Why cheap paper COVID-19 tests could be another public-health failure

OPINION: If they work, dirt-cheap coronavirus tests could make us all safer — that is, if public-health agencies can get out of the way
By John Michael McGrath - Published on Sep 01, 2020
Public-health officers were initially ambivalent about or even hostile to the idea of face masks as an anti-COVID-19 measure. (iStock/Shinyfamily)

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If we had a cheap, easy-to-use, and reliable test for COVID-19 that people could access in far higher numbers than current tests allow for, would we use it? According to some of the leading public-health officials in Canada, the answer is no.

“Without the guidance of a health care professional, there is a significant risk that a patient could use the home test kit improperly or misinterpret the results,” a Health Canada spokesperson told the Globe and Mail in a story published this week. Worse, a test conducted at home wouldn’t necessarily be reported to public-health agencies, meaning that they wouldn’t be able to properly track cases in their databases.

Ontario’s chief medical officer of health, David Williams, said much the same thing on August 20, expressing substantial reservations about the prospect of paper-based COVID-19 tests: “We have to be fairly rigorous about this … a test result may seem satisfying, but if you’re led down a garden path on a false positive, that can have impacts, and we don’t want people misled that way.”

What’s at stake here is whether Health Canada will approve paper-based COVID-19 tests — and whether provincial public-health agencies would then incorporate them into their response to the pandemic. In theory, such tests could be taken at home (perhaps simply by spitting on a paper strip) and cost only dollars each — far less than current methods. While even proponents acknowledge they would likely be less accurate than the current testing methods, they’d still probably be accurate enough to be useful, especially when someone is most infectious. Epidemiologist Michael Mina, of Harvard University, has been one of the more prominent advocates of this kind of testing, and several companies are working on these kinds of tests.

But for this approach to work, public-health officials would need to think about these kinds of tests not as replacements for the current methods, but as a whole new layer of screening. If the tests prove cheap enough and abundant enough, someone could, potentially, take one every day to make sure that they weren’t one of those asymptomatic people unwittingly infecting others or to confirm that their symptoms were of COVID-19, rather than something more benign. If they got a positive result from their at-home test, they could follow up with a more traditional test.

The concern about false positives is a real one, but it’s also a manageable one: women can buy home pregnancy tests at a dollar store, but they’re still advised to follow up with an OB/GYN if they get a positive result. There’s no real reason to believe that the public is incapable of following similar advice when it comes to COVID-19: test at home, but get the result confirmed by someone wearing a lab coat (and, in 2020, an N95 mask and a face shield).

What’s more, these kinds of tests could dramatically reduce the need for the more expensive tests Ontario has been relying on for months: on Sunday, the province conducted more than 25,000 tests to find 114 positive cases. The large majority of those tests might have been avoided if people had a reliable at-home alternative.

Certainly, “reliable” is the key. Although multiple companies are at work on this, it’s possible that no one will come up with a test that even proponents would say is accurate enough to be released to the general public. In that case, harm would be done only to company shareholders, who would be slightly less wealthy than they otherwise would have been. But, at the moment, it looks more likely that a usable test will be delayed in Canada by a kind of not-invented-here syndrome in our public-health bureaucracy, at the cost of needless illness and deaths.

This suggests that our public-health officials really haven’t learned very much at all from the face-mask debacle of earlier this year. While public-health officers were busy being ambivalent about or even hostile to the idea of face masks as an anti-COVID-19 measure, the argument in their favour was brutally simple: even if face masks worked only a little to contain the spread, they are dirt cheap and can be adopted rapidly by the entire population, making them an intervention worth pursuing. We’re now learning that, in fact, face masks are more effective than we suspected at the outset of the pandemic, making the early reticence even more tragic.

Cheap measures that can be applied to a very large percentage of the population don’t need to be perfect; even incremental improvements in our pandemic control are worth pursuing if we can do them on a large enough scale — especially if it makes the difference between a reproduction number of 1.1 (the infection is slowly spreading) and 0.9 (the infection is slowly receding). Instead of worrying about whether the public is intelligent enough to use these measures properly, put the incredible power of modern communications technology to work so you can teach the public how to use them properly.

The good news is that at least some elected officials may be ahead of their public-health bureaucracy. After the Globe and Mail reported its story on Monday, federal health minister Patty Hajdu tweeted, “the official in this case misspoke and Health Canada is open to reviewing all testing solutions as they become available and are proven effective.”

The Ontario government, contacted by TVO.org this week, is more circumspect. Health Minister Christine Elliott’s office said only, “If and when a paper based test has been approved for use in Canada, recommendations for use in Ontario will be provided by the province.”

It would be better for Canadians if both levels of government could figure out where they stand on this. The prospect of Canada languishing while other countries move ahead with a promising new form of pandemic control — and then, perhaps, being forced to play catch-up as we had to with masks and other PPE in the spring — isn’t really one to look forward to.

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