We Still Don’t Have At-Home Testing For the Flu

The tests are easy to use, and for now, paid for by insurance if you’ve got it. If you don’t have insurance, you can still get the kits for free from some community health centers.

If the test shows that you’re positive, you know to stay home and mask up, and ask your doctor about taking antiviral medications that can minimize the symptoms and keep you from getting seriously ill. If you’re a parent and testing your kids, the kits can signal when to keep them at home from school.

It’s a win-win, since knowing your status means you can protect not only yourself but your community by not spreading the virus when you stay home and get treated.

COVID-19 has set a new standard of expectations for testing, and knowing whether you’re sick, that is starting to make the way the U.S. traditionally manages winter season diseases look archaic. Why don’t we have the same self-tests for other common illnesses that spread during the colder months—such as flu and RSV? Each year flu leads to between 300,000 and 800,000 hospitalizations in the U.S., while RSV sends up to 80,000 young children under five years old to the hospital annually.

“The pandemic shifted people’s expectations,” says Dr. Michael Mina, chief science officer at eMed, a digital health company that offers at-home testing and telemedicine options to help with those tests for a range of illnesses. “It’s driving people to ask, ‘why do I need to go to the doctor when COVID-19 testing has shown me that it’s totally safe and okay for me to [use self-tests to determine] if I’m positive for a respiratory illness?’”

Until the pandemic hit, at-home testing was a health trend struggling for respect. While convenient, the medical community and health regulators at the Food and Drug Administration (FDA) weren’t convinced that people could reliably test themselves at home for things like flu, and interpret the results accurately. Decades earlier, home pregnancy test kits battled through similar validation issues, as health care experts raised concerns about releasing a test that wasn’t always completely accurate and about the need to educate women about interpreting the results. Ultimately, regulators decided that the level of uncertainty was an acceptable tradeoff for arming women with knowledge about their pregnancy status and the tests became available in 1978 over the counter.

With similar reasoning, and this time driven by the urgent need during the pandemic to limit the spread of SARS-CoV-2, the FDA authorized the first at-home rapid tests for COVID-19 in spring 2020. Millions of people have since tested themselves or their children, without a medical professional, effectively and responsibly. “The COVID-19 pandemic led to a shift in empowering citizens with the ability to test themselves for respiratory infections,” says Dr. Chaz Langelier, associate professor of medicine in the division of infectious diseases at University of California San Francisco. “The average person in the U.S. now has a working knowledge of the public health implications of respiratory infections on a level that wasn’t there pre-pandemic.”

The barriers to self-testing

Studies conducted on at-home COVID-19 tests showed that people don’t need a medical degree to insert a swab up their nose, swirl it around, and then insert the swab in a pre-made solution and read the resulting lines. In fact, that technology is essentially the same one that doctors and nurses use in doctors’ offices, emergency rooms and health centers to test for influenza, RSV, and strep. “The average person thinks that when they go to the doctor and he or she uses a rapid strep or flu test, that the doctor is doing something complicated behind the scenes,” says Mina. “But no, it’s just the same swabbing of the nose or throat and the same lateral flow antigen test [as in the home kits]. The COVID-19 self tests have demystified how some of these medical tests are performed. And opened to door to people asking, ‘why don’t I have access to that?’”

The reason they don’t yet has to do with a number of factors, from cultural bias to the economics of the flu-testing market. The medical community has historically been reluctant to entrust self-tests in the hands of the public because of concerns about how well the people without medical expertise can collect the samples and perform the chemical reaction required to detect the presence of a virus or bacteria. But streamlined ways to contain reagents and present them in a straightforward way, such as the easy-to-use COVID-19 test kits, have made the process nearly mistake-proof, Mina says.

While that may be true of the COVID-19 self tests, the self-tests for flu that are still being developed aren’t quite there yet. Doctors have relied for years on so-called point-of-care testing that provides results within minutes about whether their patients have flu, but they have also known that the false negative rate of these tests can range up to 40%. “You trade accuracy for speed,” says Dr. Lisa Maragakis, professor of medicine at Johns Hopkins University School of Medicine. Such rapid antigen tests, which pick up proteins made by viruses like SARS-CoV-2 or influenza, are relatively good at detecting people who are positive, leading to low false positive rates, but a negative result doesn’t always mean the person is free and clear. Doctors take other factors into consideration, such as the patient’s symptoms and exposures, when interpreting negative results. And if needed, they repeat the test to confirm the result.