Brand matters when arthritic hands administer COVID tests

Until this weekend, I had only personally administered two brands of COVID-19 home tests on myself or my children. All of my earlier home testing experience was with:

I wrote a detailed review of the Cue Health product a few months ago for those who can afford a more accurate, but much more expensive home test.iPhone running Cue App next to Reader device with COVID-19 test plugged in

Both the Abbott and Cue coronavirus tests were easy for me to use, had straightforward directions, and required only moderate hand strength and dexterity. I highly recommend either of these brands to those with less-than-average manual abilities.

I say this as a person living with a diagnosis of mild, seronegative rheumatoid arthritis whose small joints do not always cooperate with my intent. Those with profound disabilities may require assistance for even these tests, and near-normal eyesight is necessary for every COVID-19 test I’ve tried.

That said, if you can still brush your own teeth effectively, you can probably manage either Abbott or Cue home COVID-19 tests.Open COVID-19 test box with post it note reminder to test twice, 72 hours apart

In our busy household of five, we keep all of our coronavirus test kits on a dedicated table at the side of the living room, stacked up in order of expiration date.

Having flown cross country in March to visit my father, I consumed several tests in quick succession upon my return, and we quickly worked through our locally purchased Abbott test kits to the more recent Roche branded ones we received free from the United States government.COVIDtests.gov offers free at home COVID-19 tests to Americans

Every home in the U.S. is eligible to order 2 sets of 4 free at-⁠home tests. Click here to order yours if you haven’t already.

We test my younger child—the one who attends high school in person—every weekend before he goes downstairs to visit his paternal grandfather. Дедушка lives downstairs in our home, but he has his own dedicated space, kitchen, and a separate entrance. Still, age and health status leaves Deda especially vulnerable to a severe case of COVID-19.

We feel grateful to have the means to protect him from an infection we might unwittingly visit upon him by going about our own public lives.

On Saturday, we used one Roche COVID-19 At-Home test kit from a box of four. Fortunately, it was conducted by my hale and hearty teen, administering his own test. I did not anticipate how difficult this test would have been for me, had I been taking one myself, and I was happy to be merely an observer and reader of directions.Roche COVID-19 test instructions, box, cartridge

Steps five and six of the Roche process would have stymied me, but my healthy child had no real issue with them or with the test in general. There’s a lot of firm pinching involved in those steps, which would be beyond my arthritic fingers.

Our older home educated teen took a test later the same day, and I asked if he wouldn’t mind trying the fourth brand in our personal arsenal: the ACON Labs FlowFlex test even though this meant using test out of expiry order.

I was curious if it would present similar issues. It did.

FlowFlex was the brand sent out by our health insurance via its preferred mail order pharmacy, Express-Scripts.8 FlowFlex COVID-19 antigen tests

We are entitled to eight “freei.e., included with our employer-provided health insurance COVID-19 tests every month for each covered member of our plan. I ordered those for the two household members going to work/school as soon as the benefit was published on the website, and they were delivered about four weeks later. In the meantime, I’d ordered a batch of tests each for the other covered members of our household.

If I order directly from the preferred prescription provider, I don’t have to wait for reimbursement. Paying nothing out of pocket seemed like the best option. Now I know better.

For our household, in the future, if I’m the one who requires testing, I should go to a local pharmacy and purchase Abbott’s BinaxNOW tests instead of accepting the option available via mail-order without any out-of pocket expense. This will be a smarter choice given my manual limitations.COVID test tube in stand awaiting insertion of swab and drop-dispensing cap

I believe it is highly probable that Abbott’s BinaxNOW, Roche’s COVID-19 At-Home test kit, and ACON’s FlowFlex have similar probabilities of correctly detecting the novel coronavirus responsible for the chaos and societal disruption of 2020-2022. That said, I doubt the ability of the latter to work for me, with my limited hand strength.

