WASHINGTON – The country’s coronavirus testing capacity, already strained to meet demand, faces enormous new pressure, with holidaymakers lining up to be tested, overworked labs struggling to keep up and rapid home diagnostics flying off drugstore shelves as the Omicron variant fuels a rapid spike in Covid-19 cases.

Two years after the start of the pandemic, the growing desire for testing in the face of limited supply threatens to thwart President Biden’s response, but this is not a new issue. The United States has failed testing since the start of the pandemic, experts say, and matching supply with demand has been a persistent challenge for the Trump and Biden administrations.

Mr Biden took office promising to make testing for the virus cheap and easily accessible, and there have been some improvements since taking the oath. Lab tests are now more plentiful and more than a dozen home tests are available, up to zero in January. The Food and Drug Administration has sped up its approval process, and the supply of home testing has increased steadily since August; last month it was expected to double by March.

But the United States remains far from Europe, where more than three dozen types of home tests are available for as little as $ 1 to $ 2 per test. Americans can pay up to $ 25 for a box of two, and Mr. Biden’s plan to have insurers reimbursed those purchases won’t take effect until mid-January at the earliest.

In Miami, cars lined up bumper to bumper this week at a drive-thru test site. In Providence, RI, there were no testing appointments available at a local CVS; those looking to be tested were advised to purchase over-the-counter home tests.

In Brooklyn, people lined up for two hours on Thursday to be tested at a Park Slope medical clinic. New York State, one of the pandemic’s earliest epicenters, recorded 21,027 positive coronavirus cases on Friday, the highest number reported in a single day during the entire pandemic.

Across the country, retailers – both online and physical – are struggling to keep over-the-counter tests in stock. Walmart was selling Abbott’s rapid antigen test online on Friday, but many stores in Washington, DC and its suburbs of Maryland and Virginia were sold out. In Houston, local Walgreens pharmacist Hanh Ho said home test shipments arrive every Wednesday and sell out the same day.

“They’re a hot item,” Mr. Ho said. “A guy came in and took them all. “

Part of the difference between the United States and Europe is their different healthcare systems, but also stems from a crucial decision the Biden administration made months ago: not to subsidize testing of the same. way it subsidizes vaccines. Some Western countries decided early on to shoulder much, if not all, of the costs of testing, securing demand and, some say, lowering prices through purchase agreements with major manufacturers.

The White House Biden only recently – in back-to-back announcements in September and October – pledged to spend a total of $ 3 billion to buy tests. More than half was spent on over-the-counter tests, senior administration officials said.

“It’s been a terrible situation since day one of the pandemic, and I would say it’s still sloppy,” said Eric Topol, professor of molecular medicine at Scripps Research. “We should have a wide range of rapid tests available for free,” as in Britain, Israel and some other countries, he added.

Earlier this month, Mr Biden announced that home tests would be reimbursed by insurers for the 150 million Americans who have private insurance, and that the administration would distribute 25 million more tests to health centers. community and rural clinics, which tend to treat low-income patients.

But the announcement sparked immediate complaints from public health experts, including Dr Topol, who objected to people going through the reimbursement claim process. Dr Topol said the idea that consumers would consistently incur such costs in the hope of reimbursement was “a no-starter.”

White House officials say they are working to further expand home test production, which in turn would create competition in the market and, presumably, lower costs. Demand is only expected to increase after the Centers for Disease Control and Prevention on Friday approved a new approach to allow children exposed to the coronavirus to stay in school, testing at least twice in a week, at instead of forcing them to quarantine.

“We continue to do everything possible to continue to increase this supply,” Carole Johnson, testing coordinator for the White House Coronavirus Response Team, said on Friday.

The testing surge received a boost on Friday when a federal appeals court reinstated the Biden administration’s rule requiring many companies to require their workers to be vaccinated against the coronavirus or to undergo weekly tests.

