Self-administered rapid tests could bring quicker end to COVID-19 and the need to quarantine

With COVID-19 cases, hospitalizations and deaths climbing, policymakers understandably want a response that protects lives and livelihoods. Many have resorted to an old playbook of blunt mandates, including late-night curfews, travel restrictions, as well as school and business closures.

And while we wait at home, leaders have pinned hopes on a vaccine that remains months away from being widely available.

Unfortunately, these are public-health tools predicated on the assumption that it is impossible to know who has the virus. Therefore, we must treat everyone as infected.

However, the technology exists to equip everyone with knowledge of their COVID-positive status, using self-administered rapid tests. In fact, the Trump administration recently purchased 150 million rapid tests to distribute to those most in need. But this is nowhere near enough to collapse the outbreak’s spread. That would take, according to Harvard epidemiologist Dr. Michael Mina, half the population testing themselves with a rapid test every four days.

That requires more tests — a lot more — to transform the response to the virus. Paul Romer, a Nobel laureate in economics, argues that we need to test 50 million people per day, an investment he estimates could cost of $45 billion over three months. This is a snowflake in a storm compared to what has been spent to date in the response and the lives lost already.

Such a model would follow that being used by the NFL, which administers tests to players and other essential employees daily and requires a negative test before entering an NFL facility, along with other mitigation measures, including social distancing.

This approach would also meet Americans where they are: fatigued from both the virus and the response and resistant to additional mandates. It would empower us to know our own status and be reasonably sure others know theirs. Massive distribution of rapid self-tests for use in homes, schools, offices and other public places would replace ignorance with knowledge.

What’s in the way? Regulatory barriers, direct funding and leadership.

Realizing the promise of these tests must begin with the Department of Health and Human Services adjusting its regulatory posture. For example, one of the cheapest, most effective rapid tests, delivering results for $5 in 15 minutes, can give results at home, but HHS hasn’t cleared it for home use — not even under the supervision of a medical provider via telehealth. Instead, users have to mail it into a lab, when what’s needed to keep pace with the disease are tests with near-instant results that can be done by anyone. This restriction could be understandable if the test is difficult to perform, but it’s not.

In addition, Congress should immediately provide resources that would commit HHS to prepurchasing rapid tests over the next two years. Even if a vaccine is quickly produced and distributed, it is unlikely to reach healthy populations until 2022. During that time, additional rapid testing will be needed to ensure that the virus is contained and that schools and businesses can safely open and remain open.

And while testing capacity is ramping up, the CDC needs to provide better, clear guidance about who should get tested when. Its guidance remains conflicting and contradictory, with different web pages recommending different things.

President-elect Joe Biden has called for implementing widespread testing; President Trump should join him in that call. We have no time to waste. As we have entered a season of rising cases, we have already reached unprecedented caseload levels. Policies in place leave us no way to determine, on a rapid and widespread basis, who may have the infection and may be spreading it to others. And in response, people either are increasingly resistant to being told what to do and taking no precautions, or returning to their bunkers to wait.

These times require our leaders to ask hard questions, make difficult choices and pivot quickly as new tools and information become available. It’s time for them to look seriously at ramping up access to rapid self-testing, and do what it takes to advance it.