Adeline Fagan, MD, tested positive for the coronavirus in early July and died Sept. 19, after spending over two months in hospital.

This story was published on Thursday, October 8, 2020 in Kaiser Health News, and also ran in The Guardian.   

By Alastair Gee, The Guardian

It took Carrie Wanamaker several days to connect the face she saw on GoFundMe with the young woman she had met a few years before.

According to the fundraising site, Adeline Fagan, a 28-year-old resident OB-GYN, had developed a debilitating case of COVID-19 and was on a ventilator in Houston.

Scrolling through her phone, Wanamaker found the picture she took of Fagan in 2018, showing the fourth-year medical student at her side in the delivery room, beaming at Wanamaker's pink, crying, minutes-old daughter. Fagan supported Wanamaker's leg through the birth because the epidural paralyzed her below the waist, and they joked and laughed since Wanamaker felt loopy from the anesthesia.

"I didn't expect my delivery to go that way," said Wanamaker, a pediatric dentist in upstate New York. "You always hear about it being the woman screaming and cursing at her husband, but it wasn't like that at all. We just had a really great time. She made it a really special experience for me."

Fagan's funeral took place Saturday.

The physician tested positive for the coronavirus in early July and died Sept. 19, after spending over two months in hospital. She had worked in a Houston emergency department, and a family member says she reused personal protective equipment day after day due to shortages.

Fagan is one of over 250 medical staff who died in Southern and Western hot spot states as the virus surged there over the summer, according to reporting by the Guardian and KHN as part of Lost on the Frontline, a project to track every U.S. healthcare worker death. In Texas, nine medical deaths in April soared to 33 in July, after Gov. Greg Abbott hastily pushed to reopen the state for business and then reversed course.

Among the deceased health workers who have so far been profiled by the Lost on the Frontline team, about a dozen nationwide, including Fagan, were under 30. The median age of death from COVID for medical staff is 57, compared with 78 in the general population. Around one-third of the deaths involved concerns over inadequate PPE. Protective equipment shortages are devastating for healthcare workers, who are at least three times more likely to become infected with the COVID virus than the general population.

"It kicked me in the gut," said Wanamaker. "This is not what was supposed to happen. She was supposed to go out there and live her dreams and finally be able to enjoy her life after all these years of studying."

Fagan worked at a hospital called HCA Houston Healthcare West, and had moved to Texas in 2019 after completing medical school in Buffalo, New York, a few hours from her hometown of LaFayette.

She was the second of four sisters, all pursuing or considering careers in the medical field. A younger sibling, Maureen, 23, said Fagan dealt with patients in uncomfortable or embarrassing situations with "grace," as she had observed when she accompanied her on two medical mission trips to Haiti. "Addie was very much, 'Do you understand? Do you have other questions? I will go over this with you a million times if need be.'"

Maureen also mentioned Fagan's comical side — she was voted by her colleagues as the 'most likely to be found skipping and singing down the hall to a delivery' and prone to rolling out hammy Scottish and English accents.

Fagan "loved delivering babies, loved being part of the happy moment when a baby comes into the world, loved working with mothers," said Dr. Dori Marshall, associate dean at the University at Buffalo medical school. But she found living by herself in Houston lonely, and in February Maureen moved down to keep her company; she could just as easily prepare for her own medical school entrance exam in Texas.

It is unclear how Fagan contracted the coronavirus, but to Maureen it seemed linked to her July rotation in the ER. HCA West is part of HCA Healthcare — the country's largest hospital chain — and in recent months a national nurses union has complained of its "willful violation" of workplace safety protocols, including pushing infected staff to continue clocking in.

Amid national shortages, Maureen said her sister faced a particular challenge with PPE. "Adeline had an N95 mask and had her name written on it," she said. "Adeline wore the same N95 for weeks and weeks, if not months and months."

The CDC recommends that an N95 mask should be reused at most five times, unless a manufacturer advises otherwise. HCA West said it would not comment specifically on Maureen's allegations, but the facility's chief medical officer, Dr. Emily Sedgwick, said the hospital's policies did not involve individuals constantly reusing the same mask.

"Our protocol, based on CDC guidance, includes colleagues turning in their N95 masks at the conclusion of each shift, and receiving another mask at the beginning of their next shift." A spokesperson for HCA West, Selena Mejia, also said that hospital staff were "heartbroken" by Fagan's death.

