives and false positives. So they had a really high standard for these antigen tests and insisted that they be, you know, 80, 85% comparable to a PCR test. And that's the kind that is usually something you have to get done by a nurse and it detects the virus itself. So it's very, very sensitive. So for all of 2020, the FDA was approving PCR tests. They were also authorizing serology tests, the ones that detect antibodies, which will tell you if you already had COVID.

But they hadn't authorized many antigen tests and certainly not those that could be used without a prescription or at home by the tested person. And they were really leery of letting anyone take a test by themselves because they don't think that we understand how, which I understand, like, we're dumb. It's kind of hard. There's a lot of risk that you could take the swab wrong, right? So they insisted on a lot of usability studies

to make sure that these are comparable to PCR tests, like almost comparable. Actually, when I took mine recently, I found it really useful that like every step where you could make a really big mistake, there was like this big, bold, red note being like, now do not take it out of your nose and stick it directly into the thing. Instead, you have to first like stick it under the thing. Like they know which mistakes you're going to make and tell you not to make them. Yeah. And there's a lot of research that goes into how to make these things legible to people

who can't even read. So an at-home, no-prescription-needed test that was simple and could be cheap, didn't have a sort of device that you had to use, wasn't authorized until late March of 2021. So there was no way you could buy these things unless you like bootleg them in from South Korea. So if you're a company that wants to get a rapid test on the market in the United States, what does that process look like? The FDA put out a series of templates saying this is all of the information we need. Your studies need to look like this. And here's how we need it to be collected.

And you can't overtrain your users, right? Like they need to be just regular folks. And then you submit it and it's like a package. It's probably a couple hundred pages long, which is way shorter than a normal FDA approval process. But it would take, the average was like more than three months in late 2020 for something to get through the process and much longer for denials. It took them a long time to say, actually, we don't think this is going to work. And often what would happen is you'd get some questions back and say, we need a response within 48 hours. You couldn't make that happen. And so they would send you to the back of the line. It's called

being deprioritized. This happened to companies big and small, and it caused a lot of frustration because they said, well, gosh, I might as well just go sell this thing in Mexico or in Europe because they'll accept it and I won't go through all this rigmarole. That sounds like a disincentive to even try and break into this market. Have you talked to anyone at the FDA about this policy? Absolutely. So the FDA was really generous with their time in talking to us about this stuff because they stand by it. They really think that they were doing their job to make sure that all these tests were quality. They said that there was a lot of faked data, shoddy data, and it's, you know, guarding the health of the American

public to make sure that those don't get out on the market. And the other thing is they were working 24 hours a day and they were tired. And, you know, they were also at the same time vetting vaccines and vetting therapeutics. And by spring of 2021, vaccines were coming online and there was a sort of thought from top to bottom, from White House to the like line reviewers of the FDA that great, you know, maybe the vaccines will usher out this virus and we won't have to do this for another whole year. So the other thing that the FDA told us, and I'm going to maybe get us to our second bucket this way, is that, look, it's not our fault because the important part about affordability and availability of tests isn't the number of tests on the market. It's actually federal government commitment to purchasing large volumes of tests. That not only brings people to the market because companies are like, oh, wow, this country is spending gazillions of dollars to provide tests for free to its population. Seems like a good bet. And also, it's less subject to the ups and downs of the virus.

We've now had four waves. Investors don't love when your quarter is a bust because this thing that you banked big on during a surge is no longer profitable. So some of the big test makers saw really way reduced revenues in the second quarter of 2021. And they were not about to go invest a lot of money in production of rapid tests when they didn't think that COVID was going to come back. And then, of course, it did. And they were caught flat footed. Those at-home test kits have been a hot commodity, selling out online at many retailers. In one pharmacy we visited, the shelves were bare. This shortage is causing pharmacies to turn some people away or limit the amount of kits they can buy. We went to CVS and Walgreens locations, multiple of them, and I tell you what, they were sold out. As a matter

of fact, at one CVS location, they told me they go through a hundred of these boxes per day. There was not enough production to supply the demand, and that's why you saw almost none on the shelves, especially in late August, early September. We started with you telling us how easy it is to get tested in the UK, be it a PCR test or a rapid test.

