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COVID-19 widespread testing is crucial to fighting the pandemic, but is there enough testing? The answer is in the positivity rates.
Doctors and patients increasingly embrace telemedicine tools to diagnose and treat during the ongoing pandemic. So why is it people who want to be tested for COVID-19 are still venturing out to clinics or doctors’ offices, where they could potentially be exposed or expose others to the novel coronavirus? Moving aggressively toward self-administered in-home testing ahead of a potential second wave should continue to be a top national priority.
In March, The Centers for Medicare and Medicaid Services revised outdated regulations for telemedicine, unleashing a modernized clinic system that was penned up for far too long. But seven months into the pandemic, as the United States is averaging more than 50,000 new cases per day, we have yet to optimize our telemedicine capabilities to test, treat and isolate Americans without creating unnecessary exposure for healthy people — including the frontline health care workers who administer lab tests.
Going out to get tested is risky
On television news shows we’ve seen people waiting in line for hours to be tested for COVID. Doctors’ offices and clinics have taken all the precautions they can to protect test subjects and health care workers from exposure but, as we’ve known from the start of the pandemic, the best way to stay safe is to avoid indoor public settings.
Home testing is nothing new. American women have been able to self-administer pregnancy tests in their own home for more than 40 years. People living with diabetes test their insulin levels at home on a routine basis. There are many other examples of successful home medical testing regimens as well, including screens that can detect colon cancer or unhealthy levels of cholesterol.
Imagine if all those tests had to be administered in a clinical setting. Medical facilities would be overwhelmed and millions more people would be put at risk of exposure to contagious diseases like COVID.
A COVID-19 testing site on Oct. 7, 2020 in New York City. (Photo: Spencer Platt/Getty Images)
My colleagues and I have argued since the pandemic first took hold in the United States that COVID-19 testing at home, with supervision from a trained professional via telemedicine, could ensure widespread, equitable availability of care and slow the spread. Seven months later, that vision may finally become a reality as better testing options are becoming available. The most notable is Abbott Lab’s BinaxNOW kits, which use a simple self-administered nasal swab to deliver results within 15 minutes. The federal government announced this week it is beginning to distribute more than 100 million of these tests to the states.
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The benefits of at-home testing on digital health platforms extend far beyond the convenience and safety of individual test takers. This approach can also equip public health officials with more data and build the kind of trust necessary to safely reopen key sectors of the economy.
Once these solutions are in widespread use, a smartphone app could log test results and upload them (stripped of personal data and precise location) to a nationwide database so researchers and the public could track the spread of contagion.
Home testing to limit the spread
Self-screening at home will allow people to test themselves before traveling, going to school or work, attending a crowded event, or visiting a high-risk friend or relative. When someone tests positive, they’ll simply self-quarantine until they no longer pose a contagion risk to others.
Of course tests administered at home must be both accurate and verified. Test-takers have to know the results they’re getting are as accurate as possible. Everyone else needs to know that the results have been reported accurately. There are too many social and financial incentives for test-takers to misreport their results, so there needs to be independent validation of tests that protects patient privacy and public health. But this is very achievable. In fact, many physicians have already adopted telemedicine to talk to a patient before or after a COVID test. Abbott’s NAVICA Pass, which provides users a mobile “green light” following a negative test, is a great example of verification at work.
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As we consider the current increase in cases heading into colder weather, moving away from in-person screening and toward in-home administrating is a no brainer, and many Americans — including seniors who are at higher risk of major complications — are ready for telemedicine. A July survey of 1,000 Medicare-eligible Americans found a 300% increase in seniors using telemedicine services since the beginning of the pandemic. With 89% of respondents reporting that they owned a smartphone and over two-thirds having an iPad or other type of tablet, it would be relatively easy to use telemedicine tools to help them test for COVID-19 without leaving home.
The technology exists and people want to be able to get tested at home, where they don’t run the risk of virus exposure. It’s time to re-evaluate testing centers and invest in bringing coronavirus screening into the 21st century.
Dr. Marty Makary is a professor at the Johns Hopkins School of Public Health, editor in chief of MedPage Today and author of “The Price We Pay: What Broke American Health Care — and How to Fix It.” Follow him on Twitter: @MartyMakary
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