The Mouse That Roared: What The US Can Learn From Andorra About Covid-19 Testing

(Posted on Friday, December 18, 2020)

One country is setting the global standard for Covid-19 testing, and it isn’t the United States.

In anticipation of the winter holidays, the small European principality of Andorra has begun distributing rapid, self-administered antigen tests for Covid-19 to all residents over the age of six. These home testing kits are free, government-provided, and available to pick up at designated locations. Though allocations are limited to one per resident, more free tests will be distributed after Christmas as well.

Why is this significant? With a population of about 77,000, a landmass just 2.5 times the size of Washington DC, and both France and Spain as neighbors, at any point in the pandemic Andorra could very easily have been overwhelmed by an incoming tide of cases. While case counts did peak in October, when health authorities logged in a single month about 35 percent of their all-time 7,466 total, the surge paled in comparison to the explosive outbreaks occurring right outside their borders.

Map of Andorra

WIKIPEDIA

Testing likely had a critical role to play in driving down the spread of disease among Andorrans. The Andorran government has been on top of the latest Covid-19 testing models since April, when it ordered enough antibody tests to test its entire population twice over. The home tests being distributed this month were purchased at about $5.30 USD each from South Korea and $5.50 USD each from Abbott LaboratoriesABT—a good deal for quantities much smaller than what larger countries are buying up.

In addition to free holiday testing, Covid-19 screenings occur regularly in schools, long term care facilities, healthcare facilities, and many workplaces and local establishments, including restaurants and bars. In Andorra la Vella, the capital city that sits high in the Pyrenees, home tests are delivered to anyone older than 80 years of age. Those who would prefer not to test themselves can either seek out a mobile StopLab or one of many point-of-care facilities. As of Wednesday, local pharmacies are also authorized to sell home tests, in addition to offering on-site rapid testing for about $18 to $25 USD.

In making Covid-19 tests so widely available and encouraging residents to get tested at least once a month, the Andorran government was able to gain the upper hand over a disease that elsewhere in Europe wreaked havoc. And now that the latest tests are free, their advantage may very well carry over into the new year. Had the US government played a similarly supportive role in securing tests for its citizens, Americans might be heading into the holidays with rosier prospects. Sadly, this wasn’t and isn’t the case.

Admiral Brett Giroir, Assistant Secretary for Health at the US Department of Health and Human Services and coordinator of national Covid-19 testing efforts, gave a talk this week in which he addressed, at least in part, the many failures that have hampered Covid-19 diagnostics across the country for most of the pandemic. In addition to admitting to an utter lack of preparedness—the supply chain a “wreck” at the outset of the crisis, not to mention “nothing in the stockpile”—Giroir affirmed the importance of rapid point-of-care testing relative to PCR tests.

On the subject of PCR testing, Giroir said, “I think it has served us all poorly to create the myth that it is a gold standard.” Echoing the arguments for rapid testing that epidemiologists like Michael Mina have made for months, he added that PCR tests can be “poor predictors of contagiousness” at the population level. Since May, the number of rapid antigen tests the US has on hand has grown from 1 million to 111 million. Yet due to concerns about their sensitivity and limited access to the general public, these tests remain greatly underutilized.

The home test the Andorran government purchased from Abbott Laboratories, as a matter of fact, is probably the same one the FDA just cleared for use in the United States, along with another created by Ellume Health. Rather than being distributed among American households for free, however, they’ll be sold for about $25 to $30 USD. It’s not too late for the US government to reverse course and buy the home tests we need so direly in bulk. If Andorra shelled out just $5 a test for so small an order, the US could secure mass amounts for far less.

Correction: A previous version of the article stated that the Andorran government purchased tests from Abbott Laboratories at $4.50 USD each. The actual amount was $5.50 USD.

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Originally published on Forbes (December 18, 2020)