There are key differences between PCR and antigen COVID-19 tests. Photo: Annie Spratt, Unsplash

Cincinnatians looking for free at-home COVID-19 testing kits from the federal government should make their requests soon – the feds are pausing the program at the end of this week.

On Sept. 2, the U.S. government will stop filling orders for the free COVID-19 tests that have been available to all residents since January. Residents have been able to request several tests at a time over three rounds, for a total of 16 tests. The feds launched rounds in January, March and May, with tests delivered by the U.S. Postal Service.

A note on COVID.gov reads, “Ordering through this program will be suspended on Friday, September 2 because Congress hasn’t provided additional funding to replenish the nation’s stockpile of tests.”

As of press time, the website for the free tests still works. CityBeat staff members tested the government site Aug. 29, taking just a few minutes to input a name and address to request another round of the COVID testing kits. The process was smooth and quick, and the website indicates that the order will be shipped soon.

Why the U.S. government provided free COVID-19 tests

When the government initially launched the free program at the beginning of the year, the nation’s COVID-19 cases, hospitalizations and deaths were spiking once again due to the fast-spreading Omicron variant of the coronavirus. At the time, community testing sites were crowded or closed and at-home kits largely were gone from pharmacy shelves. Ohio and Kentucky particularly had severe spikes in COVID-19 cases.

In January, Dr. Richard Lofgren, UC Health’s former president and CEO, said of Omicron, “It truly doubles the number of cases every two to three days. It’s a math problem. And though a smaller number of people require hospitalization, a small number on a large number is a very large number of individuals. We are in the process of overwhelming our healthcare systems.”

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Elected officials also were dealing with COVID, with Ohio Gov. Mike DeWine and his wife Fran both picking up the virus and Kentucky Gov. Andy Beshear’s son getting saddled with it. A number of Greater Cincinnati schools also closed earlier this year due to many educators, staff and students being out sick after spending the winter holidays indoors with others (schools largely are not requiring masks this year, despite scientific evidence that masking significantly slows the spread of COVID-19).

COVID-19 numbers climbed again this summer due to fewer safety protocols and more gatherings. Experts have said that both the Omicron and Delta variants largely were to blame.

According to the Centers for Disease Control and Prevention, “COVID-19 spreads when an infected person breathes out droplets and very small particles that contain the virus. These droplets and particles can be breathed in by other people or land on their eyes, noses, or mouth. In some circumstances, they may contaminate surfaces they touch.”

“Anyone infected with COVID-19 can spread it, even if they do NOT have symptoms,” the CDC adds.

Local COVID-19 vaccinations stall

Local vaccinations remain relatively stalled, with only 66% of the regional population having started – not completed – a vaccine series and just 31% having received a booster.

“Progress is slow across age groups,” the Health Collaborative said in its Aug. 26 report. 

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Scientists have said that getting one of the three COVID-19 vaccination series available in the United States (the two-dose Pfizer or Moderna series or the one-shot Johnson & Johnson vaccine) greatly protects people from severe illness and likely hospitalization should they be exposed to the coronavirus, including its variants like Omicron and Delta. Adding a booster provides even more protection against serious health challenges or death, experts say. And though even vaccinated people can still contract COVID-19, they are much less likely to need hospitalization. Most hospitalized COVID patients are unvaccinated, medical staff say.

COVID-19 vaccinations are available to people ages six months and older. In June, the U.S. Food & Drug Administration granted Pfizer and Moderna vaccine series with emergency use authorization for children as young as six months, including for children who already have had COVID-19. Johnson & Johnson and Novavax vaccines have emergency use authorization for people ages 18 and older. See all FDA authorizations and approvals for COVID-19 vaccines in the United States. 

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Most people are eligible for at least one booster vaccine, and many scientists say that additional COVID-19 boosters will become necessary as the virus continues to mutate. An updated booster formula that addresses new variants likely will be available in September, experts say.

Finding COVID-19 testing or vaccination resources

Local health agencies provide lists of where residents can become vaccinated from COVID-19 for free. Hamilton County Public Health and the Cincinnati Health Department both point to free vaccination sites and events.

Most local and regional health agencies, including the Health Collaborative, also provide lists of places where residents can be tested for COVID-19 or pick up a free testing kit to use at home.

At-home COVID-19 testing kits vary widely in price, depending on the retailer and type of test used. As of Aug. 30, Walgreens sells one Flowflex COVID-19 rapid antigen home test for $9.99, while a two-pack of BinaxNOW antigen rapid self-test kits costs $23.99. Target has the Flowflex test for $7.99 but also offers an EverlyWell  PCR testing kit for $102.

PCR tests and rapid antigen tests are different. According to a previous CityBeat story:

The PCR (polymerase chain reaction) test determines whether there is viral RNA in the swab or saliva sample being tested. Those tests are the ones you would encounter most often at the doctor’s office or other testing centers, and some at-home tests allow people to swab themselves and mail the samples to a lab for PCR testing. Those tests work by first converting any of the virus’s RNA in the sample into DNA. If any of the viral genetic material is present, then multiple rounds of copying short pieces of certain viral genes should produce a signal. That would be a positive test result.

Many of the at-home kits are antigen tests, which probe for certain viral proteins. Most of the rapid antigen tests look for the coronavirus’s nucleocapsid, or N protein. That protein helps package the viral RNA.

Their accuracy is different, too:

Both types of tests are accurate but have strengths and weaknesses. Because of their round robin copycatting, PCR tests are very sensitive and can pick up small amounts of viral RNA, including before a person becomes contagious. The downside is that the test can still pick up RNA debris even after people have ceased making infectious viruses, potentially making people seem contagious when they aren’t.

At-home kits (rapid antigen tests) aren’t as sensitive as the PCR tests, but “the rapid antigen tests are really great, particularly if you’re symptomatic, to determine whether you have COVID at that moment,” says Gigi Gronvall, an immunologist and senior scholar at the Johns Hopkins Center for Health Security. “They rival PCR for accuracy for that time” when people are symptomatic and most likely to be contagious to others.

Some insurers immediately cover or reimburse the cost of COVID-19 tests, while others do not.

A tool to help determine how long you need to isolate, quarantine, or take other steps to prevent spreading COVID-19 is available on the CDC’s website. However, many doctors and epidemiologists, including experts at Yale University, caution that the CDC’s current guidance for isolation may be too short to stop or slow COVID-19 transmission to others.

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This article appears in Aug 24 – Sep 6, 2022.