We need home-based testing for COVID-19 — and more

OPINION: Home testing could help us deal with future pandemics or even just seasonal bugs. We should be working out the details now
By Matt Gurney - Published on Oct 01, 2021
This week, the Ontario government further limited when and where at-home COVID-19 tests can be distributed. (Zou Zheng/Xinhua via ZUMA Press)



There’s a story I’ve told here before, but it keeps coming to mind as the pandemic grinds on. In 2013, when my eldest was a baby just entering daycare, she brought home a bug and passed it on to my wife and me. My wife, a teacher, went through the immune-building process all elementary-school teachers do in their first years, at the end of which, they’re immune-system champions. Alas, my own system never went through that immunological bootcamp, and, like many new parents, I found myself suddenly getting all kinds of weird infections and illnesses I hadn’t even thought of since I’d been a child myself. 

In December 2013, it was, of all things, an ear infection. I ignored it at first, assuming it was just a seasonal cold. It wasn’t until I quite literally fell down in my house due to my sense of balance going wonky that I bothered to see a doctor. By that point, the infection had spread. I ended up being quite seriously ill for weeks — never quite sick enough to need hospitalization, but my doctor did warn me sternly that I should take this seriously and that if the successive rounds of oral antibiotics didn’t start knocking the infection back, he’d send me to the hospital for stronger stuff via IV. I avoided that fate and finally rallied. 

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Like I said, I’ve told this story before, but it keeps coming to mind because the thing that got me into trouble was that, even when I knew I was getting sick and assumed it was just a cold, I had no way to verify that without going to a doctor, getting a swab, and waiting for results. In hindsight, that was obviously what I should have done in 2013, since that was the rare occasion when it wasn’t just a cold and was something that could be (and needed to be) treated. You can’t swab yourself at home, though. Testing requires scheduling a visit, and it was December, just before Christmas break. I was so focused on getting work done so I could take my holiday in peace that I just didn’t make time to see my doctor until I could no longer stand up straight.

You probably see where I’m going with this by now, dear reader, but, if not, I’ll make it explicitly clear: with COVID-19, we actually can screen ourselves at home. Rapid-testing kits, of acceptably high accuracy, can be self-administered by an adult or given to a child by their caregiver. Some of these kits are approved for use in Canada; during the recent federal-election campaign, you might have seen reporters tweeting about administering the tests to themselves on a regular basis as part of being permitted to follow the party leaders on their national tours. They aren’t as accurate as the PCR tests you receive at a health-care facility, but they’re accurate enough to be a useful screening tool. 

And, in Canada, we barely use them. They’ve been used in some niche applications (the election example above is one), but there has been a baffling reluctance to roll them out widely. Our American friends can buy them at Walgreens ($23 will get you two kits in a box for at-home use with results in 15 minutes). It’s always possible for Canadians to obtain such things, if they’re willing to put in the cash and the Googling, but there is no widespread availability in Canada. Indeed, this week, the Ontario government chose to further limit when and where the tests can be distributed.

Throughout the pandemic, it has been easy to imagine worse scenarios than the ones we’ve actually lived through. What if COVID-19 had attacked children as aggressively as it did the elderly? What if we’d been hit by something as virulent as Delta in the first wave? What if the vaccines had simply taken another year or two to arrive? But we can also imagine better scenarios, both for how we could have responded to COVID-19 and for how we might respond to other pandemics or just seasonal bugs in the future. Widely available and accurate home-based testing ticks both those boxes.

Imagine if, when my symptoms first hit in 2013, I’d been able to test myself to detect the presence of the staph bacteria that ruined my next three weeks or to exclude more mundane explanations, such as the common cold. I’d have made a point of seeing a doctor earlier. There’s a nasty sinus infection loose in Ontario now; my son picked it up last month and gave it to me, but ruling out COVID-19 still required booking a test and waiting. We could do better than this now, and it’s incredible to think of how much further we could go in the future. None of this is intended to replace timely access to family medical care, which is a major problem we must continue to work on. It’s about augmenting it and even complementing virtual medicine: How useful would a doctor talking to a patient via Zoom or telephone find it to be told, “I just did a test at home, and it ruled out X, Y or Z.” Or detected the presence of this or that germ or virus?

This is still somewhat aspirational, as there would be technological and financial hurdles to overcome. But this is an example of something we could do better at starting immediately and then potentially do vastly better in the future. It’s been hard to find cause for hope these long many months, but this is an example of an area where we really could build back better — and should.

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