{"id":9719,"date":"2020-07-05T11:02:16","date_gmt":"2020-07-05T15:02:16","guid":{"rendered":"https:\/\/blogs.nejm.org\/hiv-id-observations\/?p=9719"},"modified":"2020-08-20T14:03:48","modified_gmt":"2020-08-20T18:03:48","slug":"rapid-inexpensive-home-testing-for-covid-19-may-get-us-out-of-this-mess-before-a-vaccine","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/rapid-inexpensive-home-testing-for-covid-19-may-get-us-out-of-this-mess-before-a-vaccine\/2020\/07\/05\/","title":{"rendered":"Rapid, Inexpensive Home Testing for COVID-19 May Get Us Out of This Mess Before a Vaccine"},"content":{"rendered":"
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Source: 91-divoc.com\/pages\/covid-visualization\/<\/p><\/div>\n

As cases of COVID-19 continue to climb to record numbers, it might seem impossible that something is already out there that could dramatically reduce new infections \u2014 and even bring us back to some semblance of normal life.<\/p>\n

I’m not referring to a vaccine. It’s a rapid, inexpensive home test.<\/p>\n

You’re forgiven for being incredulous. Indeed, you might be discouraged by a depressing sense of deja vu as you hear that hard-hit communities again must suffer delays on both obtaining tests and getting results.<\/a><\/p>\n

And it\u2019s not just Arizona, Texas, and Florida. Testing volume for COVID-19 has so overwhelmed commercial and national reference labs<\/a> that turnaround times to get results are at the very least several days, and can be a week or longer — tests ordered from anywhere in the country.<\/p>\n

Didn’t we learn anything from our lack of tests in the winter and spring, when contagious cases went undetected because of our inability to test all but symptomatic people? Didn’t that allow those with mild or pre-symptomatic disease to continue to spread the virus in the community, triggering an explosive increase in cases?<\/p>\n

The problem is that we’re doing it all wrong. Again.<\/p>\n

We need to test more broadly, even in people without symptoms. The critical window period for transmitting the virus starts a day before<\/i> symptom onset.<\/p>\n

And instead of relying on the gold standard for diagnosis — the polymerase chain reaction (PCR) tests, done on a nasopharyngeal swab — we need to lower the bar for accuracy and use one of the many rapid tests currently in development.<\/p>\n

As noted in this spot-on perspective on rapid home tests<\/a> written by Drs. Laurence Kotlikoff and Michael Mina, our PCR testing, while accurate, has many problems — it\u2019s expensive, it\u2019s slow, and it strains the lab supply chain. Our hospital has had to diversify the PCR tests it offers to at least 5 different platforms to avoid running low on any one particular test.<\/p>\n

Some might argue PCR is too<\/em> sensitive — it picks up fragments of viral RNA long after a patient is no longer contagious. These positive results generate all kinds of confusion and worry.<\/p>\n

In addition, a nasopharyngeal swab requires trained personnel to obtain the sample. It hurts, too, as anyone who has had the test will tell you. There’s a reason the most common “joke” heard after undergoing PCR testing is likening it to a pituitary biopsy. Ha ha.<\/p>\n

So why don\u2019t we have rapid, cheap home tests available now?<\/p>\n

It\u2019s not for lack of trying — take a look at this list of companies working on the problem as of early June:<\/p>\n

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Thanks, Tomas
That makes 16 pic.twitter.com\/QQcBDopaGL<\/a><\/p>\n

— Eric Topol (@EricTopol) June 7, 2020<\/a><\/p><\/blockquote>\n