During any infectious disease outbreak, there are two main reasons to use testing, according to experts: to determine if someone is infected and to protect others from infection. To diagnose Covid, doctors typically rely on polymerase chain reaction, or PCR, tests, which are very sensitive tests that are done in the lab.

But with the rapid spread of Omicron, experts predict an increase in demand for rapid antigen testing, the rapid over-the-counter version, which many people use for peace of mind.

During a White House briefing on Friday, CDC director Dr Rochelle Walensky advised people to “take a test and make sure you are negative before mixing and congregating in different households.” during the holidays, “for that extra insurance.”

Solace is what Stan Smith, 67, was looking for at a busy test site in Orlando, Florida on Friday. He said he had no symptoms and was vaccinated, but had already waited almost 90 minutes for a test.

“We have to look out for each other,” he said. “I don’t know if I’m going to be around someone who could infect me, but I don’t want to be that person either. Christmas is only a week away.

Mara Aspinall, an Arizona State University biomedical diagnostics expert who tracks testing capacity, predicted that in January the United States will produce a total of 613 million coronavirus tests, including 243 million rapid tests for the coronavirus. antigen, those sold over the counter.

“If Omicron continues to spread as fast as it looks, we will be very challenged on any reasonable number of tests, especially the pre-collection prophylactic tests,” she said, “and it is a huge concern. “

Test makers report that demand is booming even for the most expensive tests.

Detect executives recently received clearance from the FDA to market a new type of home molecular test, which its developers say is as sensitive – but not as expensive – as PCR tests, generally considered the standard for reference for the detection of a coronavirus infection. Their work was funded by the National Institutes of Health.

The price is steep: $ 49 per test, plus $ 39 for a reusable “hub” that is used to run the tests. But when Detect started selling the tests online this week, demand was so high that company officials said they would more than likely start cutting back on the number of test kits a person can order from. four to two.

“We haven’t done any advertising of any kind,” company chief executive Hugo Barra said in an interview on Friday. He said the company intends to increase production so that the cost of testing goes down.

Dr Ezekiel Emanuel, a bioethicist at the University of Pennsylvania who advised Mr Biden during his transition, said the administration would just have to buy over-the-counter tests and distribute them to pharmacies, where they could be sold cheaply. or even given.

“If you had a centralized government purchasing, you could lower the prices, which is very important,” he said.

For now, the high cost of home testing is a huge obstacle; in some states, including Massachusetts and Colorado, authorities distribute them free of charge. Still, some consumers have expressed unease with home tests, fearing they may not be as reliable as PCR tests.

“I would be more comfortable leaving this to the professionals rather than myself,” said Fortune Maduba, 23, a grocery store worker in Houston who was preparing to travel to Nigeria.

On Friday in Providence, Silvi Goldstein, 28 and a graduate student at the University of Rhode Island, was waiting to be tested at a state-run site outside the Rhode Island Convention Center. Staff at the testing site said the labs were overwhelmed and Ms Goldstein said she expected to wait 72 hours for her results, three times longer than she had to wait during the test. summer.

“I have considered home tests – they are expensive,” Ms. Goldstein said.

According to a report released this month by the Coronavirus Resource Center at Johns Hopkins University, the United States has both the highest per capita testing rate in the world and the worst outbreak of Covid-19. The more severe the outbreak, the more testing is needed, the center said, but experts disagree on the rate of testing sufficient.

The rate of testing varies widely from state to state, and not always in tandem with the threat of the coronavirus. For example, Massachusetts’ test rate is about three times that of Michigan, even though Michigan’s rate of positive tests is three times that of Massachusetts. Demand for testing fell in many places after vaccination became widely available.

“We got it up and running, and then everyone kind of relaxed because of the vaccine and said, ‘We’re not really going to need that stuff,'” he said. Dr Emanuel. “And the problem is, it’s not true.”

The report was provided by Maria Jiménez Moya from Houston, Ben Berke from Providence, RI, Eric Adelson from Orlando, Florida, and Grace Gorenflo from Seattle.