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In bipartisan compact, constellation of states bet on antigen tests for asymptomatic COVID-19 screening

Antigen tests are at the center of a plan to screen asymptomatic people for COVID-19 under a compact launched by seven U.S. states and The Rockefeller Foundation to fill holes left by the federal government’s response.

The question is whether the rapid point-of-care technology, which is so far authorized only for use in individuals suspected of having COVID-19, will strike the right balance of speed, accessibility and reliability for use in asymptomatic populations. Early reports have suggested antigen tests, which detect viral proteins within 15 minutes, are less sensitive than molecular tests that detect viral RNA (see “A Test for the Utility of Antigen Testing”).

The compact -- which initially included the Democratic governors of Louisiana, Michigan and Virginia and the Republican governors of Maryland, Massachusetts and Ohio -- is in discussions with Becton Dickinson and Co. (NYSE:BDX) and Quidel Corp. (NASDAQ:QDEL) to purchase 500,000 antigen tests per state, for a total of 3 million. North Carolina, the governor of which is a Democrat, joined the compact subsequently.

In an announcement Tuesday, The Rockefeller Foundation said the states would ramp up use of antigen testing to help detect outbreaks more quickly and expand long-term testing in schools, workplaces and nursing homes. The states in the cooperative purchasing agreement also pledged to coordinate on policies and protocols related to rapid antigen testing.

The Rockefeller Foundation, which first released a national COVID-19 testing action plan in April and an update report in July, said it “stands ready to assist in facilitating financing mechanisms to support this large-scale interstate testing compact.”

In its July report, the foundation advocated for a paradigm shift that differentiates screening tests from diagnostic testing, and said the former “must value speed over sensitivity and be conducted frequently,” adding that “achieving high frequency of testing requires a massive increase in test availability, ease of administration, and a significant decrease in per test costs.”

Antigen tests cost less than standard molecular tests, and avoid the lags in turnaround time plaguing centralized labs by delivering results at the point-of-care.

HHS has also highlighted rapid antigen testing as a key part of its federal testing strategy. On July 14, the agency announced it would distribute rapid, point-of-care antigen tests from BD and Quidel to nursing homes in hot-spot areas (see “NIH, HHS Fast-Tracking Point-of-Care, Pooled Tech”).

BD and Quidel are the only two companies with Emergency Use Authorization from FDA for COVID-19 antigen tests. On July 24, the agency gave its first EUA for COVID-19 screening of asymptomatic individuals to a molecular test from Laboratory Corp. of America Holdings (NYSE:LH); a prescription is still required to obtain the test.

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