Covid testing: How does the US compare to other countries?

Demand, costs and availability of rapid tests and cheap or free facilities reflect a patchwork health system

Officials in Joe Biden’s administration have fielded several questions from reporters in recent days about why the government does not plan to mail Covid-19 tests to American households, or make them free for all Americans in some other fashion.

Widely available testing for Covid-19 has become a vital component, along with vaccines and face coverings, to help control infections during the public health crisis.

Demand has increased across the US for at-home rapid antigen testing kits – which can range in costs from $10 to $25 for a pack of two, which are more common – as regular test results become integral to the return of in-person schooling, work and public life.

The US Centers for Disease Control and Prevention now recommends Americans take a rapid test before holiday gatherings, as colder weather keeps people indoors and the emergence of the omicron variant has raised concerns among public health officials studying its potential impact.

Rapid tests take roughly 15 minutes and are able to quickly detect virus proteins that trigger the production of antibodies. Polymerase chain reaction (PCR) tests are generally more accurate but take longer to process.

Rapid tests are not foolproof, and their availability in pharmacies can be limited, but they have become a central part of everyday life for many Americans balancing a public health crisis with the demands of school and work for themselves and their families.

Set to take effect in mid-January, Americans with private medical insurance will be able to file reimbursement claims for at-home testing kits purchased at pharmacies and other retailers.

Americans with public insurance through Medicare and Medicaid programmes will not be eligible for reimbursements through the new policy, which also does not cover out-of-pocket costs for millions of uninsured Americans.

On 6 December, White House press secretary Jen Psaki appeared to mock the idea that the US government could mail rapid test kits to every household when pressed by NPR reporter Mara Liasson why the US doesn’t make free rapid tests available for all Americans.

In the UK, residents can request up to seven mail-order rapid lateral flow tests at a time, free of charge. The tests are available to anyone aged 11 and older who does not have Covid-19 symptoms and has not been ordered to self-isolate, and if they cannot get tests through their workplace or school.

Canadian businesses can request free rapid test kits for their staff, to be delivered directly from the government or picked up at pharmacies.

Across Europe, at-home test kits cost the equivalent of only a few dollars or less. A free testing programme in Germany that ran from March through October included 800 million rapid tests and 200 million at-home tests. Unvaccinated residents also had to present recent test results for admission into most gatherings.

Singapore began mailing out six rapid test kits to every household in September.

Relatively high up-front costs and the lack of health insurance for millions of Americans remain barriers to adequate testing, according to a November report from the Kaiser Family Foundation.

The US is also boosting supplies of 50 million at-home tests to be distributed to health centres and rural clinics, among other community sites.

The government also supports roughly 20,000 locations where Americans can get tested for free.

How and when Americans can access those sites, and how state and local governments manage public testing centres, vary from state to state and city to city.

The availability and unpredictable costs of at-home testing in the US are related to regulations imposed by the US Food and Drug Administration and how prices are set relative to the market, but they also underscore the nation’s fragmented, for-profit healthcare system.

Healthcare is steered in part by health insurance companies, drug manufacturers and a clinical rather than social response to the nation’s care. That response means vaccines and drug treatments, rather than testing and other preventative society-based measures, have been the path out of the current crisis to keep the economy moving; Americans could test regularly and isolate, if necessary, rather than rely on an expensive care system in which cost is overwhelmingly a barrier to treatment.

Both the Trump and Biden administrations initially relied on vaccines to end the pandemic, rather than scaling up purchases of tests to send out to Americans.

The FDA has authorised 14 at-home tests in the US, and the White House has argued that the more-rigorous and burdensome standards for authorisation have maintained a “gold standard” process with more dependable results that can pick up low levels of virus.

One of the few companies with FDA authorisations, Abbott Laboratories, has dominated the over-the-counter test market with its BinaxNOW kits.

Congress passed legislation in 2020 and 2021 to funnel billions of dollars into free testing; in some cities, free government-supported testing sites pop up in public parks, public health hospitals, on street corners and at other community sites. Parts of Ohio and Colorado have also deployed free at-home tests to residents. And growing demand for tests prompted some states to reopen public testing centres.

Federal law requires insurers to cover the costs of Covid-19 tests, but patients may end up getting bills for other costs; a survey of US hospitals found prices for PCR tests ranging from $20 to $1,419, with nearly half between $100 and $200, and one in five above $300, according to an April 2021 analysis from the Kaiser Family Foundation.

A rapid test at an urgent care clinic that is out of an insured patient’s approved network of providers, for example, could cost $100 or more.

When asked on Tuesday why the US isn’t sending rapid tests to every American, White House coronavirus response coordinator Jeff Zeints said: “We believe the most efficient and effective approach is more nuanced than that.”

“If you have private insurance, we’re making sure you’ll get reimbursed by your insurer,” he said. “Everyone in America has access to free testing in an efficient and effective way.”

Ms Psaki told reporters on Tuesday that the government’s “objective is to continue to scale up our testing programme to meet demand and ensure the people who want tests are getting tests.”

“And there are a range of ways people want tests,” she added. “Some people want to do it in their homes, certainly, and we’ve seen an increase in demand for that in recent months, and we’ve quadrupled our capacity in that regards. We’ll keep building.”

The administration believes the best way to get tests to Americans is to “meet people where they are and make them available at places where people go – community health centres, rural health centres, pharmacies, doctors’ offices, schools – and also have a component where people can have tests for free at their home,” she said.

“Our approach is not to send everyone in the country a test ... to have millions of tests go unused where we know others can make use of them,” she added.