On July 8, Fagan arrived home with body aches, a headache and a fever, and a COVID test came back positive. For a week the sisters quarantined, and Fagan, who had asthma, used her nebulizer. But her breathing difficulties persisted, and one afternoon Maureen noticed that her sister's lips were blue, and insisted they go to the hospital.

For two weeks, the hospital attempted to supplement Fagan's failing lungs with oxygen. She grew so weak she wasn't able to hold her phone up or even keep her head upright. She was transferred to another hospital, where she agreed to be put on a ventilator.

Less than a day later, she was hooked up to an ECMO device for a highly invasive treatment of last resort, in which blood is removed from the body via surgically implanted intravenous tubes, artificially oxygenated and then returned.

She lingered in this state through August, an experience documented on a blog by her software engineer father, Brant, who arrived in Houston with her mother, Mary Jane, a retired special education teacher, even though they were not allowed to visit Fagan.

The medical team tried to wean her off the machines and the nine sedatives she was at one point receiving, but as she emerged from unconsciousness she became anxious and was put back under to stop her from pulling out the tubes snaking into her body. She was able to respond to instructions to wiggle her toes. A nurse told Brant she might be suffering from "ICU psychosis," a delirium caused by a prolonged stay in intensive care.

The family tried to speak with her daily. "The nurse told us that they have seen Adeline's eyes tear up after we have been talking to her on the phone," Brant wrote. "So it must be having some impact."

On Sept. 15, her parents were at last permitted to visit. "I do not think we were prepared for what we saw, in person, when we entered her room," he wrote. "Occasionally, Adeline would try to respond, shake her head or mouth a word or two. But her stare was glassy and you were not sure if she was in there."

It was too much for him. "Being the softy that cannot stand it when one of my girls is hurting, [I] commenced to get lightheaded and pass out."

Finally, on Sept. 17, it seemed Fagan was turning a corner. Still partly sedated, she was nevertheless able to sit up without support. She mouthed the words to a song, being unable to sing because a tracheostomy prevented air from passing over her vocal cords.

The next day, the ECMO tubes were removed. The day after that, Brant made his last post.

His daughter had suffered a massive brain hemorrhage, possibly because her vascular system had been weakened by the virus. Patients on ECMO also take high doses of blood thinners to prevent clots.

A neurosurgeon said that even on the remote chance Fagan survived surgery, she would be profoundly brain-damaged.

"We spent the remaining minutes hugging, comforting and talking to Adeline," Brant wrote.

"And then the world stopped."

As is often the case with healthcare policy, however, the truth is far from simple.

This article was published on Wednesday, October 7, 2020 in Kaiser Health News.

By Alex Sakariassen

Throughout the 2020 election cycle, candidates’ positions on health care have been particularly important for voters with underlying and often expensive medical needs — in short, those with preexisting conditions.

It’s no surprise, then, that protections for people who have chronic health problems like diabetes and cancer have become a focal point for candidates nationwide — among them, Matt Rosendale, the Republican contender for Montana’s only U.S. House seat.

On Sept. 22, Rosendale’s campaign hit airwaves and online streaming services with an ad featuring a Whitefish resident named Sandee, whose son was diagnosed with a life-threatening disease. Sandee told the story of how Rosendale came to her family’s aid, concluding that “Matt fights for everyone with a preexisting condition.”

As is often the case with health care policy, however, the truth is far from simple. Rosendale and many other Republican congressional candidates face the challenge of convincing voters they support these safeguards even as they oppose the Affordable Care Act, which codifies those safeguards.

Polls show broad public support for keeping the ACA’s preexisting condition protections.

We decided to investigate.

Rosendale is up against Democrat Kathleen Williams for the congressional seat now occupied by Republican Rep. Greg Gianforte, who has entered the state’s gubernatorial race. The open seat has been controlled by the GOP for the past 12 terms, but this year’s race is expected to be close. Williams, who also ran for the seat in 2018, has made health care her top campaign issue.

We contacted the Rosendale campaign to find out the basis for his ad’s claim. Campaign spokesperson Shelby DeMars listed a range of health policies backed by the candidate that would help people with preexisting conditions directly or indirectly by holding down health care costs. She specifically pointed to Rosendale’s work on the state’s reinsurance program as Montana’s state auditor and insurance commissioner, a post he was elected to in 2016.

“Matt Rosendale is a champion for those with pre-existing conditions and he has the record to prove it,” DeMars said via email. “It is because of the Reinsurance program he implemented that Montanans with pre-existing conditions can access the affordable healthcare coverage they need.”

