Americans visiting family for the holidays should consider home testing, experts say
As William Schaffner, MD, prepares for the upcoming holidays, he and his family are taking all the proper COVID-19 precautions, including testing and retesting before and after travel.
“If we're focused on the holidays, it's about getting families together. We want to protect each other, and I'm particularly concerned if there are people in the gathering who are older, who have underlying illnesses, if they're at any age at all that might put them at risk of severe COVID-19 disease. Planning ahead is a good idea,” Schaffner told Healio.
“The first thing we should ask ourselves,” Schaffner said, “is who's getting together? Who are the most fragile people? And who are the ostensibly healthy people? Are these people who've been otherwise careful?”
Schaffner, a professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center and Infectious Disease News Editorial Board Member, has family coming from outside the U.S., from Europe, as well as a mix of family members who are attending college or have serious underlying illnesses. He said that although his guest from Europe is fully vaccinated, they will still have to be tested before they board a plane to the U.S., but the precautions do not stop there.
“Their plan is that once they arrive here, they will want to get — if they can find one — a rapid test and be demonstrated to be negative once again before they interact with the family,” Schaffner said. “As you can see, we’re being very, very careful. We want to make doubly sure that we're not putting each other at risk.”
Precautionary testing may not be taken as seriously in other households this holiday season, and there are obstacles remaining for those who do wish to test themselves. Indeed, experts said the U.S. is falling short in this area of the pandemic response.
“Home testing is very suboptimal in the United States,” Amesh A. Adalja, MD, an infectious disease, bioterrorism and emergency medicine specialist and senior scholar at Johns Hopkins Center for Health Security, told Healio. “This was something that was slow in coming — and resisted by some — and is still subject to major onerous regulation, and therefore more expensive than it needs to be.”
Since March 2020, the FDA has authorized hundreds of COVID-19 tests and kits, including rapid, over-the-counter, at-home tests. Although the FDA could not provide information on how much at-home testing is being performed, it told Healio that two tests could be more widely available by early 2022.
According to the FDA, two of the most recent emergency use authorizations for OTC at-home tests for tests made by ACON Laboratories and iHealth Labs could result in up to 400 million more OTC home tests being available monthly by early 2022.
In its guidance for the holidays, the CDC suggests that people consider taking a test as an added precaution before gathering with a group of people from multiple households or different parts of the county, but it does not provide any details or specific recommendations beyond that.
Additional guidance could be necessary to ensure proper testing, Adalja said.
“The question isn’t if the U.S. is testing enough but are they testing smartly?” Adalja said.
He explained that rapid tests are useful when trying to determine whether somebody is contagious and should be used especially by unvaccinated people.
“This is something we should’ve been doing from the very beginning of the pandemic,” he said.
More testing is better than less testing, and anyone traveling should use home tests to ensure everyone’s safety, experts said.
“The value in home testing, to me, is twofold,” Adalja said. “Home tests can be a first test for those with symptoms consistent with COVID-19, and they can also be used to screen asymptomatic individuals — primarily those who are not vaccinated — for contagiousness so they can know their status and use it to guide their activities.”
Schaffner said everyone should consider not only who will be at their dinner table and in their living room but also who could be sitting beside them on the train or plane.
“We can't test our way out of COVID-19, but testing, along with vaccination along with mask wearing and social distancing, putting all those things together, I think can really help us all work to reduce the risk of transmission,” Schaffner said. “If you're getting together with family members who are older, or who have underlying illnesses, that that would be the circumstance in which I certainly would get tested.”
References:
CDC. COVID-19: Holiday celebrations. https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/holidays/celebrations.html. Accessed Nov. 17, 2021.
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