How will testing for Covid-19 change in the future?

dr Matt Binnicker, an expert in diagnosing infectious diseases, talks about the future of Covid-19 testing and why we will be testing for this viral infection for years to come.

As Covid-19 swept across the globe in 2020, all eyes were on testing for the novel virus. Many asked: “When will tests be available?” then “Where can I get a test?” and consequently, “How long does it take for my results to be available?“Initially, testing was limited to public health labs and large reference labs. In some situations, individuals have waited over a week for their results, in part due to global supply shortages and a significant testing backlog. In 2021, access to testing increased as laboratories built capacity and at-home antigen testing became available. Now, in 2022, testing opportunities for Covid-19 are widespread as the US government sends out free tests to homes nationwide.

Unfortunately, Covid-19 is spreading again in many parts of the country. This suggests that testing for Covid-19 will continue to be important in the future. But how will that be? And will the testing approach change?

If you have a respiratory condition, you’ll likely be tested for multiple viruses, including Covid-19

In the first few days of Covid-19 illness, symptoms are often non-specific and can include fever, cough and sore throat. These symptoms can be indistinguishable from other viral infections such as influenza, respiratory syncytial virus (RSV), or common cold viruses. For this reason, diagnostic tests can be important not only to identify the cause of the disease but also to determine if treatment is appropriate. While cold viruses and RSV are usually treated with supportive care – rest, hydration, painkillers – there are specific therapies, including antivirals, available for influenza and Covid-19.

In recent years, it has become common for laboratory-based PCR tests to include both influenza and RSV, so doctors have results for both viruses if their patient has a flu-like illness. During the Covid-19 pandemic, some manufacturers have developed molecular tests that look for influenza, RSV and Covid-19 in the same test. This approach is becoming more common and will likely be an option for home testing. On May 16, 2022, the FDA approved the first direct consumer influenza, RSV and Covid-19 test, which allows patients to collect their swab at home and then send the sample to a laboratory for testing of all three viruses . Options that allow full sampling at home will likely become available in the near future and testing for these viruses.

If you don’t have symptoms, you don’t need to get tested

A somewhat unique feature of the Covid-19 pandemic has been the focus on testing asymptomatic people – that is, people without symptoms. This was important because of the early observation that asymptomatic carriers can spread the virus, with one study estimating that over 50% of infections result from asymptomatic transmission. Therefore, it was important to identify those who were infected but asymptomatic in order to control the spread of the virus and reduce the likelihood of unknowingly exposing high-risk individuals.

Despite the important role played by asymptomatic testing in the early years of the pandemic, it is an unusual practice and has required tremendous resources to achieve. Asymptomatic individuals are not routinely tested for other respiratory infections, such as influenza, although transmission can occur without symptoms. In the future, high rates of natural infection or vaccination, together with the increased availability of effective treatments for Covid-19, will reduce the incidence of serious consequences and deaths. Testing of asymptomatic people is done only in rare situations, e.g. B. before certain procedures or surgeries where a person is at increased risk of a bad outcome if infected.

You can carry out a high-precision test in the comfort of your own home

The Covid-19 pandemic has ushered in a new era of innovation and likely increased the pace of diagnostic development by 5 to 10 years. Due to stay-at-home, remote work and school orders, and the importance of limited social interactions during the pandemic, there has been a great deal of emphasis on developing at-home sampling and testing facilities. There are now several Covid-19 antigen tests that can be done at home; However, these tests can miss some infections, especially when low levels of virus are present. In the future, home tests will be available that use molecular technology (e.g. PCR) and provide rapid and highly sensitive Covid-19 test results.

If there is a silver lining to the Covid-19 horizon, it is that the pandemic has accelerated a future state where novel diagnostics are more user-friendly, convenient, accessible and accurate.

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