Examining Reinsurance

In a nutshell, Montana’s reinsurance program is designed to help insurers cover costly medical claims with a mix of federal pass-through dollars and funding generated by a premium tax on all major medical policies in the state. Gov. Steve Bullock announced the formation of a bipartisan group tasked with developing reinsurance program legislation in fall 2018, and the state’s legislature approved the plan in 2019, allowing Rosendale to apply for and receive the necessary waiver under the Affordable Care Act.

Subsequent news accounts indicated the idea worked. In-state insurers credited the program with lowering premiums by 8% to 14% for 2020. As Montana Health Co-op CEO Richard Miltenberger told MTN News shortly after the 2019 legislative session, “It allows the insurance companies to have rate stabilization for those really big claims, the ones that are the earthquakes in health insurance.” He went on to say that this stability “brings the cost down for the consumer.” More to the point, the American Medical Association has also stated that reinsurance not only serves to subsidize high-cost patients but “protects patients with pre-existing conditions.”

But there’s a rub.

The reinsurance program that Rosendale touts wouldn’t exist without a state innovation waiver created by the ACA, which Rosendale says he’ll work to repeal. That effort will doubtless continue to fuel pitched battles in Congress, and how the U.S. Supreme Court may rule on a pending ACA challenge remains a point of speculation. One thing is clear, though: If the entire ACA is thrown out, the reinsurance program goes with it, along with Montana’s Medicaid expansion and the ban on insurers excluding people with health problems from affordable coverage.

When asked about the resulting elimination of the reinsurance program, DeMars emphasized that Rosendale’s work as auditor has created a system that will ensure protections for preexisting conditions “regardless of what happens to the ACA.” She did not elaborate or explain what protections would remain if the ACA were repealed.

The Short-Term Plan Component

In defending his stance on preexisting conditions, Rosendale continues to be haunted by another health care policy specter from his political past. During his unsuccessful challenge against Democratic U.S. Sen. Jon Tester in 2018, Rosendale faced criticism for promoting short-term, limited-duration health insurance plans. Unlike plans offered on the individual marketplace, these short-term plans are exempt from the ACA’s ban on excluding people with preexisting conditions. And, under a 2018 regulatory change pushed by the Trump administration, the length of these short-term plans has been extended from three months to 12, with the potential to renew for up to three years.

As state auditor, Rosendale included those plans in his March 2020 roundup of year-round options for immediate coverage. They often exclude coverage for a variety of higher-cost benefits. In Montana, for example, a review by KFF found that of four short-term plans available in Billings in 2018, none offered coverage for maternity care, mental health, substance abuse or prescription drug services. (KHN is an editorially independent program of KFF.)

Historically, short-term plans were designed to help individuals fill gaps in health coverage. According to Dania Palanker, an assistant research professor at Georgetown University’s Center on Health Insurance Reforms, the role short-term plans play on today’s health insurance landscape is to attract younger, healthier individuals seeking low-cost options to cover catastrophic events. That splits insurers into two pools — those who are less likely to incur medical expenses, and those who are more likely to incur them. Costs on the individual market go up as a result, leaving people with preexisting conditions no other option than to pay higher premiums. Short-term plans are, Palanker said, “actively hurting people with preexisting conditions.”

“Promoting short-term plans and stumping on supporting protections for preexisting conditions are mutually exclusive,” she continued.

Asked whether the cost-lowering effect of a reinsurance program would be enough to offset the effects of short-term plans, Palanker said the only way such an offset would be enough is if the program encompassed short-term plans. She hasn’t seen that happen anywhere.

Our Ruling

A campaign ad says Rosendale “fights for everyone with a preexisting condition.” While it is true that health insurance premiums have dropped during Rosendale’s tenure as state auditor, the choice to establish Montana’s reinsurance program ultimately fell to decision-makers in the state’s legislature and the governor’s office. Since his ad’s claim simply states that he “fights” for people with preexisting conditions, his testimony in support of that program and role in securing the state waiver do seem to fit the bill.

In the long-term, however, Rosendale’s positions begin to run counter to the claim. His support for short-term, limited-duration plans poses a considerable threat to keeping health insurance affordable for all, and absent a solid plan from Congress to ensure that state reinsurance programs survive, his stated goal of repealing the ACA would actually serve to unravel the very protection he’s built his case on.

We rate this statement as Mostly False.

Even with the expanded safety net created by the ACA, by the end of summer a record number of people were poised to become newly uninsured.

This article was published on Wednesday, October 7, 2020 in Kaiser Health News.

