Testing is familiar to me. I recently awoke to a call from my work telling me that my routine COVID-19 screening test came back inconclusive and that I should immediately isolate myself from my family — what a scary way to start Halloween. After a deep nasopharyngeal swab PCR (polymerase chain reaction) test and five full days in isolation, the test results arrived negative, releasing me from my quarantine bubble at home.
Every day preceding a definitive diagnosis increased the potential exposure risk of COVID-19 for my family if I were positive. The faster we get the results, the faster we can get back to our lives. How I wished then for a quick home test!
As of Dec.12, the United States is close to approaching 300,000 deaths due to COVID-19. Now is the time to bring COVID-19 testing to the people instead of bringing people to testing facilities.
Centralized testing is much harder for essential and frontline people who have to work. It is inconvenient, time-consuming and it forces infectious people out into the world when they should be isolating. Plus, in addition to overbooked rapid tests, most centralized testing PCR test results come back frustratingly too late to help us all avoid infecting one another.
So let’s send those skilled staff in breezy parking lots back to hospitals to help the sick and the dying; we can help put them there by testing ourselves for COVID-19. This is suddenly possible because the newest COVID-19 tests are relatively inexpensive at $5 a test simple to perform and provide results in 15 minutes.
In fact, these “lateral-flow” tests might sound familiar. They employ the same proven technology used for home HIV, drug and pregnancy testing. Millions of these quick test cards have just been distributed to each of the states.
Starting now, we could swab our own nostrils at home, smear the tip on the pad of a small card, wet the pad, wait fifteen minutes and watch for lines to appear on white paper. When repeated every couple of days, these simple home-tests can tell us if we are infectious, regardless of symptoms. A test like this matters the most for people that interact with others constantly, allowing them to know their status on a daily basis.
So why aren’t we home-testing? Test cards are presently in relatively short supply, but millions are being manufactured to meet strong demand. The deeper issue is that regulators have required medical supervision of these simple tests to ensure proper test technique and public health reporting of results. Additionally, while we know that asymptomatic spreaders can account for up to half of infections, emergency use authorization for the Abbott binaxNOW cards restricts use to only those with symptoms of infection.
While these goals are well-intentioned, such testing restrictions are overwhelmingly self-defeating as they create obstacles to testing, increase time without a diagnosis and are cumbersome among those who have work and childcare obligations. We should relax testing restrictions and simply mail paper test strips to everyone’s homes along with a thoughtfully deployed education campaign.
As we’re in the middle of an uncontrolled pandemic and centralized testing has been overwhelmed, home-testing has the potential to be transformational. Being able to perform repeated tests should address concerns regarding false negative results: contagious individuals are unlikely to deliver two false negatives in a row.
There exists the worry that at-home testing will impede public health reporting. Without the public health department tracking every positive case occurring at the various testing facilities in the county, it is true that we will be relying more on self-test reporting. However, if we incentivize self-reporting and make it easy, then public health departments may gain an even more refined characterization of COVID-19 in the community because far more tests would collectively be performed. At the same time, if we don’t sufficiently incentivize self-reporting, our tracking capability may decline.
Lastly, even with free and ready access to rapid COVID-19 antigen tests, some people will not participate, and this can be due to many reasons, including fear or government distrust. However, this fraction is likely to diminish as the obvious benefits of knowing whether one is contagious — such as preventing viral spread to loved ones and family or stopping community spread of the virus — should drive comprehensive use.
While home-tests might be less sensitive than the drive-through tests, they are cheaper and easy to perform, so we’ll be able to test much more often. Think of it this way: a single test result is like a photographic snapshot, a moment in time. If you had a negative test last week, that doesn’t mean you’re not infectious now. Even if you receive a negative test, it doesn’t mean you should go out to a party maskless. We still need to mask up, social distance and wash our hands in addition to rapid testing. Frequent home screening does not absolve us of our public health responsibilities.
To stop this pandemic we need to take frequent test snapshots, making more of a choppy movie of results that can catch emerging infections and stop them in their tracks with proper isolation. More frequent screening enables us to know when we are contagious. People are infecting one another because we haven’t made it easy and efficient to get tested frequently and inexpensively. Investigators at Harvard and Yale have found that quick turnaround time and increased frequency of testing is far more important than tests that are super sensitive. We need now to shift how we perceive these rapid screening tests.
To help get COVID-19 rapid testing into the hands of people, write to your state senators and representatives and tell your friends about the importance of rapid testing. Let’s bring home testing to the people. It’s time.
Benjamin Sievers PZ ’22 is a guest writer majoring in biology. He’s developing an inexpensive paper-based COVID-19 diagnostic test at the J. Craig Venter Institute in La Jolla, California where he lives with his two dogs, Woods and Bird.