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While quick home tests can be effective, they may not live up to their potential if left unchecked.

Suki Waterhouse Pregnancy

Suki Waterhouse Pregnancy

Health workers prepare to provide free Covid-19 testing to people at the Barcroft Community Center in Arlington, Virginia on May 26. Olivier Douliery/AFP via Getty Images

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Although there are more coronavirus cases than any other country, the United States has a low per capita infection rate among many countries.

The slow pace of testing “has hindered us from moving forward and reopening the economy,” said Ryan Demmer of the University of Minnesota’s department of epidemiology and public health.

Although testing for active infections has improved since March, testing remains insufficient in some areas of the country. And if there are tests, the results will take several days.

Many companies are now vying for rapid at-home testing. Instead of requiring advanced lab equipment to process like current tests, these new ones use samples collected at home and, like pregnancy tests, give a positive or negative result in less than an hour. (These tests also differ from manufactured home collection kits in that the samples must be processed in a laboratory.)

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If these rapid tests are accurate, affordable, and easy to manufacture, they could allow more Americans to test themselves, even if regularly. It could be a huge asset in the fight against the coronavirus, which is spreading across the United States and killing thousands of people every week.

“These tools are desperately needed,” said Amanda Castel, MD, a professor of epidemiology at George Washington University’s Milken Institute School of Public Health.

And for the SARS-CoV-2 virus that causes Covid-19, testing is important, Demmer said, adding that “many infections come from asymptomatic people or people who are asymptomatic or people who don’t have symptoms of the disease.” virus (In fact, people are highly contagious before they start showing symptoms.)

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But there are several caveats against widespread and rapid at-home testing for the coronavirus. For example, results must be shared with health officials to track cases and trace the contacts of those who test positive, and no one has proposed a way to do that. These tests, some of which are less accurate than current PCR tests, will take months to become available.

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Current testing methods in the US require a healthcare worker wearing personal protective equipment (PPE is still limited in some areas) to collect samples. This requires a laboratory for analysis (many hours and expensive machines to amplify the genetic signature of the virus). That strict enforcement mechanism has not come close to the 500,000 tests a day experts say the U.S. should at least do. Labs conducting these tests face constant delays and shortages of supplies, from nasal sprays to testing machines, preventing widespread dissemination.

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People are advised to self-isolate before receiving the product. In addition to not always following people, this replication delays the identification of personal contacts of infected people.

“Testing someone and sending the results right away has implications for health care and preventing transmission to people,” said Castel, who has studied HIV detection and control. So far, we have not been able to do this on a large scale against Covid-19.

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Ideally, on-site (such as a healthcare facility or testing lab) coronavirus test can provide results within a few hours, but availability is limited. The validity of another test by Abbott, who promised an answer in less than an hour, is questionable.

Testing that people can do without having to see a health care provider can help save the burden on medical staff and personal medical equipment.

“Home testing is more effective at identifying people with symptoms and can reduce exposure of health care workers,” said Emily Toth Martin, an epidemiologist at the Michigan School of Public Health Center. Those who doubt that they have the disease can be encouraged to try.

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In late April, the US Food and Drug Administration began approving some at-home kits for coronavirus testing; Six such packages have now been approved. These kits allow people to collect samples (nasal swabs and saliva) at home before sending them to the lab. By avoiding going to a health center for testing, they can prevent the spread of infection if they are infected and reduce the chance of getting infected if they are not.

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However, these new test collection methods require days for laboratory processing and results. Most are only available in small quantities and are used by front-line healthcare workers.

We have technology to detect virus particles faster than basic PCR methods and with much less equipment. In particular, there are two main approaches that researchers are currently pursuing.

One known method is antigen-based testing. These tests look for virus-specific proteins in the mucus in nasal swabs, and if the virus is present, it can be read as quickly as a line on a test strip. . (This is in contrast to PCR testing, which relies on amplifying the virus’s genetic material with expensive machinery and careful laboratory management before detecting the virus.)

Technologists are working to simplify the type of antigen test in Brazilian labs and make at-home coronavirus test kits. Pedro Vilela / Getty Images

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Antigen tests are already used in the doctor’s office as a rapid strep test and as part of an HIV test at home (which looks for antibodies to the virus). The White House has discussed the possibility of more widespread use of these tests, and the FDA will approve the first one in May.

However, the antigen test is less accurate than the current PCR test, and some companies say that one in five people with Covid-19 are not tested. This may be partly due to the fact that, unlike PCR, it does not amplify viral particles and depends only on the amount collected in the sample. Therefore, they are more likely to have the disease of people who died early or whose samples were not collected properly. Therefore, some experts say that these tests are better than the first “test”; Probable cases receive conventional PCR for confirmation and diagnosis.

Another method uses CRISPR, a gene editing technique. It releases specially designed molecules that look for the genetic sequence of the SARS-CoV-2 virus, activates the compound, and signals again if the virus is present, like a line on a test strip. It can be done at home in 20 minutes. Two of the best-known CRISPR scientists, Jennifer Doudna of the University of California, Berkeley, and MIT (Mammoth Biosciences and Sherlock Biosciences) are working to bring the tests to market. .

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Before the epidemic, CRISPR technology was a tool for rapid diagnosis of other diseases such as tuberculosis. Results from early studies, including one in tuberculosis, show this rate is very accurate, and Sherlock Biosciences researchers say their lab-based CRISPR Covid-19 test is comparable to PCR. examination

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Like current viral PCR tests, these two new types of tests only look for current infections, not past infections. Rapid at-home testing for early infection (by looking for antibodies to the coronavirus) is currently not a priority.

“I chose to do the at-home disease test before the antibody test because you can change the decisions you make that day so you don’t spread it to others,” Toth Martin said. “Getting the right virus testing in the hands of qualified people to control epidemics can prevent the spread of infection to the public, which is very expensive.”

But the common availability of these tests does not guarantee that the growth of the coronavirus will be slow. “This is a good way to expand the availability of testing, but we need to think more carefully.”

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