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At-home COVID-19 tests have room for improvement


You've probably noticed that at-home COVID tests can be hard to come by. They're often sold out in drugstores, and when you can find them, they're not cheap. If you're lucky, you might get one for $7, but some online retailers charge close to $40. With U.S. COVID cases and deaths on the rise, the Biden administration has promised to make the tests more readily available. That includes free tests, but it does prompt another important question. How can we keep track of the results when people are testing in private at home?

We're joined now by Atul Grover, executive director at the Association of American Medical Colleges. Welcome.

ATUL GROVER: Thanks for having me.

GONYEA: You spoke to the online health publication Stat about a statistical black hole, the results of home COVID tests. What's the danger there?

GROVER: So I think we're making a lot of progress in terms of trying to get at-home tests available. The challenge right now is, as we ramp those up, we are missing a critical piece of information, which is, are those tests positive or negative? And how many are being done? The challenge is for public health professionals, and I think particularly now getting into the winter, where are we having surges? How bad are they? And are we having pockets of infections that we're not aware of because people aren't reporting the results?

GONYEA: On its website for self-testing, the U.S. Centers for Disease Control and Prevention does not include anything about reporting a positive test result. So basically, as long as those who test positive at home isolate for 10 days, there's no data, no contact tracing, right?

GROVER: That is the challenge. From a public health standpoint, you know, we've really kind of been behind the curve and going blindly as far as the COVID virus goes. The challenge is that to get ahead of this, testing has been a missing piece. It's getting better, but we're still missing the information. And quite frankly, when I saw the CDC guidance change last month, I really felt as if they were throwing up their hands and giving up and saying, well, we just haven't figured out how to collect the information, so we're going to give up.

GONYEA: So just a very basic question here - say I test myself at home, and I get a positive result. Are you saying I should report that to local public health officials?

GROVER: I'm saying you should report that to local public health officials. Depending upon which local public health department you're talking to, you may get a yes or a no. And if you ask the CDC, the answer is no.

GONYEA: OK. We should be clear, too, that these tests - the rapid antigen tests are different than the PCR, the molecular tests that are performed at labs.

GROVER: So any test that's actually done by a health care professional or in a laboratory or in a clinical lab, even if that's at a pharmacy, that does have to be reported to the CDC. And they are collecting that information, which is great. The tests that we generally do at home are antigen tests, which means you're really looking for little pieces of protein from the virus itself. And that's a really good measure of whether or not you're infectious. And so you may miss some cases, but you get about 9 out of 10 early on. And if you repeat that test in 24 to 36 hours, you get a result that's really almost as sensitive as the other type of test that you're mentioning that's - that has to be done in the lab, which is PCR.

GONYEA: So the test at home is a good thing.

GROVER: It's a great thing.

GONYEA: Let's be clear about that.

GROVER: It is a great thing. And I don't want people to have the impression that I'm saying these aren't worth doing. What I'm saying is we're not getting the full benefit of the information from a public health standpoint and helping everybody in a community and nationally if we're not collecting the results.

GONYEA: What's the potential impact of what we're missing, if we're not getting the data from home tests?

GROVER: So there's two big concerns I have at this point. One is, are we sure we're going to have enough home tests? But the second concern is that we really don't have a good idea of how many people in any given community on any given day are actually infected. And potentially, we don't have the ability to see ahead a little bit to know that there are pockets of infections. You've got to be able to get all the information you can because we're really trying to get ahead of this curve, and we haven't been able to do it for two years.

GONYEA: What are your basic recommendations, A, in terms of how we should be gathering information from these home tests, but also in terms of what an individual at home should do?

GROVER: So I think we need to make it as easy as possible for people to have these tests at home. If you look at the U.K. and other governments, they mail them to people's houses. I know that the Biden administration is now asking for insurers to pay for these tests, hopefully trying to bring the cost of the test down. So people should, if they think they've been exposed, take a home test.

But what we really need to do with that information, if we can get it, is to have that information reported so that every time these tests get done - again, the U.K. has a QR code on every single test, so the National Health Service gets the data if you're willing to report it. And I know some people won't be willing to report. That's fine, but we should at least make it easy for people who want to give that data to the public health agencies at the local level the ability to do that without, you know, having to go to extreme lengths.

GONYEA: That's Atul Grover, executive director at the Association of American Medical Colleges. Thank you so much for talking to us about this today.

GROVER: My pleasure.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.

You're most likely to find NPR's Don Gonyea on the road, in some battleground state looking for voters to sit with him at the local lunch spot, the VFW or union hall, at a campaign rally, or at their kitchen tables to tell him what's on their minds. Through countless such conversations over the course of the year, he gets a ground-level view of American elections. Gonyea is NPR's National Political Correspondent, a position he has held since 2010. His reports can be heard on all NPR News programs and at To hear his sound-rich stories is akin to riding in the passenger seat of his rental car, traveling through Iowa or South Carolina or Michigan or wherever, right along with him.