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Covid or a summer cold? Without free tests, many will not know.

The United States is experiencing an increase in coronavirus transmission for the first time since the public health emergency ended in May, exposing the challenges of avoiding the virus when free testing is no longer widely available.

The Biden administration stopped sending test kits to households in June. The ones Americans have saved for the past year and a half are running out. Large insurers no longer pay for self-care tests once the obligation to do so has ended with the emergency declaration.

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As a result, those still incorporating covid into their daily lives are weighing whether it’s worth about $12 to test for every sniffle and scratchy throat and visit to grandma. The costs add up quickly for larger families and for people who have contracted covid with the intent to protect others by following federal guidelines for repeated testing to end isolation and masking.

This new testing landscape is one of the strongest examples of living in a society that treats covid like any other endemic respiratory virus. In a country with widespread immunity, most covid infections are mild with greater danger to the elderly and severely weakened immunity.

“We will continue to see people hospitalized for covid for illnesses that could have been prevented had testing been free and widely available,” said William Schaffner, a medical professor who specializes in infectious diseases at Vanderbilt University Medical Center.

The coronavirus is on the rise with multiple measures — but it’s not raising alarm among public health officials.

The Centers for Disease Control and Prevention recorded 8,000 COVID-19 hospitalizations in the week ending July 22, a 12 percent increase from the week before. But that’s well below the nearly 45,000 admissions recorded the same week a year ago. The percentage of emergency room patients diagnosed with covid-19 rose gradually in July, but is less than a fifth of the year ago. Experts believe there is likely to be an increase in mild cases of coronavirus outside of healthcare as well.

“It’s not increasing so fast that it’s alarming and nothing strange is starting to happen that’s making people sicker,” said Lori T. Freeman, executive director of the National Association of County and City Health Officials.

Fluctuations in covid activity are expected, especially during the summer – a time for holidays and large gatherings such as weddings and conferences.

Some people, regardless of their personal risk level, want to know if symptoms indistinguishable from a cold or allergies are actually Covid-related so they can avoid infecting the vulnerable.

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In mid-July, Mark Camenzind tested positive with his last over-the-counter test in his stash after hanging out with a friend who had contracted the virus. He had a vacation to the Pacific Northwest coming up, but wanted to test negative twice, 48 hours apart, as recommended by the Centers for Disease Control and Prevention, before going maskless.

But finding free tests in Lawrence, Kan., was challenging and his insurer no longer covered retail purchases.

After posting on a local Reddit forum, Camenzind found a pharmacy that ran free tests on the spot. He tested negative and bought his second test from Walmart.

“I think it’s important for the community to protect each other’s health. I’m pretty shaken by long covid, and I wouldn’t wish that on anyone,” Camenzind, 25, said. end up at the point where I want tests and it’s costing me hundreds of dollars.

With some sleuthing, Americans can still find free tests in parts of the country, such as libraries and health clinics.

Since the end of the emergency, the Biden administration has distributed an average of 4 million over-the-counter tests per week to institutions, including long-term care facilities, community health centers and food banks, according to the Strategic Preparedness and Response Administration at the U.S. Department of Health and Human Services . Federal officials also provide tests to local governments, according to the National Association of County and City Health Officials.

The CDC has a website showing where people without insurance can get tested for the coronavirus for free, but the network of sites has shrunk since the end of the health emergency.

The Big Cities Health Coalition says at least 20 of its 35 member cities have some sort of free home test distribution program, and those that don’t cite lower demand or availability in clinical settings. Los Angeles County has been distributing 250,000 kits a week, mostly to shelters and community organizations serving low-income people. Officials in Tucson handed out 800 rapid tests at a recent back-to-school event.

Still, health officials continue to emphasize vaccination to bolster population immunity rather than control transmission. Federal officials are preparing a fall booster campaign with a new formula tailored to the XBB varieties that have been dominant all year. Pfizer told investors it expects to offer its updated booster in September, pending regulatory approval.

Some medical experts say the time for widespread testing is over.

Shira Doron, chief of infection control for Tufts Medicine in Massachusetts, said the better approach to controlling covid transmission is to encourage people to stay home until they are fever-free, rather than testing to end isolation.

