Learning to Protect Communities with COVID-19 Home Testing Programs
Posted on by Dr. Francis Collins
With most kids now back in school, parents face a new everyday concern: determining whether their child’s latest cough or sneeze might be a sign of COVID-19. If so, parents will want to keep their child at home to protect other students and staff, while also preventing the spread of the virus in their communities. And if it’s the parent who has a new cough, they also will want to know if the reason is COVID-19 before going to work or the store.
Home tests are now coming online to help concerned people make the right choice quickly. As more COVID-19 home tests enter the U.S. marketplace, research continues to help optimize their use. That’s why NIH and the Centers for Disease Control and Prevention (CDC) are teaming up in several parts of the country to provide residents age 2 and older with free home-testing kits for COVID-19. These reliable, nasal swab tests provide yes-or-no answers in about 15 minutes for parents and anyone else concerned about their possible exposure to the novel coronavirus.
The tests are part of an initiative called Say Yes! COVID Test (SYCT) that’s evaluating how best to implement home-testing programs within range of American communities, both urban and rural. The lessons learned are providing needed science-based data to help guide public health officials who are interested in implementing similar home-testing programs in communities throughout their states.
After successful eight-week pilot programs this past spring and summer in parts of North Carolina, Tennessee, and Michigan, SYCT is partnering this fall with four new communities. They are Fulton County, GA; Honolulu County, HI; Louisville Metro, KY; and Marion County, IN.
The Georgia and Hawaii partnerships, launched on September 20, are already off to a flying start. In Fulton County, home to Atlanta and several small cities, 21,673 direct-to-consumer orders (173,384 tests) have already been received. In Honolulu County, demand for the tests has exceeded all expectations, with 91,000 orders received in the first week (728,000 tests). The online ordering has now closed in Hawaii, and the remaining tests will be distributed on the ground through the local public health department.
SYCT offers the Quidel QuickVue® At-Home COVID-19 test, which is supplied through the NIH Rapid Acceleration of Diagnostics (RADx) initiative. The antigen test uses a self-collected nasal swab sample that is placed in a test tube containing solution, followed by a test strip. Colored lines that appear on the test strip indicate a positive or negative result—similar to a pregnancy test.
The program allows residents in participating counties to order free home tests online or for in-person pick up at designated sites in their community. Each resident can ask for eight rapid tests, which equals two weekly tests over four weeks. An easy-to-navigate website like this one and a digital app, developed by initiative partner CareEvolution, are available for residents to order their tests, sign-up for testing reminders, and allow voluntary test result reporting to the public health department.
SYCT will generate data to answer several important questions about self or home-testing. They include questions about consumer demand, ensuring full community access, testing behavior, willingness to report test results, and, above all, effectiveness in controlling the spread of SARS-CoV-2, the coronavirus that causes COVID-19
Researchers at the University of North Carolina-Chapel Hill; Duke University, Durham, NC; and the UMass Chan Medical School, Worcester, MA, will help crunch the data and look for guiding themes. They will also conduct a study pre- and post-intervention to evaluate levels of SARS-CoV-2 in the community, including using measures of virus in wastewater. In addition, researchers will compare their results to other counties similar in size and infection rates, but that are not participating in a free testing initiative.
The NIH and CDC are exploring ways to scale a SYCT-like program nationally to communities experiencing surges in COVID-19. The Biden Administration also recently invoked the Defense Production Act to purchase millions of COVID-19 home tests to help accelerate their availability and offer them at a lower cost to more Americans. That encompasses many different types of people, including concerned parents who need a quick-and-accurate answer on whether their children’s cough or sneeze is COVID-19.
Links:
COVID-19 Research (NIH)
Rapid Acceleration of Diagnostics (RADx) (NIH)
NIH Support: National Institute of Biomedical Imaging and Bioengineering; National Heart, Lung, and Blood Institute; National Institute on Minority Health and Health Disparities
I have some health problems post covid. I am always cold. Even when I am drinking room temparature water, I am getting a cough. I am worried about that. I have tested and the result is negative. My heart rate fluctuates sometimes. Is it a risk for the heart or it is the common issue after recovering the covid?
One would think of thyroid problems or gastroesophageal reflux: the latter can cause both cough and altered heart rhythms. After taking cortisone or anti-inflammatory drugs, it is very likely.
Of course, it is always the doctor who visits who establishes the diagnosis.
Why not use the saliva testing for SARS-CoV-2 instead of the nasal swab, especially for the pediatric population?
It is so difficult to determine at present what symptoms mean what, due to the different scenarios people may be in with regard to their health, to breakthrough infections in the vaccinated, to different symptoms manifesting with different strains, and with possible reinfection of people who may both have had covid and subsequently been vaccinated. Thus, testing remains extremely crucial in determining covid status. Thank you for this timely post Dr. Collins.
Testing is one the key weapons we have in this fight. Let’s hope that this along with vaccination mandates starts to turn the tide against the COVID enemy. 700,000 dead is too many.
Hi Dr. Collins, you reference “successful eight-week pilot programs this past spring and summer in parts of North Carolina, Tennessee, and Michigan.” Where can we see the results of these? Thank you!
On indigenous people’s day, should we consider the terminology of “intended” population when it comes to clinical trial design in a pandemic situation? Are break-through cases higher in populations who are not “the main intended cohort” used in clinical trial design? Some reports from areas with higher concentrations of “indigenous peoples” in North America would suggest such even with high vaccination rates. So the main question then becomes not so much about break through infections as much as whether those break through infections are life threatening.