A Defense of Self-Testing and Supported Self-Isolation

(Posted on Friday, September 11, 2020)

In a recent CNN article, I proposed a new way of containing Covid-19. The strategy would be a self test and supported self isolation approach, but some are skeptical. Rapid antigen testing at home for Covid-19 on a daily basis increases the chances of stopping the virus from spreading. Many claim the plan is impractical and that antigen tests are ineffective. Antigen testing catches the infection when it is at its most contagious. Having the public self test and financially assisting the quarantined will stop the spread of Covid-19 and control this pandemic.

The strategy to defeat Covid-19 revolves around the free distribution of rapid, saliva based tests that are self administered at home. People are most contagious shortly after infection and before symptoms even appear, then slowly decrease in contagiousness over a ten day period. This is the period when testing and isolation is necessary. With regular at home testing, people can check themselves for the virus before symptoms occur. They can then isolate if they test positive, regardless of if they have symptoms.

It would require roughly one hundred million tests per day to rest the US population every three days. These tests could cost as little as fifty cents. Administering one hundred million tests daily at fifty cents each for one hundred days would cost roughly five billion dollars, or less than one percent of the annual military budget.

Critics claim this strategy is reliant on a type of testing that results in far too many false negatives. Antigen tests may miss between five and twenty percent of people who are RNA positive. However, people who test both antibody negative and PCR positive are only contagious about five percent of the time. No infectious virus is recoverable from people below the antibody test detection limit. In other words, no more than five percent of those actually contagious should slip through universal home testing for antigens. A ninety five percent success rate at detecting contagious infections would be a huge step in the right direction.

PCR testing as done today misses up to ninety percent of all those contagious and actively spreading the disease. PCR testing has such a high miss rate for many reasons. First, PCR tests are not universally available. They are hard to access and are mostly reserved for the worried or the ill. Only about forty thousand people get tested every day. Second, most people who are contagious do not even know that they are infected. Many have no symptoms and do not have any reason to get tested. Third, the turnaround time for the results may stretch to a week or more during which people are contagious. The reason for testing is to stop the virus from spreading, not to understand who was sick last week.

Skeptics will suggest that antigen tests cannot be home based for one reason or another. They cite the necessity of trained administration in a certified lab. These at home tests are comparable to another at home test with life altering implications: pregnancy testing. Partners have been testing themselves for pregnancy for decades. These tests are not one hundred percent accurate, but produce reliable enough results to be a mainstay of modern society. They are also simple to self administer, so why should a rapid antigen test be any different?

The assumption in this strategy is that the entire public will comply with it, which critics point out as improbable. It is true that not all will use the test. Some who do use the test may conceal a positive result for themselves or their children. That is why workplaces and schools should have their own spot checks. The University of Illinois is requiring that all students and faculty get tested twice a week to avoid spreading the virus. This kind of community responsibility is encouraging, but we can do better. With some exceptions, most people would comply with testing procedures because they want to return to normal life. Americans have been ravaged by the pandemic for six months. Were an ambitious solution available to return them to normalcy, they would take it.

To further incentivize compliance, assisted quarantine includes a daily cash stipend to compensate for lost wages and safe housing for those who do not have it, per day per household. The isolated would be assured food and medical supplies as well. There has to be help for people that agree to quarantine. About one hundred thousand households would need assisted isolation a day for three months. Presuming about five hundred dollars per family per day for food, shelter, and income compensation, the cost of the three months would be about fifty billion dollars.

Totaling fifty five billion dollars, the Covid-19 self test and supported self isolation approach would contain the spread of Covid-19 months faster than relying on a future vaccine. It would save the US trillions of dollars in lost productivity and spending. The skeptics question this strategy’s ambition, but ambition is necessary to control a global event like Covid-19.

Read the full article on the Forbes website.

Originally published on September 11, 2020.