Commentary: Free rapid at-home coronavirus tests could make pandemic life easier

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On Friday, July 30, my band took the stage at the local pub for the first of a two-night stint. We were all vaccinated, as were all of our friends in the audience. We hadn’t performed since before the pandemic and poured our hearts out onstage and off it, hugging, chatting loudly in each other’s faces during breaks and singing at full volume. Back home with the babysitter, as we later found out, my son was developing the first symptoms of covid-19. By Sunday, my wife and I had symptoms, too, followed by my daughter on Monday. But we luckily didn’t infect all our friends because before I could return to the pub Saturday, we used a rapid antigen over-the-counter coronavirus test to test our son, got a positive result within 15 minutes, and immediately canceled everything. As far as I know, no one in the band or among my friends at the bar came down with covid-19.

In our long and ongoing battle against the coronavirus, these rapid tests are underutilized and under-discussed tools that have great potential to help us assess risk and keep each other safe at a time when the delta variant has made everything so complicated. I follow the news about the pandemic closely and have been writing about parenting, education and vaccines especially throughout. Nevertheless, until we ran to the drugstore to see whether we could get a rapid test, I only vaguely knew they existed and had the sense that they were just too inaccurate to be useful.

Since then, I’ve had conversations with friends and colleagues who were operating under the same misconceptions. This isn’t a coincidence, I think, because there’s been almost no public health messaging about this type of test – and little to no distribution to people who can’t afford them. But these rapid tests are inexpensive, easy to use and, when used in volume, could be a vital tool to make the school year safer and allow us to cling to some of the fragments of public life that the delta wave is threatening.

Our problem for testing our son was accessibility. He’s a 14-year-old autistic boy with Down syndrome, and he does not spit, so saliva tests are out of the question. He’s also very defensive of his body, which is good because people with developmental disabilities need to be encouraged in their bodily autonomy. But that means that shoving a swab deep into his nasal cavity is pretty much out of the question. The rapid tests, by contrast, were easy. My wife and I sat on the couch with him and showed him with cotton swabs how to rotate it just inside our nostrils, then gave him the test swab. No problem – we counted five circles per nostril together, and like that we had our sample. The unfussy process was a relief, especially because we were so sure it was just a cold, but the sample immediately came up positive for the coronavirus. Fifteen minutes later – the directed wait time for the test – it still showed positive.

There’s nothing new about this technology or the understanding of how it might be useful if deployed widely. It’s true that these tests also aren’t as accurate as the various kinds of laboratory tests, and I definitely had the sense over the past year that they were totally unreliable. But that’s just wrong. False positives are rare because the test rarely finds the coronavirus unless there’s virus to find. False negatives are more common, with higher accuracy during peak infection and if symptomatic, but lower in other situations. The FDA recommends serial testing as needed.

But they’re still hugely useful for circumstances when speed trumps accuracy. For us, any time anyone in the house has a sniffle, we’ll be testing before work or school, with time enough for me to still make breakfast and pack lunchboxes. The key is to understand that while in some circumstances, accuracy is the most important feature, even if the accessibility isn’t so critical in your household, speed and ease may still come into play. There have been so many times during the past year and a half where I wanted to quickly evaluate risk to the best of my ability, and surely that’s true for almost everyone.

Scientists in this country and public health leaders elsewhere agree. Epidemiologist Michael Mina has been advocating massive investment in rapid at-home testing since last year. Germany has provided free tests to everyone since winter (though is considering ending the program). As of April, you can get a seven-pack free at any pharmacy in the U.K. There’s no real reason that we couldn’t implement similar policies in the United States, but we haven’t: Instead, one of the makers of rapid tests told their factory to destroy inventory and scale back production as of June, convinced that the pandemic was over. Now they are hard to find, even though interest in them is surging based on recent search statistics.

In this country, they also aren’t free. We paid $23 for two tests and went through a total of six in the following few weeks. We can afford the $75, but lots of people can’t. What’s more, once we had my son’s positive result, there was no way to use it to notify a public health authority and jump-start any necessary tracking and tracing. When my wife got a positive test of her own at a pharmacy, it triggered a Minnesota covid-19 alert app on the phones of everyone who had been near her Friday (including mine). But we had no way, other than sending texts and emails and posting on social media, to alert people who had been with us at the pub. It was a crowded room, and I do worry about the people who were in the audience but not in my friend groups.

Both of those issues could be alleviated if we wove them more fully into the fabric of civic life, both distributing them more freely and offering people more formalized mechanisms for reporting their results.

Imagine if once a week, each student, teacher and staff member at your local school took a rapid test, with positive results meaning quick quarantines, isolation and more robust testing to identify and lock down infections before they spread wildly. Throughout the pandemic, one of the big problems has been the way the virus spreads before symptoms manifest and that it spreads in the delay between the desire to get tested, the actual test and the reporting of results. Rapid tests can help mitigate that risk. And even at a more local, personal level, they might help limit the spread of the virus, as they surely did when they kept me from exposing my bandmates to possible infection on the planned second night of our reunion gig.

Over-the-counter rapid tests aren’t going to end the pandemic on their own, but that’s true of everything, including vaccines, masks, monoclonal antibodies, distancing, quarantine and, yes, laboratory tests, too. As Ed Yong wrote in the Atlantic recently, America ” went all in on one countermeasure – vaccines – and traded it off against masks and other protective measures.” The delta variant should restore some humility to our public health leadership and to each of us as we figure out what comes next. I know that throughout the pandemic, we’re going to have a set of tests in our medicine closet, ready to help us assess risk and protect our family in the hard months ahead.

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David Perry is a journalist and senior academic adviser to the history department at the University of Minnesota. He is the co-author of “The Bright Ages: A New History of Medieval Europe.”