By Steven Findlay

The Affordable Care Act, facing its first test during a deep recession, is providing a refuge for some — but by no means all — people who have lost health coverage as the economy has been battered by the coronavirus pandemic.

New studies, from both federal and private research groups, generally indicate that when the country marked precipitous job losses from March to May — with more than 25 million people forced out of work — the loss of health insurance was less dramatic.

That's partly because large numbers of mostly low-income workers who lost employment during the crisis were in jobs that already did not provide health insurance. It helped that many employers chose to leave furloughed and temporarily laid-off workers on the company insurance plan.

And others who lost health benefits along with their job immediately sought alternatives, such as coverage through a spouse's or parent's job, Medicaid or plans offered on the state-based ACA marketplaces.

From June to September, however, things weren't as rosy. Even as the unemployment rate declined from 14.7% in April to 8.4% in August, many temporary job losses became permanent, some people who found a new job didn't get one that came with health insurance, and others just couldn't afford coverage.

The upshot, studies indicate, is that even with the new options and expanded safety net created by the ACA, by the end of summer a record number of people were poised to become newly uninsured.

What's more, those losses could deepen in the months ahead, and into 2021, if the economy doesn't improve and Congress offers no further assistance, health policy experts and insurers say.

"It's a very fluid situation," said Sara Collins, vice president for healthcare coverage and access at the Commonwealth Fund, a New York-based health research group. "The ACA provides an important cushion, but we don't know how much of one yet, since this is first real test of the law as a safety net in a serious recession."

Collins also noted that accurately tracking health insurance coverage and shifts is difficult in the best of times; amid an economic meltdown, it becomes even more precarious.

Coverage Was Already on the Decline

Some 20 million people gained coverage between 2010 and 2016 under the ACA's expansion of Medicaid and its insurance marketplaces for people without employer-based coverage. A gradually booming economy after the 2008-2009 recession also helped. The percentage of the population without health insurance declined from about 15% in 2010 to 8.8% in 2016.

But then, even as the economy continued to grow after 2016, coverage began to decline when the Trump administration and some Republican-led states took steps that undermined the law's main aim: to expand coverage.

In 2018, 1.9 million people joined the ranks of the uninsured, and the Census Bureau reported earlier this month that an additional 1 million Americans lost coverage in 2019.

The accelerating decline is helping fuel anxiety over the fate of the ACA in the wake of the death of Supreme Court Justice Ruth Bader Ginsburg. The high court is scheduled to hear a case in November brought by Republican state officials, and supported by the Trump administration, that seeks to nullify the entire law.

In July, researchers at the Urban Institute, a Washington, D.C., think tank, forecast that around 10 million workers and their dependents would lose employer coverage in 2020. But they estimated that two-thirds of them will have found new coverage by year's end — leaving about 3.3 million uninsured.

A more recent Urban Institute report, released Sept. 18, and using 2020 data from the Census Bureau, calculated that of the roughly 3 million people under age 65 who had lost job-based insurance between May and July, 1.4 million found coverage elsewhere — most through Medicaid — and 1.9 million became newly uninsured. Notably, 2.2 million of those who lost their coverage were between 18 and 39 years old; 1.6 million were Hispanic.

Another recent study, using different methods, reported higher numbers for the same period. The analysis released by the Economic Policy Institute last month determined that between April and July 6.2 million people lost employer coverage. The authors didn't calculate how many found alternative coverage via Medicaid or the ACA, however.

Other findings support the notion that the health insurance loss trend shifted by mid summer. KFF, for example, published an analysis Sept. 11 showing that most companies that offered coverage to begin with chose to continue insuring furloughed and temporarily laid-off workers between March and the end of June. But as the virus continued to batter the economy, employers moved to permanently shed those jobs. (KHN is an editorially independent program of KFF.)

"The issue now is that the temporary layoffs have greatly decreased and permanent job losses, including jobs that came with health coverage, are increasing," said Cynthia Cox, a KFF vice president and director for the Program on the ACA.

Many low-income workers who lose their jobs and don't have coverage through a spouse or parent turn to Medicaid, the federal-state health program for low-income people. The Centers for Medicare & Medicaid Services reported last week that enrollment in Medicaid and the Children's Health Insurance Program grew by 4 million between February and June, a nearly 6% increase since the beginning of the coronavirus crisis.

The Impact of the Marketplaces

Gains and losses of coverage in the ACA marketplace are not yet clear, experts say. The Trump administration issued a report in June indicating that 487,000 people had, between January and June, enrolled in an ACA plan via the federal website, healthcare.gov. But that report failed to say how many people dropped an ACA plan in that period — for example, because they could no longer afford the premiums.

