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Why rapid tests for COVID-19 may not return to state testing sites in Utah

State epidemiologist says tests may not fit in state’s post-pandemic plans

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Emilia Lewis, 17, gets a COVID-19 test at the Cannon Health Building in Salt Lake City on Dec. 15, 2021.

Emilia Lewis, 17, gets a COVID-19 test at the Cannon Health Building in Salt Lake City on Dec. 15, 2021.

Laura Seitz, Deseret News

The pause on rapid COVID-19 tests conducted by the Utah Department of Health could turn out to be permanent.

“I don’t think there’s a guarantee for anything. I think we need to figure out what we can do. Right now, it’s actually very hard to get the antigen tests,” state epidemiologist Dr. Leisha Nolen said Monday, the day after a temporary halt on rapid antigen testing was announced at state-run sites due to questionable results.

At a news conference Sunday, she said out of every 100 people who were confirmed positive for COVID-19 through a lab-processed PCR test, only 38% tested positive on the GenBody rapid antigen test used since late last year, a much higher rate for false negatives than expected.

Even among those with symptoms that clearly indicated they were infected COVID-19, the rapid antigen test identified only 41% as having the virus, Nolen said. The state health department said test results for nearly 18,000 Utahns who took both types of tests on the same day were analyzed after concerns were raised last week.

“We were really concerned by those numbers and we certainly want to evaluate why this is happening. We prefer to do this pause rather than give out inaccurate information,” she said, and will work to determine if the issue is with the test or how it is being administered.

Nolen said Monday while the announcement was not part of the state health department’s plans to transition from treating COVID-19 as a pandemic disease, “it’s something that makes us think a lot more about how we get there. It might change the path we go along.”

That could mean relying on home test kits for rapid results, she said, rather than resuming antigen testing at state sites run by the state health department as well as contractors. New mass testing sites opened at the University of Utah and at Utah Valley University already offer only PCR tests. Results for PCR tests usually take at least 24 hours.

“We need to see what we can get and what we can supply for people,” Nolen said. “But also, we do want to think about what is the longer-term plan. How do we get to something where people can go back to their normal lives and we can have health care occurring where we’re used to it.”

The state switched to using GenBody rapid antigen tests when the preferred brand, BinaxNOW, ran out, Nolen said. The price tag was more than $5 million — $5.65 for 900,000 GenBody rapid antigen tests, paid for with federal COVID-19 relief funds, state health department spokesman Tom Hudachko said.

So far, only two other states, Texas and Kansas, are also using the same rapid antigen tests, which are authorized by the federal Food and Drug Administration, Nolen said, but had not analyzed their data. She said the state health department is also talking with the FDA and GenBody.

Unlike Utah, Nolen said most states either never offered rapid testing or have already shifted exclusively to PCR tests.

“We are talking to a number of states to see how they transitioned to that kind of approach, trying to consider what worked for them, what didn’t work for them, so that we can consider it here,” she said. “So I think the reason why we’re unusual is because we actually have been offering this. Most other states are not.”

Test sites run by the state were so overwhelmed last month as the incredibly transmissible omicron variant surged through Utah that Gov. Spencer Cox and other state officials, including Nolen, urged most Utahns with COVID-19 symptoms to skip testing and isolate at home.

Nolen said omicron has lessened the value for testing.

Before omicron, “a test was really valuable because infection was not super common. So we couldn’t say it was likely you had an infection. During omicron, it’s just been so likely that anybody who has symptoms has omicron that it almost decreases the need for a test,” she said.

COVID-19 tests “are good when we can weed out the few. But when so many are positive, it’s not as important,” Nolen said. “We can just say you are infected because you are currently a resident of Utah and infection is so likely. As we go forward, we’re going to have to reevaluate that, because omicron is going away.”

Testing for COVID-19 may end up being replaced by what she called the “influenza approach. You should be a person who can evaluate your own status and decide, ‘OK, am I sick? I should not go expose other people. Am I sick enough I need to see a doctor? Can I use this home test I got from one of the pharmacies?’”

Other states are already headed in that direction, Nolen said, treating the virus as endemic — still a threat, but not as widespread. She said she believes omicron has peaked in Utah, but it’s far from certain there won’t be another variant to take its place.

“I’m hopeful that now we have enough immunity in our community either because of the vaccine or because of people’s previous infections that even with some newer variant, it won’t be the extreme that we saw when all of us were vulnerable,” she said. “But this virus could throw us a curveball.”

COVID-19 case counts are dropping in Utah, but with people being discouraged from testing, they’re no longer seen as an accurate reflection of infections in the state. Nolen said she’s looking at other markers, including ER visits and wastewater samples, although hospitalizations and deaths remain high.

“I think we need to plan for both options. We can sort of move towards the endemic state but have a backup plan of what happens if something comes along that is going to restart it all again,” she said, adding any move will be gradual, including a decision about restoring rapid testing.

“It won’t be an abrupt thing,” Nolen said. “We’ll be definitely talking about it in the next few weeks and see how things go.”