Vermonters have shoved a lot of swabs up their noses in the two years since the Covid-19 pandemic began.
Vermont has logged about 3.6 million Covid tests, according to data from the state Department of Health, amounting to nearly six tests for every person in the state.
And that figure includes only PCR tests, the bulk of which were conducted at state-run testing sites. Vermonters have taken countless other take-home antigen tests in the roughly six months since they became widely available.
Corey is one Vermonter who has taken full advantage of state-run testing. As an immunocompromised person, she avoids indoor gatherings and wears an N95 mask when she shops for her groceries.
But her partner can’t avoid meeting people at his public-facing job, so she gets tested for Covid often — sometimes twice a week.
“It’s ebb and flow based on what’s happening,” said Corey, who asked not to use her last name in order to discuss private health information. “During the Omicron surge initially, in the winter, that’s when I started testing more frequently.”
Corey was disheartened by the news that Vermont plans to wind down its state-run testing sites next month. Announcing the change last week, Health Commissioner Mark Levine said pharmacies and health care providers would be able to meet the state’s testing needs.
“We are fortunate that home testing supplies are widely available, and we are committed to this remaining as convenient and free as it is now,” Levine said.
For Corey, the shift means that she will have to switch to antigen tests, which she’s worried will be less sensitive at picking up illness. She thinks she’s not the only one who will miss PCR testing: Her preferred site in Burlington still has a line every time she goes.
Experts and public health practitioners are also worried about the loss of convenient state testing sites.
“I understand that this has been a really probably expensive, time-consuming effort to have the state-run sites,” said Cassandra Pierre, an epidemiologist at Boston Medical Center. “However, there was a clear benefit in terms of people being able to get their vaccines (and) people being able to get their tests to forestall additional infections.”
Jumping through hoops
Three main types of Covid-19 tests are available to the public: PCR tests, LAMP tests and antigen tests.
PCR tests are administered and collected by a health professional and sent to a testing lab. They are considered very accurate, but can take days to return results. They are still sometimes required for international travel or other purposes.
The rate of PCR testing peaked in mid-January, the height of the Omicron surge, with over 10,000 tests per day, according to the health department. About 3,500 PCR tests have been performed per day in recent weeks.
LAMP tests are similar to PCRs, but can be performed at home and return results within a few hours.
Antigen tests use a different mechanism to detect Covid, one that experts caution is less sensitive, although still broadly accurate for most uses. Antigen tests can be self-administered at home and take a few minutes to return results.
State-run testing sites in Vermont relied on PCR testing until March, when sites ramped up distribution of LAMP and antigen tests for people to take home. Antigen tests are also available at many pharmacies throughout the state.
PCR testing is harder to find outside of state-run sites. Only 12 Kinney Drugs locations in Vermont provide PCR testing. CVS Pharmacies, a testing provider in 45 states, does not offer any on-site testing in Vermont.
Ben Truman, a spokesperson for the health department, said via email there was no comprehensive resource for PCR testing availability. “Vermonters seeking a PCR test will need to check with their health care provider or local pharmacies,” he wrote.
Emanuela Taioli, an epidemiologist and population health researcher at Mount Sinai Medical Center in New York City, said that PCR tests can sometimes be necessary at times when antigen tests aren’t sensitive enough to detect Covid’s presence.
“The rapid test is more likely to be negative just because there's not enough virus. So you need to do a PCR, which is way more sensitive,” she said.
Taioli recently encountered that problem herself: After testing negative on antigen tests three times, she finally tested positive via PCR.
But her central concern about cutting back state-run testing sites is that disadvantaged communities, particularly people with low incomes, would have a harder time finding and affording any type of test.
Taioli’s research showed that in the first months of the pandemic in New York City, people of higher socioeconomic status were more likely to get tested.
Those in white, higher-income neighborhoods “will go and get tested as a preventive measure,” she said, while those in less affluent areas, or areas with more people of color, “will go and test probably just when they have symptoms, essentially.”
That’s because health providers and pharmacies were more concentrated in higher-income communities, she said. The cost of testing and the lack of weekend hours could also present barriers — which she said could persist with the new antigen test-based strategy in Vermont.
Health insurers in Vermont are required to cover eight antigen tests per month, Levine said. People who cannot afford antigen tests, such as uninsured people, can call local free clinics or federally qualified health centers to get tested.
But several Vermonters told VTDigger that their insurers required them to pay upfront for tests, then fill out a form for reimbursement. Kelly Adams of Essex Junction said via email that it took her insurer — Cigna, based in Massachusetts — more than two months to pay her back for the antigen tests she needed for her family in mid-February.
“Money floating out there for a couple months is not a hardship for us … but I am concerned that it would be for many,” she wrote.
The U.S. Congress also failed to pass funding for Covid testing, vaccination and treatment for uninsured people in March, and the Vermont government has not yet announced any plans to step in and cover that gap.
Anne Sosin, a health equity researcher at Dartmouth College, pointed out that pharmacies and health care providers can be distant from many rural communities in Vermont. She lives in Thetford, but the closest PCR testing location available to her after state-run sites close will be in Bradford, about 17 miles away.
Policymakers should be asking, “how do we increase access, particularly in our rural communities where we don't have the same health care infrastructure in place?” she said.
Sosin said testing is particularly important as a gateway to treatment options, such as the antiviral medication Paxlovid, which prevents severe Covid complications in high-risk people. Health officials recommend that people who qualify for the medication start treatment as early as possible.
“We can't send our highest-risk, least-resourced Vermonters on an expedition to find the resources that they need to protect themselves,” Sosin said.
She said that if Vermont dismantles its testing infrastructure, “it's not that people are going to go through their insurance or jump through other hoops. It's that they're going to simply stop testing entirely.”
Individual responsibility
Since the initial Omicron surge waned in mid-February, Vermont officials have taken steps to peel back Covid restrictions and policies, while increasingly framing the future of Covid around individual decision-making.
In March, the Vermont government ended its indoor mask recommendation and struck guidance that schools should require masking. The health department changed its masking guidance to state that “each person can decide if they want to take precautions” based on their individual risk.
Later that month, Levine said Vermont would wind down Covid vaccination clinics, instead directing Vermonters to pharmacies and health care providers’ offices.
Earlier this month, Levine announced that the health department would phase 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 health care providers.
But those providers may not be ready to take up the mantle of Covid care for Vermonters, according to Pierre, the Boston Medical Center epidemiologist.
“Many places have been so reliant on state-run facilities for testing and for vaccinations,” she said. “There hasn't been a corresponding ramp-up of those kinds of resources at primary care sites.”
Sosin said the loss of PCR testing data from state-run sites could also affect Vermont’s Covid data, since the health department has previously relied mainly on PCR test results.
“Testing is what gives us the data to inform individual and community-level decision making,” she said. “If we want to individualize public health decision making, then we need to empower people with good data and guidance.”
Taoili said testing benefits not only individual Vermonters, but helps to limit community transmission in general.
“Not being tested is a problem for transmission because people just go around and infect other people without knowing,” she said. “And it's also a problem for creating variants because the more infection there is, the more likely we are to have variants that we cannot control.”
Corey, the frequent PCR test recipient, said she feels left behind by the loosened guidelines and the lack of strong messaging about viral levels, which remain high.
“Don't just act like we're just sailing through, because that's the message that's getting through,” she said. “That's what I see in public: that people are freewheeling it, like nothing's going on. Like we’re over it.”
