At home universal testing: a solution?

[Cdd89]

I read this article a few weeks ago and it really stuck with me:

How We Can Stop the Spread of Coronavirus by Christmas

We have a long road ahead before a vaccine is safe, effective and, most crucially, widely available. Here's how we can stop the spread of COVID-19 by Christmas.

time.com

It’s a long article (worth a read in full), so I’ve only quoted the most relevant bits below:

Antigen tests are “contagiousness” tests. They are extremely effective (>98% sensitive compared to the typically used PCR test) in detecting COVID-19 when individuals are most contagious. Paper-strip antigen tests are inexpensive, simple to manufacture, give results within minutes, and can be used within the privacy of our own home—the latter is immensely important for many people across the U.S.



If only 50% of the population tested themselves in this way every 4 days, we can achieve vaccine-like “herd effects” (which is when onward transmission of the virus across the population cannot sustain itself—like taking fuel from a fire—and the outbreak collapses). Unlike vaccines, which stop onward transmission through immunity, testing can do this by giving people the tools to know, in real-time, that they are contagious and thus stop themselves from unknowingly spreading to others.



With antigen testing, specificity (or potential for false positives) are important to consider and can be easily solved by including a second confirmation test to confirm original positive test results. With every pack of 20 paper strip tests sent to a household, three additional confirmatory tests would be included. When you test positive, you immediately use a confirmation test at home, and if you confirm positive, you stay home and isolate. If negative on the confirmatory test, you test again the following day to be sure.



Contact tracing needs would be minimal because the population will already be testing themselves regularly. One of the major reasons for contact tracing is to trace contacts and ask them to get tested. Usually this is just once and with testing delays and low access to testing it is usually too late anyway. In public health screening using widespread rapid testing, people won’t need to be traced and asked to test in order to know if they are infected. They will already be testing. Because testing will be twice per week, contacts will figure out if they are infected much earlier than they would through a test-trace and isolate contact-tracing program—which, despite being cornerstones of our national efforts to date, have largely failed to control the virus.



To catch infectious people, rapid antigen tests work in asymptomatics as well as they do in symptomatics. A public health test doesn’t care about symptoms, it cares only about detecting virus—and if someone is very infectious, the virus will be there, detectable by the test—regardless of whether the symptoms are.

To my mind this sounds highly credible and very promising, but it is something talked about very little. There are lateral flow tests, but they are only taken by a minority.

Is the reason this hasn’t been deployed in the manner described concerns about false negatives, the thought that it won’t work, too expensive, inability to manufacture to the scale received, test approval issues, or something else?

It should be noted that it was written before vaccines were available, but it still seems relevant as something that could be targeted to the ever decreasing proportion of the population that have not yet received a vaccine.

 

[SS4]

It's a decent idea as long as people know how to do the test effectively and if they actually do the test and send back the results - that'll be a problem with the covid deniers.

The other issue is waste - we were making such good steps to clean up our act and putting a lot of single use plastic into the environment isn't going to do it any good - let's not litter the oceans with PPE and testing kits

 

[Yew]

I fear that it's an idea that sounds good in theory, but in practice would be impractical for a virus in endemic circulation in the population.

 

[Bantamzen]

I have to ask the simple question, but why would we need this? With a vaccine rapidly rolled out & the most vulnerable given priority access to it the risk of hospitalisation / death will be dramatically reduced. So what would be the point in constantly testing. As mentioned above it would be hugely wasteful & damaging to the environment plus incredibly costly, & for what effect?

Sounds like a money making scheme in all honesty.