march 2020 • JAMA Internal Medicine

Self-Service Diagnosis of COVID-19—Ready for Prime Time?

Shantanu Nundy, Kavita K Patel



As the world grapples with the novel coronavirus (COVID-19), experts have called for increased access to health care resources, including diagnostic testing, particularly in light of the recent expansion of the Food and Drug Administration’s Emergency Use Authority to make such testing more widely available in the United States.1 Despite rapid expansion, there are significant barriers to testing in ambulatory clinics, emergency departments, and hospitals, which are likely to see a substantial increase in demand. Such access points also pose risks due to overcrowding and nosocomial transmission.Current policy solutions are trying to eliminate financial barriers as well as facilitate additional points of access through increased use of telemedicine. However, telemedicine itself has limitations, because patients still need to go to a health facility to have a specimen collected and sent for processing.In the wake of this epidemic, other countries have expanded testing through “testing drive-thrus,” which have also been employed in limited settings in the United States. Self-testing for COVID-19 has been proposed in the United States in a limited setting. We propose expanding access more widely with a self-service diagnostic pathway for COVID-19 using at-home nasopharyngeal swab collection.