A study by Avalere, a health research and consulting firm in Washington, D.C., has estimated that enrollment in the ACA marketplaces since March could have swelled by around 1 million. That includes new enrollees in the 13 ACA marketplaces that states, plus the District of Columbia, operate. Many of those states held a "special enrollment period" when the pandemic hit. Healthcare.gov, run by the Trump administration, did not offer a special enrollment period.

About 11 million were enrolled in an ACA plan in February. Open enrollment for coverage that would start on Jan. 1, 2021, begins Nov. 1.

Jessica Banthin, a senior health policy researcher at the Urban Institute and until 2019 deputy director for health at the Congressional Budget Office, said it's anyone's guess how many people who lost their job-based coverage this year will choose this option. She said numerous factors will influence people's health insurance decisions this fall, and into 2021.

Chief among them is gauging whether they might soon get a new job, or get back an old job, that offers insurance. That may hold some people back from enrolling in an ACA plan this fall, Banthin said. Plus, buying insurance may be too expensive, especially for families more concerned with paying for housing, food and child care while going without a paycheck.

"Health insurance may not be their immediate concern," Banthin said. "Many people's lives have been disrupted as never before. There's a lot of trauma out there."

Collins of the Commonwealth Fund said that, even before the pandemic, a growing proportion of families were vulnerable to loss of coverage and care.

In a survey of more than 4,000 adults early this year, Collins and colleagues found a "persistent vulnerability among working-age adults in their ability to afford coverage and healthcare that could worsen if the economic downturn continues."

In large part, that's because 1 in 5 respondents who had coverage were "underinsured." Underinsurance reflects the extent to which coverage leaves people at risk of high out-of-pocket costs — a situation exacerbated by widespread job loss.

"Now is absolutely not be the time for the ACA to be further undermined, let alone killed outright," said Stan Dorn, director of the National Center for Coverage Innovation at Families USA.

But the transition has not been immediate. Regulators and scientists are generally cautious about new, unproven technologies.

This article was published on Tuesday, October 6, 2020 in Kaiser Health News.

By David Tuller

As the coronavirus pandemic broke out across the country, health care providers and scientists relied on the standard method for detecting respiratory viruses: sticking a long swab deep into the nose to get a sample. The obstacles to implementing such testing on a mass scale quickly became clear.

Among them: Many people were wary of the unpleasant procedure, called a nasopharyngeal swab. It can be performed only by trained health workers, putting them at risk of infection and adding costs. And the swabs and chemicals needed to test for the virus almost immediately were in short supply.

Some places, like Los Angeles County, moved early to self-collected oral swabs of saliva and sputum, with the process supervised at drive-thru testing sites by trained personnel swathed in protective gear. Meanwhile, researchers began investigating other cheaper, simpler alternatives to the tried-and-true approach — including dribbling saliva into a test tube.

But the transition has not been immediate. Regulators and scientists are generally cautious about new, unproven technologies and have an understandable bias toward well-established protocols.

"Saliva is not a traditional diagnostic fluid," said Yale microbiologist Anne Wyllie, part of a team whose saliva-based test, called SalivaDirect, received emergency use authorization from the Food and Drug Administration in August. "When we were hit by a virus that came out of nowhere, we had to respond with the tools that were available."

Eight months into the pandemic, the move toward saliva screening is gaining traction, with tens of thousands of people across the country undergoing such testing daily. However, saliva tests still represented only a small percentage of the more than 900,000 tests conducted daily on average at the end of September.

Yale is providing its protocol on an open-source basis and recently designated laboratories in Minnesota, Florida and New York as capable of performing the test. Besides the Yale test, the FDA has authorized emergency use of several others, including versions developed at Rutgers University, the University of Illinois at Urbana-Champaign, the University of South Carolina and SUNY Upstate Medical University. A further advance, an at-home saliva test, could be headed for FDA authorization, too.

Since the start of the pandemic, the Trump administration's approach to testing has been hampered by missteps and controversy. As a key health agency during an unprecedented emergency, the FDA's effectiveness relies on public trust in how it balances the need for speed in authorizing innovative products, like saliva tests and vaccines, with ensuring safety and effectiveness, said Ann Keller, an associate professor of health policy at the University of California-Berkeley.

"You obviously want to get new tests into the mix quickly in order to address the emergency, but you still need to uphold your standards," Keller said. The White House's public pressure on the FDA has complicated the agency's efforts by undermining its credibility and independence, she said.

