early rollout raises equity concerns; where’s the data?

The federal government’s policies aimed at helping Americans get free rapid tests are insufficient for many households including people of color. Graphic via KHN.

This week, the U.S. government unveiled a new website where Americans can get free at-home COVID-19 tests. The site is hosted by the U.S. Postal Service (USPS)—which will also distribute the tests—and it’s been lauded for its straightforward navigation and ability to handle a high level of traffic, both of which are unusual with government sites.

On Tuesday, the site went live early in “beta test” form before its formal launch on Wednesday. Within hours of it going live, public health experts were already raising equity concerns about the free test distribution program. To address these concerns, the federal government should release data on where the free tests go—including breakdowns by state, county, ZIP code, race and ethnicity, the tests’ delivery dates, and more.

As the link to the testing order site was shared widely on social media, one thing quickly became clear: people who lived in high-density settings were at a disadvantage. Americans in traditional apartment buildings, houses split into multiple living spaces, dormitories, and other multi-unit dwellings attempted to order tests—only to get an error message stating someone at their address had ordered tests already.

The USPS ordering page is set up to allow just one test order per address, to prevent people from abusing the free test program. But, despite having literally every address in the U.S. on file, the USPS apparently failed to account for many apartment buildings. Some apartment-dwellers were able to get around this issue by placing their apartment number on the first address line, removing “Apt” from the address, or otherwise adjusting how they filled out the form, but these tricks didn’t work for everyone.

I myself ordered the free tests before I learned about these issues on Twitter; I later sheepishly texted the groupchat for my Brooklyn, seven-unit apartment building, preemptively apologizing in case I’d fucked up my neighbors’ chances of obtaining free tests. (Luckily, my building seemed to be unaffected by the USPS issue—one of my neighbors responded saying that she was able to order the tests without a problem.)

This issue “stems from buildings not being registered as multi-unit complexes and affected only a ‘small percentage of orders,’” the USPS said in a statement to POLITICO. And people facing this issue as they order tests can file a service request with USPS or call the agency at 1-800-ASK-USPS, according to KHN.

Still, a “small percentage of orders” could add up to millions of people living in multi-unit housing who were unable to obtain free tests, or would have to share just four tests among an apartment building’s worth of residents. Without more precise data, it’s hard to understand the scope of this problem.

All the Twitter discourse about apartment buildings obscures another group that shouldn’t have to share a small number of tests among many people: large households. The USPS is sending just four tests in each order—not four testing kits, four individual tests. That’s not enough for a family of four to test themselves according to FDA recommendations (i.e. twice within two days) after a potential exposure; it’s certainly not enough for large families including five or more people.

And minority communities are more likely to include such large households. According to a Kaiser Family Foundation analysis of Census data: “More than a third of Hispanic Americans plus about a quarter of Asian and Black Americans live in households with at least five residents…Only 17% of white Americans live in these larger groups.”

Households in West coast states are also more likely to include five or more residents, according to a similar analysis from the University of North Carolina Chapel Hill’s Carolina Demography center. States with the highest shares of five or more resident households are: Utah (18.8%), California (13.7%), Hawaii (13.5%), Idaho (13.2%), and Alaska (12.9%). On the other hand, in some East coast states, under 7% of households include five or more residents.

The USPS test distribution system also gave an advantage to Americans with internet access. At one point on Tuesday afternoon, the USPS order site was drawing more than half of all government website traffic, demonstrating its popularity with internet users—while people without internet were not yet able to order tests.

As of Friday, those without internet access can order the free tests over the phone, at 1-800-232-0233. This phone line is open daily from 8 AM to midnight Eastern Time, according to NPR, and Americans can order in over 150 languages. The USPS website itself is available in English, Spanish, and Chinese.

While this phone line is very helpful now, the delay between the website’s release (on Tuesday) and the phone line’s release (on Friday) means that Americans without internet may be behind in the queue for actually receiving their tests. Already, the federal government has said that people who ordered their tests may need to wait for weeks to receive their tests.

Of course, as analysis from KHN has shown, Americans of color are less likely to have internet access than their white neighbors. 27% of Native Americans, 20% of Black Americans, and 16% of Hispanic Americans have no internet subscription, compared to 12% of white Americans.

Finally, the USPS test distribution system leaves out one major group of vulnerable Americans: those who don’t have an address at all. Homeless people are particularly vulnerable to COVID-19: many outbreaks have occurred in shelters, and many of these people have health conditions that increase their risk of severe symptoms. The impact of COVID-19 among homeless Americans is not well understood due to a lack of data collection; still, we know enough to indicate free tests should be a priority for this group.

The White House has said that equity will be a priority for the free rapid test rollout: each day, 20% of test shipments will go to people who live in highly vulnerable communities, as determined by the CDC’s Social Vulnerability Index. This index ranks ZIP codes according to the communities’ ability to recover from adverse health events, based on a number of social, environmental, and economic factors.

This priority is nice to hear. But without data on the test rollout, it’ll be difficult to evaluate how well the federal government is living up to its promise of equitable test distribution. I’d like to see data on the free test distribution that goes to the same level of detail as the data on our vaccine distribution, if not even more granular.

The data could include: tests distributed by state, county, and ZIP code; tests distributed to ZIP codes that rank highly on the Social Vulnerability Index; tests distributed by race, ethnicity, age, gender, and household size; dates that tests were ordered and delivered; tests delivered to single- and multi-unit buildings; and more.

Unlike other COVID-19 metrics that are difficult to collect and report at the federal level, the federal government literally has all of this information already—they’re collecting the address of every person that orders tests! There is no excuse for the government not to make these data public.

In short: USPS, where is your free rapid test distribution dashboard? I’m waiting.

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