With widespread home testing, there are new compromises

Almost every morning Melody Goodman walks her dog, makes tea and sits at her desk to manage the data.

Goodman, a biostatistician at New York University, pulls files from the city, Johns Hopkins University, and the New York Times and runs them through code she wrote to find out where we are in the pandemic.

The data, of course, shows an extremely high number of new COVID-19 cases and rising hospital admissions caused by the swelling Omicron variant – an increase she expected weeks ago.

However, those data could soon be a little less reliable, Goodman says, as the city expands the availability of rapid home tests, also known as antigen tests.

While the city tracks almost all PCR test results, it receives extremely limited data on home test results, although it plans to expand their use to tens of thousands of tests daily. There is no app for residents to log the results of their home tests. The state doesn’t directly track test results at home, a spokesman for the state’s health department said.

However, for Goodman and some other health professionals, greater availability of home tests is worth the price of less accurate test data, especially if it encourages people who test positive for the tests to stay at home.

“The type of data we can collect will thwart us. But everything in public health is a compromise, ”said Goodman, assistant professor at NYU’s School of Global Public Health. “I prefer people to do this risk assessment and act accordingly than have great public health data.”

The Omicron variant has brought new positive coronavirus test results to the highest levels during the pandemic, increasing demand for tests and creating long waits for PCR tests across town.

This has driven the demand for tests for at home, which are relatively rare in the city: anecdotally, the tests are sometimes more likely to be found in a mom and pop pharmacy than in a branch and in urban vans, where home tests are given out by long queues and limited supply.

But the city is rapidly expanding the availability of the tests, especially for students in public schools. On Tuesday, Governor Kathy Hochul announced that she would make 3.5 million tests available to the city to be used by people in classrooms where someone tested positive for the coronavirus.

In the past two weeks, the city’s test and trace program has been distributing more than 75,000 home test kits per day, according to Adam Shrier, the program’s spokesman. Test kits usually contain two tests.

Last week, Dr. Ted Long, who heads Test and Trace, that home testing could soon bring the city’s total testing capacity of public and private websites to more than 200,000 tests per day, up from around 150,000 today.

The city doesn’t keep a record of who gets the test kits it distributes or where the kits are distributed, Shrier said. If a person gets a positive result on a home test, they can contact the Test and Trace Corps for additional resources, such as: B. a hotel room to isolate them from family or roommates, but the result is not used for contact tracing.

Shrier said increasing the availability of home testing will allow New Yorkers to quickly disrupt chains of coronavirus transmission.

“Our COVID-19 data is used for monitoring purposes, and we are collecting enough information to give us a solid clue as to how COVID-19 is spreading across the city,” said Shrier. “This applies even to the spread of home tests. We have never been able to identify every single case of COVID-19 as those that are asymptomatic may not be tested. “

However, some epidemiologists fear that the increased use of home testing will turn the spread of the virus into something of a black box, potentially affecting their ability to keep track of where the virus is going.

“One of the persistent problems with this pandemic is that we catch up with infections as soon as they arise,” said Dr. Bruce Y. Lee, Professor of Health Policy at the CUNY School of Public Health. “What you want to do is get one step ahead of the virus. But that will possibly make this worse. “

Without an infrastructure to track home tests, the city will have a worse idea of ​​where infections are increasing in the counties, Lee said. Contact tracing for a positive test will not be conducted on positive results that the city is unaware of, he added.

Lee said he was concerned that this could exacerbate the existing health inequalities that the pandemic has exposed.

“Perhaps people aren’t diagnosed or treated properly soon enough, and once they’re seen they could have a worse case of COVID-19 by then,” he said.

However, increasing the supply of home tests will have other benefits, said Dr. Nathaniel Hupert, physician and public health researcher at Weill Cornell Medical College.

Hupert is currently on a sabbatical in the UK, where there was ample home testing until recently – and it was free. He is surprised at how liberating and relieving it is to have practically unlimited access to tests, even though home tests are less accurate than PCRs.

“You put enormous psychological stress on yourself, your family and your friends,” said Hupert. “It radically changes any interaction when you feel like you’ve done something to keep you from being the spreader.”

Hupert said the idea of ​​numerous home tests challenges traditional public health research methods, which rely on widespread reporting of test results to monitor infections in the population. It could be, he said, that foregoing a clearer picture of infections in exchange for greater security for citizens is a worthwhile compromise.

Imagine, he said, how much easier life in New York City would feel now – relatively – if you could quickly determine if your runny nose was just that and not COVID-19 without blocking your afternoon off to to stand in the cold a swab of the nose.

“I have seen myself that in a country where billions and billions of pounds have gone through it, it really changes the way you think about your ability to live in a pandemic,” he said.

And one way or another, according to Goodman and Hupert, our existing data picture is already flawed, as no level of government is doing the kind of proactive, random sample testing of the population that would give a really accurate picture of infection numbers.

“We don’t fly blindly, but we look in the rearview mirror of our car with a darkened windshield,” said Hupert, referring to a metaphor used by Cornell University’s engineering professor, John Muckstadt.

In fact, the unreliability of test positivity as a metric for monitoring the spread of the coronavirus caused Mayor Bill de Blasio to stop using it as a key element of pandemic decision-making in August. At that time, the total test numbers were decreasing, reducing the accuracy of the metric.

However, Goodman believes positive tests will continue to be an important metric for the city and health professionals as it doesn’t expect the PCR tests to go away anytime soon.

She stressed that, alongside PCR testing, masking, social distancing and vaccination, home testing should be viewed as just another “layer” of COVID-19 protection.

“This is an extra tool in our tool box, and COVID is something that requires more than just a hammer and screwdriver,” she said.

Goodman said the city or academic research facility should consider starting work on an app that residents could use to report their test results at home. Even though the Omicron spike is likely to end in the coming weeks, we’ll need it for the next variant, she said.

“We will live with COVID,” she said. “We have to think about how we live with it.”

About Clayton Arredondo

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