Vermonters have swabbed their noses a lot in the two years since the Covid-19 pandemic began.
Vermont has logged about 3.6 million Covid tests, the equivalent of nearly six tests for every person in the state, according to the Health Department.
And that number only includes PCR testing, the majority of which was done at government testing sites. Vermonters have made countless other take-home antigen tests in the roughly six months since they became widely available.
Corey is a Vermonter who has taken full advantage of state testing. As an immunocompromised person, she avoids indoor gatherings and wears an N95 mask when shopping for her groceries.
But her partner can’t avoid meeting people at his public job, so she’s often tested for Covid – sometimes twice a week.
“It’s up and down depending on what happens,” said Corey, who asked not to use her last name to discuss private health information. “During the Omicron surge earlier this winter, I started testing more frequently.”
Corey was disheartened by the news that Vermont plans to close its state testing sites next month. In announcing the change last week, Health Commissioner Mark Levine said pharmacies and healthcare providers would be able to meet the state’s testing needs.
“We’re fortunate that home testing supplies are widely available, and we’re committed to keeping this as convenient and free as it is now,” Levine said.
For Corey, the postponement means she’ll have to switch to antigen testing, which she fears will make her less susceptible to disease. She thinks she’s not the only one who’ll miss PCR tests: her favorite Burlington location still has a queue every time she goes.
Public health experts and practitioners are also concerned about the loss of convenient government testing sites.
“I understand that this was a very likely expensive and time-consuming attempt to have the state websites,” said Cassandra Pierre, an epidemiologist at Boston Medical Center. “However, there was a clear advantage in terms of people being able to get their vaccines (and) people getting their tests to prevent additional infections.”
Jump through hoops
Three main types of Covid-19 tests are available to the public: PCR tests, LAMP tests and antigen tests.
PCR tests are performed and collected by healthcare professionals and sent to a testing laboratory. They are considered very accurate, but it can take days for results to be returned. They are still sometimes required for international travel or other purposes.
The rate of PCR testing peaked at over 10,000 tests a day in mid-January, the peak of the omicron surge, according to the health ministry. Around 3,500 PCR tests have been carried out every day for the past few weeks.
LAMP tests are similar to PCRs, but can be performed at home and provide results within a few hours.
Antigen testing uses a different mechanism to detect Covid, which experts warn is less sensitive, although still largely accurate for most uses. Antigen tests can be done at home and take a few minutes to give results.
State-run testing sites in Vermont relied on PCR testing until March, when agencies ramped up distribution of LAMP and antigen tests for people to take home. Antigen tests are also available at many pharmacies across the state.
PCR tests are harder to find outside of government agencies. Only 12 Kinney Drugs locations in Vermont offer PCR testing. CVS Pharmacies, a 45-state testing provider, does not offer on-site testing in Vermont.
Ben Truman, a spokesman for the Department of Health, said via email there was no comprehensive resource on the availability of PCR tests. “Vermonters seeking a PCR test must check with their doctor or local pharmacies,” he wrote.
Emanuela Taioli, an epidemiologist and population health researcher at Mount Sinai Medical Center in New York City, said PCR testing can sometimes be necessary when antigen tests are not sensitive enough to detect the presence of Covid.
“The rapid test tends to be negative just because there aren’t enough viruses. So you have to do a PCR, which is much more sensitive,” she said.
Taioli recently encountered this problem herself: After testing negative on antigen tests three times, she finally tested positive via PCR.
But their key concern in reducing government testing sites is that disadvantaged communities, particularly those on low incomes, would have a harder time finding and affording any type of test.
Taioli’s research showed that people of higher socioeconomic status were more likely to be tested in New York City in the early months of the pandemic.
Those in higher-income white neighborhoods “will get preventive testing,” she said, while those in less affluent areas or areas with more people of color “will likely only test if they have symptoms.” essentially.”
That’s because healthcare providers and pharmacies are more concentrated in higher-income communities, she said. Testing costs and a lack of weekend hours could also present obstacles — which they say may remain with Vermont’s new antigen-testing-based strategy.
Health insurers in Vermont are required to cover eight antigen tests per month, Levine said. Individuals who cannot afford antigen testing, such as B. Uninsured individuals can call local free clinics or government-qualified health centers to get tested.
But several Vermonters told VTDigger that their insurers required them to prepay for the tests and then fill out a reimbursement form. Essex Junction’s Kelly Adams said via email that it took her insurer — Massachusetts-based Cigna — more than two months to pay her back for the antigen testing she needed for her family in mid-February.
“Money hanging out there for a few months is not a necessity for us… but I worry it would be for many,” she wrote.
The US Congress also failed to approve funding for Covid testing, vaccination and treatment for the uninsured in March, and the Vermont government has not yet announced plans to step in and fill the gap.
Anne Sosin, a health equity researcher at Dartmouth College, pointed out that pharmacies and health care providers can be remote from many rural Vermont communities. She lives in Thetford, but the closest site for PCR testing available to her after state sites close will be in Bradford, about 17 miles away.
Policymakers should ask themselves, “How can we improve access, particularly in our rural communities where we don’t have the same healthcare infrastructure?” she said.
Sosin said testing is particularly important in providing access to treatment options such as the antiviral drug Paxlovid, which prevents serious Covid complications in people at high risk. Health officials recommend that people who qualify for the drug start treatment as early as possible.
“We can’t send our highest-risk, least-resourced Vermonters on an expedition to find the resources they need to protect themselves,” Sosin said.
She said that when Vermont dismantles its testing infrastructure, “it’s not like people are going to run through their insurance or jump through other hurdles. It’s like they’re just going to stop testing altogether.”
Individual responsibility
Since the initial omicron surge subsided in mid-February, Vermont officials have taken steps to lift Covid restrictions and guidelines as they increasingly focus the future of Covid on individual decision-making.
In March, the Vermont government ended its recommendation for indoor masks and issued guidance that schools should make masks mandatory. The health department changed its masking policy so that “each person can decide whether they want to take precautions based on their individual risk.”
Later that month, Levine said Vermont would close Covid vaccination clinics and instead direct Vermonters to pharmacies and health-care provider offices.
Earlier this month, Levine announced the health department would be phasing out its daily Covid dashboard in favor of a new weekly surveillance report. Now, as with vaccination clinics, Vermont plans to shift Covid testing away from the state and toward a network of healthcare providers.
But those providers may not be ready to take on the mantle of Covid care for Vermonters, according to Boston Medical Center epidemiologist Pierre.
“A lot of places have been so reliant on government agencies for testing and vaccination,” she said. “There has not been a corresponding increase in these types of resources at primary care sites.”
Sosin said the loss of PCR test data from state sites could also affect Vermont’s Covid data, as the health department has historically relied primarily on PCR test results.
“Testing gives us the data to make decisions on an individual and community level,” she said. “If we’re going to individualize public health decision-making, we need to empower people with good data and guidance.”
Taoili said testing not only benefits individual Vermonters, but also helps limit community transmission more generally.
“Not getting tested is a problem for transmission because people just go around infecting other people without knowing it,” she said. “And it’s also a problem for variant creation because the more infections there are, the more likely we are to have variants that we can’t control.”
Corey, the frequent recipient of PCR tests, said she felt left behind by the relaxed guidelines and the lack of a strong message about the still high levels of the virus.
“Don’t pretend we’re just sailing through because that’s the message that’s coming through,” she said. “That’s what I see in public: that people let it roam free like nothing’s going on. Like we’re over it.”
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