Eric Adams believes the future of COVID-19 testing is on four wheels, even if it comes at the expense of the city’s free PCR sites. At a press conference last week, the mayor claimed the city’s COVID-19 testing programs were expanding, despite the reported reduction of existing “brick-and-mortar” locations listed on the NYC Health + Hospitals website.

“We’re leading the country on how to respond to COVID,” said Adams. “Our home testing has prevented people from coming to the hospital, coming to their office or school sick. We are now using mobile units where once we test you, we’re giving you the medicine right there, so you can go home.”

Last month, the mayor announced a fleet of 30 “Test to Treat” vans would soon hit New York City streets. First of its kind, the pilot program recently rolled out and sites can be tracked down on the city’s online test finder. The mobile units offer free rapid antigen testing, no insurance required—if the result is positive, the person is directed to onboard clinicians for immediate treatments such as a prescription to COVID-19 “miracle drug” Paxlovid from a nearby pharmacy. According to Dr. Nathaniel Hafer, an assistant professor of molecular medicine at University of Massachusetts Chan Medical School, the quick turnaround time from rapid testing is essential when administering the pill.

“One of the key things about [Paxlovid]: to be most effective, it needs to be given quickly to the individual,” said Hafer. “If it’s not started within the first couple days of the infection, it actually shows much lower efficacy. So that’s why having this quick loop where you can get tested and get your meds and get them started right away, is so important.”

For high-risk patients, quick results and immediate treatment can be life-saving, especially with the recent emergence of Omicron subvariant BA.5. But the arrival of mobile sites spell uncertainty over the future of free PCR testing, as the vans’ introduction coincides with the closures of multiple city lab sites, according to The Gothamist. Officials credit the distribution of at-home kits. But antigen tests, whether self-administered or conducted at a site, cannot offer the accuracy of a PCR, which typically identifies a positive infection two days earlier at the cost of a longer wait time.

“The PCR test amplifies the genetic material in the sample,” said Hafer. “It’s looking to detect and amplify the SARS-CoV-2 genetic material. And because there’s an amplification step, it is extremely sensitive—it can measure really, really small amounts of genetic material. And so that’s why you hear it known as ‘the gold standard.’”

And the decrease in PCR testing makes it difficult to determine accurate infection numbers across the five boroughs.

“PCR tests, because they require a certain amount of technology, are all reportable,” said Dr. Edward Telzak, St. Barnabas Hospital’s Department Chair of Medicine. “The vast majority of rapid tests do not get reported. Keeping track of what’s going on and individual communities and counties and cities, and nationwide, it’s now much harder to do that because of the swing towards rapid tests and mostly home tests.”

The shift from PCR to antigen will also likely save the city a big chunk of cash. PCR tests require expensive lab equipment, and each kit costs between $100-150. According to Hafer, most antigen tests cost roughly a tenth of that. Beyond that, training is more expensive since the technology used in a PCR is significantly more advanced.

And uninsured New Yorkers shouldn’t count on third-party testing booths like LabQ or LabWorq to shoulder the costs. If the hastily-applied duct tape over the word “free” in “free PCR test” doesn’t give it away, the nose-swabbing will no longer be on the house in many cases. In fact, it never was, but for many tents, the cost will now be passed along to New Yorkers and their insurance companies.

Still, Telzak believes the city is moving in the right direction.

“I think PCR tests still need to be available,” he said. “But I think there’s [a] general swing from PCR to antigen tests as we’re seeking to go back to a more normal world. [It’s] probably the right way to go.”

So how can New Yorkers ensure more accurate results as PCR testing becomes more rare in the Big Apple? Turns out many at-home kits come in pairs not as a “buy-one-get-one free” promotion or to share with a friend like a Twix candy bar but rather to help ensure correct results.

“When you test two times within 24 to 48 hours between each test, the results of those two tests in combination can give you an accuracy that’s on par with a PCR test,” said Hafer. “The important thing is for people [when] they take that first test and they don’t see it being positive, say they have symptoms, wait a day or two and take that test again.”

Tandy Lau is a Report for America corps member and writes about public safety for the Amsterdam News. Your donation to match our RFA grant helps keep him writing stories like this one; please consider making a tax-deductible gift today by visiting: https://tinyurl.com/fcszwj8w

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