Eleven days after she went to get a coronavirus test, Washington, D.C., resident Megan Bishop was still waiting for her results. An email reply from the public testing site informed her that they weren't ready yet, and to expect delays during times of increased demand.
Eight days later, she still didn't have an answer. Bishop eventually learned that a technical glitch was responsible for the slowdown. Nearly a month after she went to get tested, she received her results: negative for COVID-19.
Despite improvements since the beginning of the coronavirus pandemic, people across the country have recounted similar experiences with the testing process, receiving their lab results long after the 10-day period of self-isolation recommended by the Centers for Disease Control and Prevention (CDC) for positive cases. And it's a system that epidemiologist Michael Mina said isn't doing “much good” when it comes to halting the spread of the new virus, which so far has infected more than 5 million Americans.
The main reason: Scientists think people infected with the coronavirus (SARS-CoV-2) are most contagious from a few days before COVID-19 symptoms appear till a few days after they start. Meaning that by the time someone gets tested and receives the results, the information is less useful. At that point, the infection may be over and it could have already spread to others, rendering it too late to make effective use of contact tracing — the process of identifying and warning people who may have been exposed to an infected individual.
"We're contact tracing millions of people who don't need to be contact traced because they were actually infectious weeks ago. We're also quarantining millions of Americans for 10 or 14 days who haven't been transmitting for weeks by the time they got their result,” Mina, an assistant professor at the Harvard T.H. Chan School of Public Health, explained on a recent call with reporters. “And this isn't even taking into account the fact that result times are so delayed.”
Instead, he wants to see a testing strategy that doesn't just diagnose cases but also helps to stop them from happening in the first place. And the way to do that, he argued, is with fast, inexpensive and accessible at-home tests that can let people know their infection status on a regular basis — no lab or lab equipment required.
"If we can get a test that everyone wakes up and just like they put in their contact lenses, they take a test, and if it turns positive, they stay at home … it will stop the vast majority of transmission and cause these outbreaks to disappear in a matter of weeks,” said Mina, who has been calling for over-the-counter tests since the beginning of the U.S. outbreak.
"People can act on it because they're getting immediate results."
No lab, no machine
Right now, these tests do not exist. But a groundswell of support from public health experts has pushed the demand for rapid at-home tests to the forefront in recent weeks. In late July, the Food and Drug Administration (FDA) — the federal agency in charge of approving diagnostic tools — posted a template that allows for companies to apply for emergency use authorizations for tests that can be conducted and analyzed in non-lab settings, such as schools, offices and homes. An emergency use authorization allows for expedited approval of a test so it can come to market faster in a public health emergency.