Growing use of Covid-19 home testing leaves health authorities in the dark about unreported cases – Community News
Covid-19

Growing use of Covid-19 home testing leaves health authorities in the dark about unreported cases

WWhen fans of the band Phish across the country fell ill with Covid-19 after a Halloween concert weekend in Las Vegas, public health officials were largely in the dark about what appears to have been a super spreader event. In a mid-November Facebook post with hundreds of comments, concertgoers compared symptoms and positive test results, many of those taken from home tests. But that data has not been added to the public health figures of the spread of Covid.

It’s a story that’s becoming commonplace in the age of rapid home Covid testing: People who test positive are almost never counted by public health agencies tasked with controlling the pandemic. While home tests have obvious benefits — they’re convenient and quickly inform people of their infection status so they can take steps to prevent the virus from spreading — most who test positive don’t come to the attention of health officials unless they’re sick enough to see a doctor. .

Certainly, the growing availability of home testing is good news for a country that went through more than a year of the pandemic with insufficient testing resources. But as the US enters a second pandemic holiday season with the Omicron variant looming, state and local health departments are increasingly relying on incomplete data and educated guesses to capture ups and downs in the infection rate and guide decision-making. For example, home test samples are not submitted for genomic sequencing, which could delay identification of the Omicron variant in communities. And contact tracers can’t track cases they don’t know about.

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“If no one reports the tests, are we really getting the information we need?” said Atul Grover, a health policy researcher and executive director of the Association of American Medical Colleges. “We have no idea what the true positivity rate is.”

Grover and his colleagues have been monitoring the availability and use of Covid testing in the United States for months and are increasingly concerned about the black data hole that is home antigen testing, especially with cases on the rise again. The Biden administration last week announced plans to make home testing free and significantly increase testing availability. While these tests are still hard to come by, the Food and Drug Administration has authorized emergency use for 10 at-home tests for sale to consumers, with more coming online, so home testing is poised to become the primary Covid tracker. to become.

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Complicating matters is that health authorities have little idea how many home tests are being performed in their states and communities, and thus how many results they are missing. There is some evidence that home testing at the national level has already surpassed the number of PCR tests – which are processed by labs that are required to report the results to health authorities. In contrast, most home tests do not have a mechanism by which patients can easily report their results. Only two of the approved home tests include an app to report results, and it’s unclear if they are used in most states. Most people are also too busy to bother, and the Centers for Disease Control last month dropped guidelines urging users of home tests to report the results to public health authorities.

Mara Aspinall, director of Health Catalysts Group, an Arizona-based consulting firm that focuses on life sciences companies, has tracked test data using industry reports, test production figures, and a host of other sources. It’s nearly impossible to read exactly how many home tests are used each week in the US, but her best estimates show that home testing now makes up the bulk of Covid testing and the number will grow as more tests become available. Aspinall says, according to her count, there are about 40 million Covid tests performed each week. Of those, she estimates 12 million PCR tests and about 28 million antigen tests. Of the antigen tests, the vast majority are taken at home and never reported to public health authorities, she said.

The amount of home testing and the growing information gap are driving a shift toward managing the pandemic through personal behavior, leaving public health officials dependent on people’s own personal choices.

“Why are we testing at all? We test not to count the number. We’re testing to be able to give people the information to isolate the positives,” Aspinall said. “It would be much better if we knew how testing is done in an accurate, reliable and consistent way. But the most important thing is that people use the tests and use them effectively and regularly.”

STAT contacted public health authorities in 10 states now dealing with increasing Covid cases and found that none were able to track the data surrounding home testing. Officials in the states said they are confident in their Covid data and have minimized the impact of the home testing data gap so far. They said they use a patchwork of PCR test data, estimates, some self-reports and in some places wastewater samples to detect infection levels in their communities and guide health policy.

In New York, state health officials are heavily promoting a message for those who test positive, whether at home or in a doctor’s office, to follow Covid protocols, including isolation and quarantine. But in many other states, that guidance has faded from the public eye as political and popular will grows weary.

In Massachusetts, residents are urged to confirm rapid antigen test results with a PCR test, relying on hundreds of free testing sites across the state. But in less-funded, more rural, and Republican-led parts of the country, like Montana, widespread on-demand PCR testing simply doesn’t exist.

Public health authorities are quick to point out that at-home testing is a key weapon in the arsenal against Covid.

“We believe it is valuable for several reasons to continue making testing available — both monitored and unverified,” said Alicia Shoults, spokesperson for the Ohio Department of Public Health in an email.

“To the extent that more people test and report on their results, it gives us a better (albeit admittedly imperfect) picture of our overall case rates. And even when people don’t report, they use their test results to monitor their behavior related to going to school or going to work, informing family visits, so these tests can help slow the spread of communities and protect vulnerable residents.”

Grover said a solution could be as simple as adding a barcode to home test kits that link to a website or app that allows users to scan or call and report results. Michael Mina, a former Harvard epidemiologist and advocate of Covid home testing, recently joined a biotech software company, eMed, in part to solve the data reporting problem, he told the Boston Globe. The company is working with a home testing company on a test that would relay the results to local health authorities and come with a stamped envelope so consumers can submit positive swabs for sequencing.

Grover called for a national solution, adding that, as with all things related to the pandemic, communities of color are likely to be harmed by inaccurate monitoring of spikes. “The federal government needs to lead the way because it’s such a patchwork of not just inequality, but bad public health policies,” he said.

This story is part of a project funded by the NIHCM Foundation. The foundation played no role in the reporting, editing or presentation of this work.


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