Self-Service Diagnosis of COVID-19—Ready for Prime Time? Article Swipe

As the world grapples with the novel coronavirus (COVID-19), experts have called for increased access to health care resources, including diagnostic testing, particularly in light of the recent expansion of the Food and Drug Administration's Emergency Use Authority to make such testing more widely available in the United States. 1 Despite rapid expansion, there are significant barriers to testing in ambulatory clinics, emergency departments, and hospitals, which are likely to see a substantial increase in demand.Such access points also pose risks due to overcrowding and nosocomial transmission.Current policy solutions are trying to eliminate financial barriers as well as facilitate additional points of access through increased use of telemedicine.However, telemedicine itself has limitations, because patients still need to go to a health facility to have a specimen collected and sent for processing.In the wake of this epidemic, other countries have expanded testing through "testing drive-thrus," which have also been employed in limited settings in the United States.Self-testing for COVID-19 has been proposed in the United States in a limited setting.We propose expanding access more widely with a self-service diagnostic pathway for COVID-19 using at-home nasopharyngeal swab collection. New Delivery ModelUse of an at-home nasal swab enables a diagnostic pathway for COVID-19 to be delivered remotely using widely available tools:• Step 1: Individuals experiencing symptoms would access a telemedicine service and be advised by a qualified clinician who would triage them and determine whether testing is appropriate per the latest CDC guidelines.• Step 2: Individuals able to be safely tested at home would receive a test kit through home delivery from a local distribution site; pickup at a local clinic, pharmacy, or public health center; or by mail; and then swab their nasopharynx themselves or with the help of caregivers.• Step 3: The test kit would then be delivered or mailed to a local laboratory, which would provide results to the individual and their ordering clinician. BenefitsThere are several benefits to a self-service model, including wider availability with lower costs and mitigated risk of exposure to the virus.Home testing would also decentralize care and promote social distancing, particularly for older adults who have already been identified as high risk because of the increased mortality for adults over 50 years of age.Decreased use of health care facilities during an epidemic also has the advantage of allowing scarce resources to be allocated appropriately.Simply put, teams in hospitals, emergency departments, and clinics can focus on the patients with the highest-acuity health care needs and minimize nosocomial risks.At-home testing could also promote health equity and patient-centeredness. Providing access to such testing could reduce language, cultural, or logistical barriers to seeking care at a clinic, +