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Illustration: Maura Losch/Axios

As America's record Omicron surge continues, cities and states across the country have no cohesive strategy to monitor the results of at-home rapid COVID tests.

Why it matters: This patchwork system means the official COVID case counts are almost certainly a vast undercount. Many cities don't have an accurate sense of just how prevalent COVID is as they make decisions about mask mandates, school closures and other restrictions.

One of the better systems is run by Washington, D.C., where the city has established a portal to report positives from an at-home rapid test, allowing a contact tracer to get in touch.

Yes, but: Residents don't always know about these options, and because they're all ad hoc systems, they can be difficult to track down even for the people who are inclined to use them.

The other side: Many areas simply don't have a system in place at all. "It is my perception that there is an understanding that cases are indeed higher because some people are testing positive using home kits," said Jessica Corbitt, a spokesperson for Georgia's Fulton County, which contains most of Atlanta.

  • Chicago says that at-home tests are a helpful diagnostic tool, but they "are not included in official COVID-19 case counts."
  • In Des Moines, the Polk County Health Department only counts cases verified using a PCR test.
  • In the Twin Cities, the Minnesota Department of Health cites the lack of "a good way to verify the results" as its basis for not tracking at-home results.

What they're saying: Minnesota Department of Health spokesman Doug Schultz told Axios that the state's reasoning on at-home tests is based on the fact that "we don’t have complete case ascertainment now."

  • "We may not be able to count every case, but people will continue to get laboratory-run testing, so our data will still provide a picture of what is happening in the state," Schultz added.
  • North Carolina has a similar take. "There are going to be more cases out there than are reflective in our data. What we’re really interested in is our hospitalization data. That’s our key focus right now," said Dr. Susan Kansagra, acting senior deputy director for the state's Division of Public Health.

The big picture: Rapid tests are already in short supply, and a small preprint study released this week found that people may not test positive with them until after they're infectious, which would make them an unreliable measure of whether it's safe to gather, as Axios' Caitlin Owens reported.

  • "Based on viral load and transmissions confirmed through epidemiological investigation, most Omicron cases were infectious for several days before being detectable by rapid antigen tests," the study's authors wrote.

The bottom line: Omicron may have exposed the limitations of at-home rapid tests — not only as a gauge of how big the current case surge truly is, but also as a possible pathway to avoid COVID disruptions in daily life.

Axios' Chelsea Cirruzzo, Jason Clayworth, Katie Peralta Soloff, Asher Price, Torey Van Oot and Thomas Wheatley contributed to this report.

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Go deeper

Jan 15, 2022 - Health

Experts warn of more COVID-19 variants after Omicron

Three COVID-19 testing companies place testing locations outside Grand Central Terminal on Jan. 14 in New York City. Photo: Alexi Rosenfeld/Getty Images

Experts are warning that subsequent COVID-19 variants are likely to come after Omicron, AP reports.

Why it matters: The warnings come as there's no guarantee that subsequent variants "will cause milder illness or that existing vaccines will work against them," underscoring the need for widespread vaccination, AP writes.

Minneapolis and St. Paul to require vaccine or test for indoor dining

Illustration: Shoshana Gordon/Axios

New vaccine-or-test requirements for indoor dining and drinking in Minneapolis and St. Paul take effect Wednesday.

The big picture: A growing number of major cities, including Boston, Chicago and New York, have instituted similar requirements in an effort to protect public health.

Yes, but: Questions about enforcement, logistics and effectiveness of the temporary measures here remain.

Report: LGBTQ+ Afghans' lives "dramatically worsened" under Taliban rule

Taliban fighters in Kabul, Afghanistan, earlier this month. Photo: Mohd Rasfan/AFP via Getty Images

LGBTQ+ Afghans have been threatened, attacked and "faced an increasingly desperate situation and grave threats to their safety" since the Taliban seized control of Afghanistan last August, per a report published Wednesday.

What they're saying: "We spoke with LGBT Afghans who have survived gang rape, mob attacks, or have been hunted by their own family members who joined the Taliban, and they have no hope that state institutions will protect them," per a statement from study co-author J. Lester Feder.

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