What's the approval process like in Europe? How is it different from what we have with the FDA? Yeah, so it's complicated because there is a central vetting body at the European Union, and you get something called a CE mark. And those are pretty quick processes. They're basically self-certification. And there are now a few dozen rapid antigen tests that are approved that way. And most countries in Europe accept it. Some of them have applied additional testing regimes. But how that usually works is like, for example, in the UK,

they have a national laboratory called Porton Down. and they take your test and they run it through all the same studies that a company would do, except for the government is doing it. And that way they know everything is benchmarked the same way. You can actually apples to apples compare tests. They put a bunch of tests through that ringer, picked the best one, spent $4 billion buying those tests. So that was basically their process. And, you know, it had some shortcomings. It's not like it was perfect. But I think that people in the UK understand the use of a test that is not perfectly accurate. They know it's not a free pass to go breathe out a bunch of people if they have credible exposure. But it's just the kind of thing that if you do it enough, it'll pick up the virus when it matters most. Why isn't the United States making the same investment in rapid testing as it has in, say,

vaccines, where we clearly came out ahead? Yeah, I mean, I think it starts with a sort of cultural issue. And we love silver bullets. We love a pill you can take that will solve it, a shot you can take to keep you from getting the vaccine. And, you know, obviously, during the Trump administration, they weren't fans of testing because that meant more COVID cases. It could be the testing's, frankly, overrated. Maybe it is overrated. It was a debate within the administration. There were those who were pushing the FDA to approve more of these things quickly, but the FDA doesn't love pressure. They think that's political interference and like they because, again, it wasn't a necessity to reopen in the same way that it has been in Europe.

We bet on vaccines. We didn't bet on tests. Where does that leave us now? We're heading into the holidays. It's a week from Thanksgiving. People are going to be seeing friends, family, traveling. How easy is it to get a rapid test now? So it's getting better. Companies have been ramping up supply. They've especially, though, been focused on fulfilling their orders

from big companies who are testing their entire workforces. So they're getting onto pharmacy shelves pretty slowly. Often, BinaxNOW, the dominant test out there made by Abbott, is just out of stock. And that's a pretty unacceptable outcome nearly two years into this pandemic. Like, these things need to be as ubiquitous as toothbrushes or whatever, because they're not that much more sophisticated than a toothbrush. And meanwhile, in Europe, it's as easy as buying a pack of gum. Yep.

Europe's got the tests, but they're also doing the worst on COVID-19 right now in the world. More on that in a minute on Today Explained. Thank you. frame by Wirecutter. Aura frames make it easy to share unlimited photos and videos directly from your phone to the frame. When you give an aura frame as a gift, you can personalize it, you can preload it with a thoughtful message, maybe your favorite photos. Our colleague Andrew tried an aura frame for himself. So setup was super simple. In my case, we were celebrating my grandmother's birthday. And she's very fortunate. She's got 10 grandkids and so we wanted to surprise her with the AuraFrame and because she's a little bit older, it was just easier for us to source all the images together and have them uploaded to the frame itself. And because we're all connected over text message, it was just so easy to send a link to everybody.

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Going into the summer, it seemed like we were actually in a pretty good place to weather the next phases of the pandemic. The vaccines were rolling out. They made it a requirement in places like restaurants, cafes, theaters, opera houses, that you had to be either recently vaccinated, recovered from the virus, or tested. There's also been this massive testing effort called Alles Gergelt, which means everybody gurgles. It is as it sounds. So you pick up a box in this chain of health and beauty stores, bring it home and gurgle with the saline solution. And then you get your result within 24 to 48 hours over email. The government also made it a requirement on transit and in shops to wear only FFP2 masks, so high-quality masks.

We've been pretty comfortable, even with our 20-month-old son, to live a relatively normal life. But one other thing that's happened is that the vaccine rate plateaued here. There's a third of the population that still isn't vaccinated. Then, of course course the virus started spreading again and now we're in an exponential growth phase. Cases are absolutely exploding here. There are parts of the country where the ICUs are overwhelmed, where doctors are having to rush in care. And so we're kind of back, even with all these incredible efforts on the part of the government, back to square one.

So on Monday, the government introduced a lockdown for the unvaccinated. People who don't have COVID vaccines are not supposed to leave their house unless it's essential. Two of the hardest hit provinces, Salzburg and Upper Austria, are going to impose a full lockdown. So we're kind of just bracing ourselves to see what's next. The continent of Europe is the epicenter of the pandemic at the moment. John Henley, Europe correspondent, The Guardian. Europe is the only continent where both case numbers and deaths are kind of increasing. Nearly 2 million new cases were reported in Europe last week. That is the most in a single week in that region since the pandemic started.

Basically, countries that are lowly vaccinated or have poor levels of vaccination, typically in Central and Eastern Europe, countries like Romania, Bulgaria, the Czech Republic, Slovenia, they have sky-high incidence rates and sky-high death rates. The more rural it gets, the more people are reluctant to get the jab in Romania.

