Do over-the-counter COVID tests make our communities safer? The COVID-19 pandemic has driven a significant mobilization towards ensuring that information we all need to live our lives during a pandemic is readily accessible. Part of this is knowing whether we or others in our community have the virus. Fortunately, at-home testing is widely available. But is it helpful?

FOR THE INDIVIDUAL:

Most home COVID tests are known as “rapid” tests, which means that results are typically available in less than an hour. They vary from the less rapid “diagnostic” tests in that they detect viruses differently. The rapid tests, antigen testing, check for evidence of viral particles in your nose/mouth. In contrast, the diagnostic tests, PCR, check if there is evidence of the material that the virus uses to replicate itself. PCR is considered higher quality as it can give a positive test earlier in infection when there is less virus floating around in a person’s body. It is also more expensive and requires more specialized laboratory equipment to do. Home tests are thus attractive, although they come with caveats.

Home tests are less accurate where not all people who are truly COVID positive will test positive, and not all people who are COVID negative will test negative. If one communicates with their healthcare provider, one should be able to work around this to an extent. If you have an unexpected test result, a “confirmatory” PCR may be done. There may also be sufficient clinical evidence for your provider to recommend a quarantine regardless or suggest that it would not be needed. Talking with your provider is the best thing you can do with these tests because medical science is complicated, and it is hard to make sense of it, even for healthcare professionals.

The accuracy of home testing can also vary between brands. Naturally, all tests are designed to make the best test possible. Unfortunately, consumer technique, virus, or manufacturing/storage variation can deter this desirable perfection. Fortunately, most brands are pretty good, though this illustrates the importance of communicating with your healthcare provider to ensure that you or your family members make the best healthcare decisions possible.

FOR PUBLIC HEALTH PURPOSES

Over-the-counter testing is attractive because it improves the accessibility of healthcare information. Individuals can obtain information needed to guide their actions and support public health measures flexibly and cost-effectively. While a clear advantage, there are issues with this. One could argue that consumers may not respect test results or use them as a means to justify risky behaviour. Surely now that we are over two years into the pandemic, we all understand the profound implications of the virus on ourselves and those with whom we come into contact.

A point of contention that is unfortunately not resolved is the impact on public health tracking of the disease. Many of these at-home tests lack any result reporting methods. While this should arguably be inconsequential given that those who test positive can be assumed to reach out to their healthcare providers or employers and report their status, which should then be reported to public health, valuable data can be lost in this pipeline.

Knowing the number of individuals concerned enough about COVID to test themselves, the number of tests that are positive out of all tests, and the geographic distribution of these statistics could guide public health efforts to focus on the communities that need more attention. While the number of positive tests can be used to direct resources, there is value in a more complete picture that would require these at-home tests to inherently involve result reporting, regardless of the outcome.

Fortunately, some tests already do this where one must use a mobile app to get the result or at least an “official” result. However, some tests do not involve this. While not requiring a smartphone to get one results improves the accessibility of diagnostic care because not everyone has or can afford a smartphone, it, regardless, leads to loss of information.

COVID-19 has improved the availability of medical diagnostics for the average individual. Inexpensive or free diagnostics have become widely accessible and offer flexibility that was not present in the past. While at-home COVID-19 tests are helpful, they are imperfect, and they are best used as adjunctive tools to services offered by healthcare providers. They also have their uses on the public health level, though they come with caveats considering that not all results are reported to epidemiology offices.

When the next pandemic rolls along, as we know that it will an undefined amount of time from now, hopefully, manufacturers and public health groups will take the lessons learned from our current pandemic to produce a more effective and cohesive response.

Reference: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8196235/