HOLIDAY HOMEWORK — By the time the Biden administration makes 500 million at-home, rapid Covid tests available to the public, we will be deep into our post-holiday hangovers. The festivities will be over, and unvaccinated Omicron patients will be filling hospital beds. And the number of tests — which adds up to not even two for every American — will barely make a dent in the country's overall testing infrastructure, especially given how quickly Omicron can spread. "It's a speck in the ocean," said Eric Topol, director of the Scripps Research Translational Institute, who estimates that the country will actually need billions of tests in order to contain Covid spread. The free Covid tests will help people make decisions about whether to gather more safely or attend school or work. Yet early studies show that an Omicron infection replicates about 70 times faster than Delta, so an infected person could show a negative test in the morning then be infectious by the time an evening party rolls around. There are "worrisome signs" that, with Omicron, a symptomatic person could initially test negative, meaning they would need to test multiple times to make sure they are not infectious, said Michael Mina, a former Harvard epidemiologist who is chief science officer at eMed, a company promoting rapid at-home testing, on a call with reporters today. The criticism about how often to test obscures bigger questions about what to do after the test, said Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Center for Health Security. "Our problems are not just about technology," she said. "It's about the absence of a strategy." Even if the administration were to blanket the country with billions of tests, there would still need to be updated guidance on how to react to test results, as well as better incentives to convince people to get tested, public health experts said. On the first point, there are glimmers that new advice is on the way. The CDC is considering cutting isolation time down from 10 days for fully vaccinated individuals who test positive for Covid but don't show symptoms. The agency endorsed a new approach last week that keeps unvaccinated kids in schools through testing. But on the second point, the country still has a long way to go. For some people, a positive test doesn't mean just missing out on a party or canceling a flight. Those who miss work and lose out on pay after a positive test or who can't follow guidelines because they have nowhere to isolate probably aren't going to get tested. Even NFL players under the league's new guidelines may not report a sore throat for fear of getting a positive test and missing a game, said Asaf Bitton, executive director of Ariadne Labs and associate professor of health care policy at Harvard. "A true pandemic response should include a way to incentivize someone to isolate," Mina said. The country continues to underinvest in public health infrastructure that would help more Americans safely quarantine with paid time off and a place to go, Bitton said. The U.S. would rather invest in equipping hospital systems with the latest technology than simpler tools that help people from getting sick in the first place, he said. "All of Covid — and this testing microcosm of Covid — show we invest in a sick care system," Bitton said. At least one big incentive for rapid, at-home tests is coming later this week when the FDA is expected to approve the first pills to treat Covid, which need to be taken early in the illness. "It is the most important thing we have seen since the vaccines to get us out of the pandemic," Topol said about the coming Covid therapies. Welcome to POLITICO Nightly. It looks like many of you spent quite a bit of time reading POLITICO journalism this year: Chartbeat's Most Engaging Stories of 2021 included three POLITICO stories in its top 10 articles — including two of the top five — that readers spent the most time interacting with over the past 12 months. Reach out with news, tips and ideas at nightly@politico.com. Or contact tonight's author at rrayasam@politico.com, or on Twitter at @RenuRayasam. A programming note: Nightly won't publish from Friday, Dec. 24 to Friday, Dec. 31. But don't fret: We'll be back and better than ever on Monday, Jan. 3.
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