The coronavirus pandemic has only just gotten started in the continental U.S., but testing for the virus is already a mess. While the Families First Coronavirus Response Act mandates that medical providers and insurers must provide testing free of charge, tests remain widely unavailable, thanks in part to private companies and labs that have been charging high fees for what few tests they have in stock.
Seizing on an opportunity to expand their reach, a number of telemedicine startups swooped in, leveraging their robust userbases and pre-existing networks with private labs to secure a bunch of testing kits and charge as much as $135 for access—that is, until the FDA put a stop to it last weekend. It seems that companies will continue to try and find ways to capitalize on the pandemic, because that’s how healthcare works in this country: As long as there are patients who can afford the care they need, a profit-driven business will be there to provide it.
The testing shortage—which also stems from an international shortages of nasopharyngeal swabs, stringent government policies on which biological samples can be tested, and confusion about which labs are permitted to do the testing—has led to our current situation, where being rich is one of the only surefire ways to insure you’ll be able to get tested. Celebrities, politicians, professional athletes, and private individuals with enough wealth at their disposal have managed to get tested while poor people are dying without medical care and frontline healthcare workers and schoolteachers have been repeatedly turned away, despite exhibiting symptoms.
Everlywell, which offers at-home testing services of dubious medical value, was the first to announce the availability of “home testing kits” for coronavirus, priced at $135 per testing kit. Competitors moved quickly to beat Everlywell to its Monday launch date, and Carbon Health and Nurx announced their intent to roll out their own at-home services on Friday, March 20. “At this stage in the pandemic, we believe that every additional test counts towards slowing the virus and relieving the overwhelming burden on our healthcare system,” read a press statement from Nurx that VICE received that same day.
In less than 24 hours, their plans came to a grinding halt. The Food and Drug Administration updated its diagnostic testing guidelines for SARS-CoV-2 on Saturday to expressly note that it has not yet authorized at-home testing, forcing Everlywell, Carbon Health, and Nurx to discontinue whatever barely operational services they’d managed to get out the door earlier that week and release the testing equipment they’d sourced from partner labs for use by hospitals and clinics in dire need of more.
The blink-and-you-missed news cycle might be over and done with—well, except for the letter that members of the House Subcommittee on Economic and Consumer Policy sent Everlywell demanding answers on their failed plan by Friday—but some of the companies involved have said that they will continue to pursue home testing services. “We are exploring ways to be supportive during this crisis in the meantime,” a Nurx spokesperson told VICE. In another interview, a spokesperson for Everlywell told VICE that the company is “still committed to making a COVID-19 test available to consumers who fall within the CDC’s guidelines for recommended testing and are actively working with the FDA on a path forward for COVID-19 sample self-collection in a home setting.”
Other direct-to-consumer brands in the telemedicine sector like Hims & Hers, K Health, and Forward will also continue to provide “screening” services for people who want to know if they should get tested—services that don’t offer anything better than what numerous other telehealth companies already provide, except for the chance to send a press release to my VICE inbox.
The issue here isn’t with at-home testing in principle, which, experts agree, could eventually help to alleviate the overwhelming strain on hospitals around the country while also protecting frontline healthcare workers from further exposure to the virus. "At-home testing is a good idea," Joseph Osmundson, a molecular biologist collaborating with the COVID-19 Working Group, told VICE. “If you have someone swab themselves, you’re not going to run through the personal protective equipment for healthcare workers, which are already in short supply.”
But it’s still extremely unclear how an at-home test can get valid, usable results in this case. At-home testing has proven effective with certain diseases and infections, as The New York Times noted earlier this week, but there is zero available evidence yet to conclude that self-testing for coronavirus will be the same. Biological samples swabbed for testing must be stored at temperatures between 35 and 40 degrees Fahrenheit—conditions that seem difficult to ensure both at home and during shipping. There’s also the matter of patients mishandling the at-home sample collection kits, rendering whatever they send back to the lab unuseable, thereby wasting testing equipment amid rampant scarcity.
These for-profit companies are also still trying to operate outside the medical system, which is providing free testing, giving anxious people a place to throw their money for a result that is not at all proven to work. Everlywell, $135 price for itsat-home sample collection kit would have been cost-prohibitive to many. When I asked Osmundson if $135 were an affordable price for testing, they laughed: “Are you kidding me? No. Scaled up testing is a good idea, but it should be free.”
Should the FDA update its guidelines once more to expressly allow at-home testing, and provided that anyone can develop an at-home test that works, companies like Nurx and Everlywell might be able to offer these services once more, assuming they can get their hands on the necessary testing materials. Even if those at-home testing services never see the light of day, other companies’ products might: The startup incubator YCombinator is currently offering funding to startups that are trying to address the pandemic, while Amazon has teamed up with Bill Gates’ investment arm Gates Ventures to get at-home testing to Seattle-area residents. Someone will emerge from this pandemic a hero, and one way or another they’ll be richer for it.
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