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“We can be contagious for flu or RSV for a week, but we’ve always said you can go back to work or school when you’re fever free. Yes, people can still be contagious, but so can asymptomatic people who are walking around and transmission is inevitable,” Doron said. “Most people don’t need to know what virus they have and don’t need to buy tests all the time.”

Those who would benefit from regular testing, Doron added, are those who are at higher risk of hospitalization and would benefit from antiviral drugs such as Paxlovid in the early days of symptoms to stop progression to serious illness.

Susan Grammerstorf, a 65-year-old nurse in Virginia Beach, started using Paxlovid after testing positive for covid in July. Determining her status after returning from a cruise with a dry cough and nausea wasn’t easy, she said.

She tested negative on home kits she got for free from the government, but didn’t trust the results because the kits had expired. She could no longer get free tests from Walgreens through her Medicare plan. Although she works remotely, she drove 45 minutes to the medical school where she works for a free test — only to find out she was infected.

The experience left her frustrated and worried about the months ahead.

“All those people walking around with covid aren’t testing. They’re giving it to other people. Nobody’s really paying attention,” Grammerstorf said. “It’s important to offer them for free so that people do the responsible thing.”

Medicare and the five largest private insurers — United Healthcare, Aetna, Cigna, Anthem and Humana — no longer reimburse over-the-counter coronavirus tests for all beneficiaries, according to their websites, though some individual plans may differ. Medicaid will continue to pay for free tests through September 2024, after which coverage will vary by state. A program that allowed Medicaid programs to offer free testing to the uninsured ended with the public health emergency.

Free over-the-counter tests marked a major shift in the nation’s pandemic response, giving Americans an easy way to gather safely and break the chains of transmission early. The free test-by-mail program — which sent more than 750 million tests to Americans — improved racial disparities in the pandemic, with blacks and whites benefiting similarly, according to a CDC analysis, and African Americans much more likely to those tests than those bought in stores.

“Removing that financial barrier made COVID testing a lot more accessible to those groups, which in turn improved the ability to identify disease and reduce spread,” said Latoya Hill, a senior policy analyst with the KFF Program for racial equality and health policy.

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With gaps in test coverage and inconsistent access, health equity experts worry the coronavirus will spread more easily in low-income or predominantly Black and Latino communities, where people are more likely to have underlying conditions and with greater complications of the coronavirus are facing.

“We’re going to see a pattern we saw before in the pandemic of people from socially marginalized groups and communities with higher rates of infection,” said Lisa Cooper, director of the Johns Hopkins Center for Health Equity.

Libby Young, a 33-year-old nonprofit executive in New York, said she tests less often than she used to because she has to pay out of pocket. Money is tight due to medical expenses to treat long-term covid symptoms that leave her fatigued after exercise. When she and her partner fell ill in July, they rationed tests they bought on Amazon. Testing her Google searches for free in her Hudson Valley community turned up nothing.

“Additional health care costs, plus medications I’m taking, is a huge burden,” Young said. “It’s prohibitively expensive and you often don’t test positive until day 3, 4 or 5.”

With a new school year just around the corner or already underway, regular testing for the coronavirus is becoming unsustainable for parents accustomed to children having frequent runny noses and coughs while a host of viruses are circulating.

Kristin Riddick, a mother of three young children in Richmond, canceled a vacation in June after she and a son tested positive before their trip. The family decided not to test even when others fell ill due to the cost and challenges of swabbing young children, but waited more than 10 days to return to work and attend daycare.

“We have to be a little more picky when we decide to test,” says Riddick, 32. “It’s just so hard to know when to take them out and when not to, but we don’t want to traumatize our kids either.” by always sticking things up their noses.”

Sharon Nachman, chief of the pediatric infectious disease unit at Stony Brook Children’s Hospital, said she hears similar sentiments from the parents of her patients.

“They were like, ‘No, we don’t have kits in the house and we’re not spending money to buy those kits,'” Nachman said. “The consequences of not testing mean you don’t know. And if you don’t know, that means you can’t tell anyone else.”

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