In many parts of the world, rapid COVID-19 testing is part of daily life. Despite the FDA emergency use authorization and the advocacy of many infectious disease and public health experts calling for more widespread use, the role of at-home rapid antigen tests remains unclear in the lives of most Americans. This is unfortunate, as these tests are valuable and an underutilized resource in our tool kit for living with COVID-19.
My fully vaccinated husband recently woke up with a mild cough and a headache. Having read about rapid at-home tests during the delta surge, I bought several boxed test kits to keep on hand. My husband tested positive. We quickly pulled out two more tests — one for me and one for our toddler. She was positive, I was negative.
We quickly jumped into crisis mitigation mode. My husband emailed our Seattle area day care and scheduled us for PCR tests (often nasal swab) while I texted the other parents whose toddlers share a classroom with ours. The parents all responded saying no one had been symptomatic, and folks started texting their testing plans for the day. The day care director was able to quickly review current protocols and decided to close the affected classrooms the following day. We were fortunate that our symptoms started on a holiday so that no one was at the child-care center the day my family started exhibiting symptoms. We received the results from our PCR tests 24 hours later, confirming the rapid antigen results.
This case study is a prime example of one of the many benefits of rapid at-home testing. My husband’s symptoms were so mild that he commented that most people either wouldn’t have gotten tested, or would have dragged their feet about it if it meant that they had to schedule an appointment or wait in line for a PCR test. Even if he had gotten a PCR test, with the lag time of results, we may have sent our daughter, who was asymptomatic, to day care the next day and possibly for several days after that. We likely would have waited to schedule tests for my daughter and myself until my husband’s returned positive, which would have further delayed the response time.
We now know that when my daughter tested positive on the rapid antigen test, she had levels of virus in her system that were likely high enough to be contagious. Several more days of her going to day care with dozens of unvaccinated classmates would have been a recipe for a COVID outbreak, one that was averted largely due to our use of a rapid at-home antigen test.
By most accounts, we have been lucky. We are not very sick, and with my recent booster as a health care worker, it looks like I may skate by without getting infected at all. But serious illness, hospitalizations and deaths are not the only measures of poor outcomes. Our day care had to close two classrooms for a minimum of five days, and my family has to be out of child care for 10. These closures affect the working productivity of dozens of parents. The negative impact of repeated and unexpected child-care closures on our mental well being is tremendous.
Much of this is avoidable with a combination of vaccines and widespread testing. In Europe, rapid daily testing allows day care centers to stay open without outbreaks. There, the tests are widely available and free, or they cost around a dollar. Here they are somewhat affordable — usually around $20-$30 for a two-pack — but not cheap enough to make them a practical public health tool for regular use. They can also be difficult to find. As a nation, we have poured so much money into vaccinations, but for the under 5-year-old set, vaccines remain elusive. Vaccines are part of the answer, yes, but until we can have a fully vaccinated population, accessible and affordable rapid testing is the missing link back to “normal” life.