Let us test for COVID-19 at home
This test could change everything about how we handle the pandemic — if only the FDA would let us normal people use it
One of the great frustrations of the coronavirus era is that most discrete acts of social distancing are objectively pointless. At any given moment, even if you live somewhere cases are spiking, you are probably not transmitting the coronavirus. Yet you don't know that — asymptomatic infection is not only possible but common — so you act as if you are contagious all the time.
But what if you could know? That's the possibility raised by the launch of a new antigen test from a New Jersey company, Becton Dickinson (BD), which announced Monday that the Food and Drug Administration (FDA) had granted emergency approval for facilities like pharmacies and doctors' offices to offer this quick screening. The BD test is easy, cheap, fast, and accurate. It could change everything about how we handle this pandemic. It could re-open schools, churches, and restaurants and allow us to visit elderly family with minimal concern.
If only the FDA would allow everyone to use it. Libertarians like me are always going on about how the government needs to get out of the way and let people make their own choices, but really, this time, the government needs to get out of the way. Widespread, rapid testing is now possible, and it is unconscionable for the FDA to prevent it.
This BD antigen test is remarkable in four ways: One, it's performed by swabbing the inside of the nose — there's no blood draw, and the swab isn't that long one that practically reaches into your brain — meaning it doesn't require laboratory personnel. Most people can learn to do this, contrary the FDA's repeated expressions of doubt in the average American's competency. (That doubt is why the FDA has only approved a few COVID-19 tests with at-home sample collection and none with at-home results processing. Meanwhile, average Americans somehow manage to self-administer tests, many with at-home results, for pregnancy, ovulation, ketosis, colon cancer, blood glucose, UTIs, HIV, Lyme Disease, Chlamydia, strep throat, and the composition of our genomes, among other things.)
Two, it only takes about 15 minutes to produce a result.
Three, it costs just $20 per test with an initial platform cost of around $300, and it's plausible that price could be lowered at scale. Another, similar test, from a company called Quidel Corp., can already be run for as little as $5 per use. Other, cheaper tests intended for daily home use are in development, too. These paper strip tests, even simpler to administer than the swab, would run as low as $1 per use. We'd need them in production to implement the kind of testing I'm suggesting; Becton Dickinson aims to ramp up to making 2 million tests per week by the end of September, which by itself is not nearly enough.
And four, the BD test is capable of 84 percent sensitivity and 100 percent specificity, which means it correctly identifies positive cases 84 percent of the time and negative cases all the time. A few false negatives will slip through, but this is high enough accuracy to make the test enormously useful. It gets us to a risk level that will be acceptable to the vast majority of people. (Frequent testing can also help catch the false negatives.)
The potential effects of a test with these attributes are incredibly appealing. I've argued that we should move outside for as many activities as possible if that's what it takes to approximate educational, religious, and commercial normalcy. But if a test like this were widely available, we wouldn't need to be outside.
Do you want to eat inside a restaurant with no bugs buzzing around your face and just have someone else fry you some potatoes and mix you a drink — fries and cocktails by someone else's hand, the luxury! The decency! Just show up 15 minutes before your reservation and take a test. All clear? Right this way to your table.
Do you want to be back in your office and off these dismal Zoom calls? Get swabbed at the front door, then wait in your car until you get a text to come inside. Mark brought in doughnuts, by the way.
Do you want your kids to be back in school because working remotely while "homeschooling" is simply not feasible (or, if you have the misfortune to work for Florida State University, not permitted) for another nine months? Get to the parking lot by 7:30 on Tuesdays and Thursdays, please, so there's time to get everyone tested before homeroom begins.
Do you want your church to resume in-person services, perhaps even with sacraments and singing? Arrive in time for the deacons to swab your nose. Babies whose families all test negative may proceed to the nursery, and children may go to Sunday School as usual. Sanctuary, indeed.
"People keep saying 'For that [price], I want to buy one for my house,'" said Becton Dickinson chief executive Tom Polen of his company's test. Yeah, so do I. And so, I suspect, do many schools, churches, and businesses of all kinds that require more sustained, in-person interaction than does a grocery store — to say nothing of families who have been worried that by visiting their grandmother right now, they could be shortening her final years.
Now that it is available at this ease, price, speed, and accuracy, routine testing could return us to something very close to normalcy. It could thwart unknown thousands of business failures and restore to millions the ordinary human interaction we need to flourish. The privatization and decentralization of the testing would allay fears of state coercion or invasion of medical privacy. And the testing itself would help lower overall infections as well, catching many cases that now go undetected.
The FDA has a moral responsibility to let this happen. It has a duty to back off.