Early in the first wave, when we were all locked down and COVID-19 was still very poorly understood, I idly speculated about what it might mean if the virus were really as deadly as we originally feared (thank God it wasn't). Viruses are notoriously difficult to defeat, and vaccines normally take years to create. There was a real possibility that we would be stuck, for many years, with a deadly virus that we couldn't effectively treat or vaccinate against. Staying at home was a short-term measure — at a certain point, we would not only all go bonkers, but also be starving when we did. The economy is something we normally think about in the abstract, but it is very much a real thing, and without it, stuff that we need to live — food, medicine, energy, essential tools, appliances, and building material — doesn't get grown, built, or distributed.
It didn't go that way, as noted. COVID-19 is dangerous enough, more dangerous than too many give it credit for, but it's not deadly enough to a wide enough swath of the population to be a civilization killer. And our vaccine-development efforts have been astonishing successes; a medical miracle is unfolding before our eyes. But during that first-wave pondering session, it was still possible that this was going to be a major, long-term challenge.
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What the hell were we going to do about it?
The concept is rich for dystopian sci-fi solutions, but it occurred to me that there were two likely solutions to that kind of problem that didn't involve leather-clad road warriors looting supplies or human-hating cyborgs roaming the ruins of our cities. The first solution actually has been used effectively elsewhere — a hard, hard lockdown. Like, a real lockdown, as we've seen in such places as Australia, New Zealand, and Israel. Imposing hard lockdowns, when needed, followed by a rapid reopening, was one obvious way we could have dealt with COVID-19 in the long-term, had major adaptations been necessary. The other was far more palatable: make testing so fast and routine that it becomes a part of almost everything we do.
When I had this idle notion, rapid testing was as much a sci-fi idea as the killer cyborgs. Ontario was then struggling to get its lab testing above a few thousand a day, and there were long processing times to get those results back. But it wasn't hard to envision a future in which we had designed testing kits accurate enough, simple enough, and affordable enough to use them everywhere. Imagine going into a shopping mall but stopping for a five-minute swab test first. Or imagine dropping your kids off at school, and they all line up by class and get tested on the way in. Imagine this everywhere — restaurants, hospitals, transit systems, and, of course, those essential, civilization-sustaining enterprises I mentioned above. If you can't beat it, or vaccinate against it, you have to detect and isolate it.
My late-night musings were still somewhat grounded in reality, and I was not blind to the obvious challenges involved in this approach. It would add costs and delays. It would be expensive. It would raise civil-liberty concerns. At best, you could probably use such a system defensively, to protect key sites and industries, and even then, perhaps only on a rotating basis.
But it could work, so I speculated even further: What if the way out of this was a home-based COVID-19 test that you took before leaving the house? If you get a green light, your phone gets an updated code, and you're good to go for 24 hours, tapping in and out of places as you please. Thinking about what would happen if you got a red light takes us back down some of those dystopian paths; if we've learned anything this last year, alas, it's that we can't rely on people to make the right decision because they're honourable, smart, and civic minded. We've all heard stories about impaired drivers trying to get around their ignition-interlock devices. Imagine what people would do to evade a home-based COVID-19 test if they were worried they had it but didn't want to stay at home for two weeks. Still. The idea had at least theoretical appeal.
All this came to mind when I got a note from my children’s school. In co-ordination with Michael Garron Hospital (the former Toronto East General), 130 schools in eastern Toronto have received take-home COVID-19 testing kits. Our school is one of them.
These aren't quite the sci-fi kits I'd dreamed up a year ago. But it's a step in that direction. If a child is sick with symptoms or has been exposed, a test can be picked up at school. An oral-nasal swab is rubbed inside the mouth and nostril (it's not one of those deep, probing swabs we've heard so much about) and then dropped off at a collection site. The swab is tested at the hospital and results reported back.
The aim of the program is to make testing so easy that families will be more inclined to test if they have any concerns. It will also help get kids with negative tests back into the classroom sooner. It's a wonderful idea — I had both my kids tested last fall for COVID-19 after they had cold symptoms, and I'd have jumped at something like this if it’d been available. With vaccine procurement and distribution still running slowly in Canada, and many months left on the school calendar, this program could be very useful, especially if Ontario experiences a third wave before we vaccinate ourselves out of this mess.
It's likely that we'll have brought COVID-19 under control before we invent the kind of cheap, accurate, and simple tests that anyone could use at home. Perhaps that'll be an idea we have to save for the next pandemic. But home-based testing, particularly for essential workers and school students, is a great idea that we should definitely remember. You don't need sci-fi-level technology when a smart use of what you've got will work almost as well.