The Biden administration’s 97-page National Covid-19 Preparedness Plan, released this month, features a “Test to Treat” initiative that would set up “one-stop” locations for handling Covid infections. Like many of the administration’s pandemic proposals, it seems more like a publicity stunt than a well-considered or necessary plan.
Despite the plan’s length, the details of Test to Treat remain unclear. The White House says these sites “will be operational by March” at pharmacy-based clinics, community health centers, and long-term care facilities across the country. Yet none of the likely program participants—Walmart, CVS, and Walgreens have announced they will join—knows where the sites will be or what is needed to set them up.
These details are important. In his State of the Union speech, President Biden promised that if people test positive, they would “receive antiviral pills on the spot at no cost.” But antiviral pills are not recommended for everyone who tests positive. The FDA’s Emergency Use Authorizations for Pfizer’s Paxlovid and Merck’s Molnupiravir authorized the pills only for people with mild to moderate symptoms who are at high risk for progression to severe Covid-19, including hospitalization or death: that is, the elderly and those with multiple underlying medical problems. Most infected people do not qualify, either because cases of the currently dominant Omicron variant are generally mild or asymptomatic or because they are not in the vulnerable groups at risk of severe disease.
The EUAs also specify that the pills may be prescribed only by physicians, advanced-practice registered nurses, and physician assistants, not pharmacists. Such authorized prescribers are not routinely available in most of the proposed settings. The American Pharmacists Association complained that the plan is “narrow and does not enable any willing and able pharmacy to be a ‘test to treat’ pharmacy.”
These medications could be dangerous if carelessly prescribed. Paxlovid is not recommended in patients with severe kidney or liver disease and interacts with dozens of commonly prescribed medications, risking serious adverse reactions. Molnupiravir does not have known drug interactions, but it is not authorized for use in persons under the age of 18 or during pregnancy because it has potential to affect bone and cartilage growth or cause genetic mutations. The plan provides no details on who, if anyone, will check if certain patients qualify for treatment, determine what their medicines and potential drug interactions are, and balance the risks and benefits of prescribing either of the authorized pills.
In any case, why is such an initiative needed now? Covid-19 cases and hospitalizations haven fallen precipitously from their mid-January peaks to levels approaching the lows of the pandemic. Perhaps Test to Treat would have been a good idea several months ago, but now it seems unnecessary. And even though the administration has touted the millions of orders placed for Paxlovid, which is far more effective than Molnupiravir, adequate supplies of the drug will not arrive for months.
The cynical and likely answer to the proposal’s timing is that the administration wants to demonstrate that it is doing something. But the solution to every problem, real or imagined, isn’t government programs and spending. With the exception of the public-private partnerships in Operation Warp Speed that generated new vaccines and therapeutics in record time, studies of the pandemic have shown that most government measures, including the severest lockdowns, had little effect. Individual responses to avoid and mitigate the risks and costs of infectious disease were far more important.
There is no point in requesting and spending billions of dollars on Test to Treat, especially when tens of billions of dollars out of the $5 trillion already appropriated to fight Covid remain unaccounted for and unspent. Instead, the administration should cease micromanaging the production and distribution of existing treatments and encourage innovation for new treatments so that, if a new surge of Covid cases occurs, people can obtain tests and medicines from authorized providers.
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