Imagine getting up in the morning and taking a quick, cheap at-home saliva test that will tell you whether you’re infected with the coronavirus, and to help you decide whether you’re going to head to work, to school, or to grandma’s house.
That’s the vision being promoted by experts at Harvard, who say less-sensitive but faster and cheaper tests could be a game-changer at a time when the US testing system is facing challenges.
Dr. Ashish K. Jha, faculty director of the Harvard Global Health Institute, said Wednesday in an op-ed in Time, that such tests could be a strong step toward curbing the virus.
“If everyone in the United States did this daily, we would dramatically drop our transmission rates and bring the pandemic under control. Schools and businesses could reopen with the peace of mind that infectious individuals had been identified and were staying home.”
Jha said laboratories are facing shortages of key supplies and backlogs and “in many states, it now takes 10-15 days to get test results — rendering these tests useless as a tool to prevent transmission and bring the pandemic under control.”
With schools about to reopen, he said, “it is time to radically rethink our approach to testing. The way forward is not a perfect test, but one offering rapid results.”
Dr. Michael Mina, an epidemiology professor at the Harvard T.H. Chan School of Public Health, has been an outspoken proponent of such tests.
In an op-ed early last month in The New York Times that he coauthored with Laurence J. Kotlikoff, an economics professor at Boston University, Mina argued, “Simple at-home tests for the coronavirus . . . could be the key to expanding testing and impeding the spread of the pandemic. The Food and Drug Administration should encourage their development and then fast track approval.”
The authors envisioned people spitting in a test tube with saline solution then inserting a paper strip that would change color if a person is infected. The test would take 15 minutes.
“The strips could be mass produced in a matter of weeks and freely supplied by the government to everyone in the country,” the authors wrote. “The price per person would be from $1 to $5 a day, a considerable sum for the entire population, but remarkably cost effective.”
Rapid tests are already under development by several companies, they noted.
“I envision a time when everyone can order a pack of 50 tests for $50 and have those and use them every other day for a couple of months,” Mina told NPR on July 22.
“The #COVID19 tests we are performing in the US are often not COVID tests in the way we think of them,” Mina said recently on his Twitter feed. “A diagnostic test should diagnose in time to use the info. W/ 7+ day delays, our testing often amounts to just “theater.”
Dr. Benjamin Pinsky, medical director of the clinical virology laboratory at Stanford University, told USA Today on July 26, “I’m on board with (this) thinking . . . I think that would be quite useful.”
The rapid tests wouldn’t pick up as many cases as current tests do, but people who do the test daily might easily learn they’re infected when they take the test the following day, Mina has said.
Jha said in his op-ed that there had been “significant pushback from those who believe it would be irresponsible to widely use a test that might miss many positive cases. But the frequency of testing and the speed of results counters that concern.”
“The evidence makes clear it is time for a paradigm shift on testing,” he said. “It is time for the federal government to take strong leadership on directing our resources toward this new strategy.”
The FDA on Wednesday took what some proponents of the idea saw as a step forward when it announced a new template for how the agency will approve at-home tests for the coronavirus.
FDA Commissioner Dr. Stephen M. Hahn said in a statement, “The recommendations provided today are intended to help get tests to market that are simple enough to use at home, similar to a pregnancy test. We hope that with the innovation we’ve seen in test development, we could see tests that you could buy at a drug store, swab your nose or collect saliva, run the test, and receive results within minutes at home, once these tests become available.”
The agency also said, “While the recommended sensitivity for these non-lab tests is lower than lab-based tests, the tremendous benefits of broader access to simple and fast testing options generally outweighs this risk.”
But Mina told USA Today on Wednesday that the FDA hadn’t gone far enough. “Unfortunately the template does not offer this type of ‘new’ avenue that I think is going to be necessary if we want to see truly $1 daily tests become a reality,” he said.
Martin Finucane can be reached at firstname.lastname@example.org.