We are in the town of Gajesti. There are currently over 90 COVID patients in the local hospital and only four doctors. It's starting to pick up also in Germany, Austria, Switzerland, a bit less so in France and in Southern Europe, which are the countries where you have really high levels of vaccination. I mean, Portugal is the most vaccinated country in the EU at the moment. Nearly 90% of the whole population of Portugal is vaccinated. Portugal's state health care system has had a robust vaccination program since its battle against polio in the 1960s. There we're seeing very little increase, a little bit, but really not very much. People are used to get the vaccine, their children to get the vaccine,

their grandchildren to get the vaccine. So it's a normal health procedure. So is this just one of those pandemic of the unvaccinated stories, or is there something else going on here? Well, I think it's, I mean, it's a combination of factors. Firstly, I mean, this pandemic clearly comes and goes in waves. We've been seeing that for the last sort of two years now. And Europe has entered its fourth or in some countries, its fifth wave. There's also, you know, other factors that come into play.

Firstly, obviously, Europe was quite fast to roll out its vaccines. And we know that vaccines become marginally less effective after about six months or so. So, you know, much of Western Europe in particular, you know, everybody started getting their or had their second dose of vaccine, you know, pretty much by kind of May, June. So we're starting to get to the period where, and particularly the most vulnerable, older people were vaccinated even earlier. So, you know, the effectiveness of the vaccines is starting to wind down a little bit. And another factor that plays into it is that in Europe, people started to take these kind of distancing measures a little bit less seriously.

So because not everybody is vaccinated, virus is circulating. It's a combination of all those factors that's kind of, you know, causing this spike. And that's even with much better testing, as we discussed in the first half of the show. Yeah. If I talk just about France, which is where I'm based, testing was completely free until about six weeks ago or so. Since then, it's remained free for people who are vaccinated. But for people who are not vaccinated vaccinated they now have to pay. I did several tests before and it's the first time I have to pay with my own money 25 euro so I was asking the guy and there is no choice if I'm not vaccinated I have to pay. And that's part of the effort by the French government

and lots of other governments in Europe have done the same thing, to kind of push people into getting vaccinated, to push as many people into getting vaccinated as possible. Unfortunately, the decision to make people who were not vaccinated pay to get tested has kind of coincided with the arrival of this new wave, which means actually that, you know, there may be many more cases in Europe than we know about at the moment. Who are the unvaccinated Europeans? Are they sort of the anti-vax folks we think about in the United States who don't trust the government or don't trust the science? Or is there something else going on? Yeah, I mean, there's a wide range of people who haven't been vaccinated yet. There's one category that I think is probably worth mentioning, because it's particularly large in these kind of German speaking countries that Germany, Austria, Switzerland, which, as I said, were the least vaccinated countries in Europe. And those countries also happen to be the countries in Europe that I guess are kind of the most accepting of alternative medicine or, you know, alternative therapies, homeopathy, this kind of thing.

So there's quite a strong holdout there against vaccinations, people who kind of don't like big pharma, who prefer kind of natural healing, that kind of thing. We heard from our colleague, Julia Blues, who lives in Austria, about how that country is handling a spike in cases. It's locking down the unvaccinated and in some parts of the country, even the vaccinated. Is that happening outside of Austria? Romania and Bulgaria, the Czech Republic, Slovakia have been starting to kind of introduce lockdowns or partial lockdowns. And with cases reaching peak pandemic levels in the Netherlands, officials launched a partial lockdown Saturday, sparking tense clashes among protesters and police.

I imagine for some people in our listening audience, this is all sort of hard to believe going back into lockdowns, even in some cases, if you are vaccinated. How are these new waves of lockdowns being enforced in places like Austria? It is being checked up on by the police. And several other countries are likely to follow suit down that road. It's very likely that Germany, which is also experiencing kind of record numbers of infections at the moment. So Germany and several of these German states, you know, Germany is made up of a number of semi-autonomous states.

They're already introducing similar measures. And I think, you know, a focus on making life generally tougher for people who are not fully vaccinated is probably the route that most European governments will go down. Do you think the United States should be bracing for the kinds of surges you're seeing out there in Western Europe and Eastern Europe as well? I'm not an expert on the U.S. and I'm not an epidemiologist, but I find it quite hard to believe that you're not heading into some kind of new wave. France is like 68 percent fully vaccinated. Germany, 68% fully vaccinated. Germany, 68% fully vaccinated. If you look at the numbers in the US, you're around about 58% at the moment. So I find it hard to believe that this new wave isn't going to hit the United States. And it is in fact quite possible that it already is hitting the United States.

You just don't know it because you're not testing as much as everybody else. Cool. John Henley. He writes about Europe for The Guardian. He's based in Paris. Our episode today was produced by Miles Bryan. He's based in Philadelphia.

He had help from Will Reed. He's based in Brooklyn. Thanks to our colleague Julia Belouz. She's based in Paris. Our episode today was produced by Miles Bryan. He's based in Philadelphia. He had help from Will Reed. He's based in Brooklyn. Thanks to our colleague, Julia Belouz. She's based in Vienna. I'm Sean Ramos for him, along with ProPublica's Lydia DePulis, based here in the District of Columbia. It's Today Explained. Thank you. you