Respiratory viruses colonize areas inside the nasal cavity and at the back of the throat. Besides the nasopharyngeal approach, nasal samples obtained with shorter and less invasive swabs have proven effective for the coronavirus and have become widely adopted, although they also generally require a health care worker's involvement. The millions of rapid tests that will be distributed across the country, per a recent White House announcement, rely on nasal swabs.

In the early months of the pandemic, some studies reported significant levels of the virus in oral secretions. In a Hong Kong study published in February, for example, the virus was found in the saliva of 11 of 12 patients with confirmed coronavirus infection.

In Los Angeles, which began using the oral swab test in late March, more than 10,000 samples are collected per day, said Fred Turner, chief executive of Curative, the company that developed it.

Turner sees an advantage to the swabbing strategy. The self-swab procedure takes only 20 to 30 seconds, while producing enough saliva for testing can take people two to three minutes, and sometimes longer, he said. "That might not sound like much difference," Turner said, "but it is when you're trying to push 5,000 people through a test site."

Curative's three labs process tens of thousands of tests from jurisdictions across the country in addition to L.A., Turner said. A test developed at SUNY Upstate Medical University, which is expected to become available at state labs around New York, also uses an oral swab.

For the Curative test, a health care worker is supposed to oversee the sample collection —reminding people to cough to bring up fluids, for example. When investigators at the University of Illinois launched what they called a "Manhattan Project" to develop a saliva test by mid-June, they hoped to make it possible for people to visit a collection site, drool into a test tube, seal it and drop it off without the aid of a health care worker.

The university is now testing more than 10,000 people a day at its three campuses and is seeking to expand access to communities across the state and country, said chemistry professor Paul Hergenrother, who led the research team. Like the similar Yale test, it is being made freely available to other laboratories. The University of Notre Dame, in Indiana, recently adopted it.

Like tests using nasopharyngeal and other kinds of nasal swabs, these saliva tests are based on PCR technology, which amplifies small amounts of viral genetic material to facilitate detection. Both the Yale and University of Illinois tests have managed to simplify the process by eliminating a standard intermediate step: the extraction of viral RNA. Their protocols also don't require viral transport media, or VTM — the chemicals generally used to stabilize the samples after collection.

"You don't need swabs, you don't need health care workers, you don't need VTM, and you don't need RNA isolation kits," Hergenrother said.

In correspondence published in the New England Journal of Medicine, the Yale team reported detecting more viral RNA in saliva specimens than in nasopharyngeal ones, with a higher proportion of the saliva tests showing positive results for up to 10 days after initial diagnosis.

The National Basketball Association provided $500,000 in support for the Yale project, said David Weiss, the NBA's senior vice president for player matters. He said the Yale team's decision to eliminate the process of RNA extraction, which separates the genetic material from other substances that could complicate detection, involved trade-offs but did not compromise the value of the test.

"Any molecular test that has an RNA extraction step is almost by definition going to be more sensitive, but it will also be more expensive and take longer and use supplies that are in shorter supply," he said. "If we're trying to look at surveillance testing to open up schools and nursing homes, a test that's still very sensitive and a lot cheaper is an important innovation."

Prices for coronavirus tests vary widely, running upward of $100. Tests based on the Yale or University of Illinois protocols, which require only inexpensive materials, could be available for as little as $10. The Curative testing service, which includes collection and transportation of samples as well as the laboratory component, averages around $150 per test depending on volume, said Clayton Kazan, chief medical director of the L.A. County Fire Department, which uses the tests.

Despite the advances in sample collection, tests using PCR — polymerase chain reaction — technology still require laboratory processing. Researchers have been investigating other approaches, including saliva-based antigen tests, that could be self-administered at home and would provide immediate results. (While PCR can detect coronavirus genetic material, antigen tests look for viral proteins that can signify a current infection.)

At least one company has announced it is seeking emergency use authorization for a saliva antigen test, although two others have dropped plans to develop their own versions as infeasible, according to The New York Times. Meanwhile, scientists at Columbia University, the University of Wisconsin and elsewhere are investigating the use of saliva with other kinds of rapid-test technologies.

"There's tons of interest" in an at-home saliva test, noted Yvonne Maldonado, chief of pediatric infectious diseases at Stanford University School of Medicine.

"People really do want to get that pregnancy-type kit out there," she said. "You could basically send people a little packet with little strips, and you pull off a strip every day and put in under your tongue."

This KHN story first published on California Healthline, a service of the California Health Care Foundation.