An open letter to Yale Health on access to rapid tests and the end of the Public Health Emergency

When the federal public health emergency officially ends on May 11, the requirement that insurance companies cover at-home rapid antigen tests for COVID-19 will also end. We hope that Yale Health will decide to continue offering its members eight free rapid tests per month.

Access to rapid tests is an equity issue. Reducing workplace transmission from asymptomatic and pre-symptomatic people is important for everyone, but it’s especially important for people with disabilities, and caregivers, and those who live in multigenerational households with higher-risk elderly people. It’s important for low-paid workers whose jobs have to be done in person; if they get sick, they may have to take unpaid time off to comply with Yale’s COVID-19 isolation policy.

No one wants to transmit COVID to their family, friends, and community, but asymptomatic and presymptomatic people can do that unintentionally. In one outbreak investigation, seventy-five percent of transmission to non-household contacts happened when the index patients were presymptomatic. That’s why it’s so important to interrupt transmission chains by identifying COVID-19 infections early and by using risk mitigation techniques like ventilation and tight-fitting masks.

There are lots of situations in which we are advised (by CDC, FDA, and Yale) to use rapid tests:

• Use rapid tests when you’re going to an indoor event or gathering
• Use rapid tests when you have symptoms, even if mild
• Test again each day the symptoms persist if initial rapid antigen tests are negative
• Use rapid tests serially: at least two tests over three days if you are symptomatic, and at least three tests over five days if you are not symptomatic
• Use rapid tests to test out of isolation
• And for 90 days after testing positive, use rapid tests instead of PCR tests. The average number of Yale community members in this situation, in the first thirteen weeks of 2023, was 1,671 people, about 10 percent of the campus community (calculated based on data online) 

Use rapid tests in all these situations, and you’ll go through them quickly indeed. And, at the retail price of $10-$12 per test, the costs will add up fast. 

If Yale Health members lose the option of getting free rapid tests through their health insurance, they will use fewer tests. As a result, cases will get identified later (or not at all), and there will be avoidable transmission between members of the Yale community and from the Yale community to the larger New Haven community.

Yale Health can’t solve this problem for the whole country, state, or city. But Yale Health can mitigate the problem for people who get their health insurance through Yale Health, through these feasible actions:

• Continue to offer Yale Health members 8 rapid tests per month, at no cost, even after the expiration of the public health emergency
• Remove non-financial barriers to rapid test access through Yale Health, through policy changes such as more pickup locations, longer pickup hours, removing the 4-tests-per-visit limit, and standing orders (or remove the advance request requirement altogether)
• Reimburse Yale Health members who buy rapid tests at outside pharmacies for the full cost, including tax
• Educate Yale Health members about when and how to use rapid tests (including best practices for serial testing)

It’s easy to calculate the cost of the rapid tests that Yale Health has bought and distributed to members during the Public Health Emergency. It’s harder to estimate the cost savings to Yale of infections, absenteeism, and cases of Long COVID that have been avoided because of rapid tests. But if rapid tests can help Yale Health members avoid post-COVID pulmonary embolism, post-COVID myocardial infarction, post-COVID stroke, post-COVID renal failure, and post-COVID diabetes, maybe continuing investment in bulk purchase of rapid tests is actually a cost-effective move for Yale Health. Rapid tests: good for equity and good financial sense.

Please join us in asking Yale Health to continue to offer members free rapid tests, and to reduce the non-financial barriers that make it harder for members to access rapid tests through Yale Health.  

Kate Nyhan, MLS, Cushing/Whitney Medical Library

Marney White, PhD, MS, Professor, Yale School of Public Health and Yale School of Medicine

Vermetha Polite, Library Services Assistant 5, Cushing/Whitney Medical Library

Melanie Norton, Cushing/Whitney Medical Library

Bender, J. K., Brandl, M., Höhle, M., Buchholz, U., & Zeitlmann, N. (2021). Analysis of Asymptomatic and Presymptomatic Transmission in SARS-CoV-2 Outbreak, Germany, 2020. Emerging Infectious Diseases, 27(4). https://doi.org/10.3201/eid2704.204576

Bull-Otterson, L. (2022). Post–COVID Conditions Among Adult COVID-19 Survivors Aged 18–64 and ≥65 Years—United States, March 2020–November 2021. MMWR. Morbidity and Mortality Weekly Report, 71. https://doi.org/10.15585/mmwr.mm7121e1