Home Testing Safe, Efficient Early in COVID-19 Outbreak

By Anne Harding

March 18, 2020

NEW YORK (Reuters Health) - Home testing for infection with the 2019 novel coronavirus offers a feasible alternative to testing at the hospital, according to a new report.

"In the early part of an outbreak, like this one, we found home assessment to be a very important tool to help test people outside of the hospital," said Dr. Chloe Bryson-Cahn of the University of Washington School of Medicine and Harborview Medical Center, in Seattle.

"This method saved tremendous resources and time for our hospital," she told Reuters Health in an email. "But as cases start to rise, thinking about drive-through or walk-in testing opportunities to safely test larger numbers of people makes sense."

The Harborview Home Assessment Team (HAT) was originally developed, in collaboration with Public Health-Seattle and King County, to test quarantined patients for Ebola virus, although it was never implemented, Dr. Bryson-Cahn and her colleagues note in Clinical Infectious Diseases. They reworked HAT in response to the 2019 novel coronavirus (SARS-CoV-2) outbreak, and launched it in January.

"In an early outbreak, testing is crucial to help isolate and quarantine cases," Dr. Bryson-Cahn said. "Once cases rise, testing is best reserved for folks at high risk of spreading the infection and for vulnerable patient populations."

The HAT tested 15 patients for SARS-CoV-2, and found two positives. Patients were isolated in single-family homes and commercial properties, and all said that being evaluated at home was "highly acceptable."

Dr. Bryson-Cahn and her team provide a detailed description of the testing procedure, which takes about three hours from dispatch to return, in the article.

A member of the team, which includes one physician, one nurse, at least one trained personal protective equipment (PPE) observer and a site commander, first contacted the patient to make sure that he or she didn't need emergency treatment or hospitalization. The HAT member discussed visit details with the patient, planned locations for donning and doffing PPE, and registered the patient with the hospital.

The authors also describe procedures for handling samples after collection, doffing PPE, and waste disposal. Each HAT member logged their temperature and respiratory and gastrointestinal symptoms every day for two weeks, or until a test for SARS-CoV-2 came back negative.

"Given the current community spread in Seattle, our goal is no longer to identify and quarantine cases, but rather to keep people home who are sick and don't require medical care, to increase social isolation to decrease transmission, and to save resources in the hospital so we can deliver appropriate and safe care to those who do require emergency care," Dr. Bryson-Cahn said.

"We want people to think creatively about ways to approach evaluation of patients outside of the traditional healthcare setting, to evaluate their use of PPE and conserve whenever possible, and to use every opportunity to train their staff so they are ready when this infection comes their way," she added.

SOURCE: https://bit.ly/33qydzh Clinical Infectious Diseases, online March 13, 2020.