New COVID Test Initiatives Show Why Testing Still Matters

COVID-19 vaccines dominate the coronavirus news these days, but public health experts don’t want people to forget that there’s still a need for COVID-19 testing for many people. 

That’s because millions of Americans still are not vaccinated against COVID-19, with many still saying they have no plans to get the shot. 

“For the foreseeable future, the need for testing will continue,” Stephen Kissler, PhD, a research fellow in immunology and infectious diseases at the Harvard T.H. Chan School of Public Health, tells Verywell. “With so many people still unvaccinated, testing continues to be important for identifying people with COVID-19 so that they can be monitored for treatment if needed and be isolated to keep others at risk from getting the virus.” 

Many remain at risk. Half of American adults were fully vaccinated by the end of May, according to the Centers for Disease Control and Prevention (CDC). But a survey released May 28 by the Kaiser Family Foundation found that the “size of the two most [vaccine] reluctant groups…remains largely unchanged from April, with 7% saying they would get vaccinated ‘only if required’ for work, school or other activities, and 13% saying they will ‘definitely not’ get vaccinated.”

Drew Altman, PhD, president of the Kaiser Family Foundation says “at this point, there’s almost no low-hanging fruit.”

Rapid Tests Dominate Recent Initiatives

Because half of adults are still at risk for COVID-19, companies and public health officials alike have recently rolled out rapid testing initiatives to deliver quick results. But just how effective—and accurate—these rapid initiatives will be remains to be seen. 

There are two types of COVID-19 diagnostic tests. Antigen tests, the type that offer rapid results and can be used at home or school, for example, work by detecting specific proteins from the virus. The second type, molecular tests, detect genetic material from the virus, and may take over a day to be processed in a lab.

The Infectious Diseases Society of America (IDSA) recently issued recommendations on use of antigen tests, stating that the sensitivity of antigen tests was heavily dependent on how much virus a person had in their body, whether a person had symptoms, and when the testing was done relative to the beginning of any symptoms. The guidelines authors concluded that molecular tests “remain the diagnostic methods of choice for diagnosing SARS-CoV-2 infection.”

In the real world, however, cost and ease of use are expanding the use of antigen testing. The IDSA authors do say that “when molecular testing is not readily available or is logistically infeasible, [antigen] testing can help identify some individuals with SARS-CoV-2 infection.”

In a June 2 reporter briefing, IDSA fellow Angela M. Caliendo, MD, PhD, acknowledged that antigen tests “are more practical…[but] you have a higher likelihood of missing positive results.”

3 New Testing Initiatives

Major testing initiatives right now include:

• A nasal swab self-testing option for United Airlines travelers returning from outside the U.S. (Antigen test)
• Say Yes! COVID Test: A joint project from the CDC, the National Institutes of Health (NIH), and state and local health departments, aimed at promoting frequent at-home testing (via nasal swab) in Pitt County, North Carolina, and Chattanooga/Hamilton County, Tennessee. (Antigen test)
• A saliva-based testing program aimed at keeping children in school created by the Mount Sinai Medical Center in New York City. (Molecular test)

Testing Travelers Flying into the U.S. 

The CDC requires that both returning residents and foreign travelers to the U.S. have proof of recovery from COVID-19 or a negative COVID-19 test within three days before boarding a plane. (Many foreign countries have similar rules.) In early May the CDC updated its requirements to broaden the use of self-tests.

But caveats abound. The nasal swab self-test must be “proctored” through a telehealth visit, and an employee of the telehealth firm must observe the test being taken and be aware of the test results.

As of late May, only United Airlines had a complying test. The airline is partnering with Abbott Laboratories for its BinaxNow nasal swab test, which travelers must buy from United before they leave on their trip. Abbott’s partner for the telehealth portion is a telehealth company called eMed. The initial cost is $150, which covers six tests and the telehealth visit. For now, the tests cannot be shared among travelers, even though people will likely need just one each.

Aaron McMillan, Managing Director of Operations Policy and Support at United Airlines, tells Verywell the airline is considering selling fewer tests for less money, allowing sharing of tests, and even allowing travelers to pay for the tests with United airline club miles. Emed, the telehealth firm that will be proctoring the tests, says it is speaking with other airlines about self-testing as well. 

Testing Underserved Communities

The CDC/NIH-sponsored Say Yes! COVID Test initiative is recruiting more than 100,000 residents from the North Carolina and Tennessee counties. Participants will have access to free, rapid antigen nasal swab tests, and will test themselves three times a week for a month. Enrollment is rolling and began in April.

NIH is providing the tests—a nasal swab made by a company called Quidel—and will use the data to determine whether frequent self-administered COVID-19 testing helps residents reduce community transmission of COVID-19.

The health departments in North Carolina and Tennessee say they will be specifically be reaching out to vulnerable and underserved populations who are less likely to be vaccinated than other groups.

"If self-testing is shown to effectively reduce viral spread in the selected communities, the hope is that it will lead to wider distribution and acceptance of frequent home testing across the country—ultimately providing an easy and accessible new means of stemming the spread of the virus,” Elizabeth A. DiNenno, PhD, an associate deputy director for surveillance, epidemiology, and laboratory sciences at the CDC, said in a news release.

Testing Schools

If kids under 12 are not vaccinated by the fall, regular testing will be important for keeping schools open and kids well, Kissler says.

To set an example of what schools can do to keep students safe, the Mount Sinai Health System announced it was expanding a saliva-based COVID-19 testing program after completing a pilot study at several schools in New York City. 

The tests are conducted at school, but they are not rapid antigen tests. They are molecular-based tests and are processed at the hospital’s laboratory. Despite the more laborious process, during the pilot, over 99% of tests were returned within 24 hours—a fast turnaround time urgently needed if the tests will be of use to stem spread at schools. 

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.