Close to Home: Rapid testing is an equity issue
As we boarded the plane home from our vacation, we were distressed to hear the man across the aisle talking on the phone about how he felt sick and was planning to get a COVID test after he got to his destination. He proceeded to cough a lot during the flight. Two days later my husband had the sniffles, so even though our family is fully vaccinated he wanted to be sure he wasn’t spreading COVID. The earliest appointment for a PCR COVID test was several days off, and the results wouldn’t be available for even longer. Luckily, we found a rapid antigen test at the local drugstore, and he tested negative.
Rapid tests are an important tool for helping people who have been exposed to COVID or are exhibiting symptoms do the right thing — isolate if they test positive or, if they test negative, stay engaged with their everyday lives — going to school, work, social engagements. Although false negative tests are more common with rapid tests than PCR tests, this risk can be decreased by repeating the rapid test in two days.
As we enter this next phase of the pandemic, in which daily living coexists with the virus, equal access to all available tools to protect ourselves and others is paramount.
While vaccine equity has been a focus in health care and the media, access to rapid antigen tests has not. Rapid tests are readily available over the counter for those who can afford to pay at least $25 for a box of two. However, that is cost prohibitive for those with limited incomes.
While PCR tests are available for free, their utility is limited because of system navigation, travel time, lines and long waits for results. This is a serious equity issue that needs to be addressed. In Europe, rapid tests are easily available for free or very low cost to anyone. Since February, schools in the U.K. send home two rapid tests per week per child for families to use. And since June, people in need can pick up rapid tests for free at public libraries.
Imagine if your child wakes up with sniffles and a headache. You know you can’t send her to school, but is it safe for grandma to take care of her while you go to work? A rapid test can answer that question in 15 minutes. Additionally, if the rapid test is positive, you can alert the other kids in her class immediately and stop potential spread to their families.
Safe socializing in and outside of school is vital, as we face an urgent mental health crisis in our youth. Rapid tests at the door of a sleepover, birthday party or holiday gathering can dramatically increase the safety of that event. Well-educated, wealthy people know this and are using rapid tests routinely to protect their families and community in exactly these ways. But this tool is out of reach for many, particularly low-income people of color, who have already suffered most from the pandemic.
This inequity is demonstrated all around us. A private school in Santa Rosa stocks rapid tests and uses them to test parents when they come for social gatherings, allowing this important school function to continue safely. This same school rapid-tests children with symptoms when they are sent home, protecting their families if positive and allowing the child to return to school more quickly if negative.
In contrast, just a few miles away at the public school, whole families are being sent home to get PCR tests when one sibling complains of a stomachache. Since a negative PCR test is required to return and the school doesn’t provide rapid testing, the student, family, class, even the whole school are more at risk of infection while waiting days for PCR results.
Every day out of school for children is a day lost from social support and learning; it also impacts parents’ ability to work.
President Joe Biden has announced proposals to ensure access to rapid tests, but it remains unclear how this will address equitable access. These tests must get into the medicine cabinets of lower-income families. Public health agencies or philanthropists should give away rapid tests to working-class families and community health workers (such as “promotoras”) already out in the community. Medi-Cal and other insurers should cover buying rapid tests at the pharmacy.
It is imperative that those communities that continue to suffer most from COVID-19 infections, death, economic and mental health consequences have access to this essential public health tool to protect themselves, their families and their community.
Dr. Rain Moore, chief medical officer of community health and advocacy at West County Health Centers, contributed to this commentary. Dr. Panna Lossy is a UCSF clinical professor, faculty member at the Sutter Santa Family Medicine Residency and physician at the Santa Rosa Community Health Center.
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