One of the most critical elements to reducing the spread of the novel coronavirus, Covid-19, and providing health care to those who suffer complications is our ability to rapidly and safely test large numbers of people for the virus. At-home testing, which several organizations hope to soon introduce once guidance from the U.S. Food and Drug Administration (FDA) has been clarified, could play an important role in rapidly expanding the number of people who are tested.
The test that’s currently being performed in hospitals and clinics employs a polymerase chain reaction (PCR) molecular technique and involves a nasal swab usually administered by a trained care professional. It presents a major challenge in times of a pandemic like we are in now. We are hearing dozens of stories of patients, like 29-year old Katherine, who have to first understand if they are qualified to get a test, then go to a facility to get tested where they may inadvertently expose others to infection, including health care workers, and then if there happen to be tests available, get tested and wait days for the result.
To address this challenge, a paper we published last week in the Journal of the American Medical Association (JAMA) describes a straightforward and seemingly effective way to expand safe access to Covid-19 testing: at-home testing. Already there are reports of organizations planning to offer a home-testing option, including the Gates Foundation for individuals in Seattle and direct-to-consumer start-up companies. A recent HBR article includes home-testing as part of a comprehensive national response.
Here is how home testing would work. It starts with a telemedicine call with a clinician to determine whether testing is needed. A test kit would then be mailed to your home, where you would perform the test and then send your sample to a laboratory for analysis. While awaiting the results, you would remain self-quarantined. The entire diagnostic process is done virtually, and for the vast majority of people who are low-risk and can be safely cared for at home, the entire diagnosis, treatment, and recovery process can be done at home.
Such a service can promote social distancing — which is crucial for reducing the spread of the virus — and improve health outcomes by freeing up capacity for hospitals and clinics to provide care for people who truly need it.
The novelty of the solution is its simplicity. But if you take a deeper look, you will see that the success of such a service is predicated on a number of assumptions about how users will behave. Looking at self-testing for Covid-19 from a human-centered design perspective, it looks like the kind of behavior that we know how to solve.
To better understand what we mean, we can look at Covid-19 self-testing as requiring three fundamental shifts in behaviors.
The first is to encourage people to not run to a health care facility when they feel non-severe or life-threatening symptoms, but rather call a telemedicine service first. When we or a loved one are feeling sick and even scared, it is only natural to seek expertise where we know we will get it and to default to deeply ingrained habits, in this case, going to the doctor’s office or an emergency room (ER).
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