Both the Roche and the ACON FlowFlex test require a user to firmly pinch the included vial between one’s fingers for an extended period of time to get an accurate result. I doubt I could do this reliably, repeatedly, for accurate test results.Fingers squeezing plastic test tube for COVID test

I did experiment with my teen’s FlowFlex vial post-test to determine that I’m capable of dispensing the mixed drops with that product without too much discomfort, but dispensing four drops into the test cartridge is less effortful for some of us with weak phalanges than holding tight to the tube while spinning the test swab therein.Hands squeezing to dispense drop of liquid for COVID test onto cartridgeI felt compelled to compose and post this particular piece as quickly as possible to share my experience with the world. Had I only tried that first test brand, that I happened upon at my local pharmacy last fall, I would have no idea how tricky other versions of COVID-19 tests might be for those of us with more limited mobility.

It is worth reporting that, if I did not have such limitations to my dexterity, I would prefer the more compact packaging offered by Roche and ACON Labs over Abbott’s fairly bulky box, especially for travel. The Roche multi-pack uses far less packaging for four tests than two boxes containing two each of the BinaxNOW. Roche/FlowFlex’s volume will be decidedly less if packed in a suitcase.

Aside from the need to firmly grasp a plastic tube for steps five and six (Roche)/step 2 (ACON’s FlowFlex), I would not have such a distinct preference for Abbott’s BinaxNOW over the competitors. That being said, my limitations have settled in as a near constant over the past decade, and I no longer expect my own normal to return to a more median average.

From my perspective, if you require an at-home COVID-19 diagnostic test, and you have limitations to your manual dexterity, you should try to get an Abbott BinaxNOW antigen test or a molecular one from Cue Health.

If your hands are crippled by arthritis, and you must use Roche or ACON Lab’s tests, ask a fully able bodied friend for assistance, if possible.


Disclosure: The author of this post owns 51.044 shares of ABBOTT LABORATORIES (ABT) stock at the time of writing. Abbott Labs makes the BinaxNOW test kit product.

I find written directions easy to follow and actually enjoy the step-by-step process of assembling LEGO toys and IKEA furniture kits, so my experience may not reflect that of average people.

Taxing actual miles is better, but vehicle weight should be a factor for VMT

Because I’m in the 99th percentile for having strong opinions, a recent Washington Post article about some states experimenting with “vehicle-miles driven” (VMT) taxes in place of gasoline taxes got my attention. I’ve been complaining about the rampant up-ramping inadequacy of taxing only gas as a proxy for road usage for years.

Wear & tear is a cost of all cars, not just gas burners

Though they use less gasoline, it is obvious that hybrid and electric cars also cause wear and tear on roads, just like those powered by internal combustion engines do. Excluding those which weigh less than an average human being, every driver of any* vehicle on the asphalt should be paying a share of maintenance for streets, tunnels, and bridges.Pile of money

First let me point out that I think eliminating the gas tax entirely would be stupid. We should continue to tax fuel purchases for as long as they occur commercially because burning gas directly tracks with carbon dioxide emissions. Every breathing creature on the planet is affected by that pollution, not just the people driving automobiles. Taxing it is just!

I believe America’s leadership made a terrible mistake when it didn’t radically increase the fuel tax after 9/11. At that moment, patriotism might have mitigated the political hit. The true cost of every gallon of gasoline includes our spending on wars in the Middle East, defense against terrorism, and the ongoing environmental damage of carbon emissions and oil spills.

Gas is a dirty fuel in every sense of the word.USA flag - 1

With that being said, even 100% electric vehicles are not without deleterious effects upon our motorways. Never mind the generation of electricity—environmental issues there can be managed via different levers—but consider the physical reality of the cars themselves. A 2021 Toyota Camry rolls 3310 to 3475 lbs around our pavements depending upon trim level; a Camry Hybrid weighs in at an even heftier 3580 lbs.

That hybrid is eating some asphalt.

Space is occupied by hybrids as readily as by conventional cars

Add road congestion, parking issues, and traffic to the question of wear and tear. Engine type doesn’t affect those either.

To be clear, my position is that a combination of a fuel tax collected at the gas pump and VMT computed from individual vehicle data should start out with a total tax burden similar to today’s for a typical driver—specifically, those opting for efficient, mid-sized cars traveling an average number of miles.

I’m not advocating for a sudden huge jump in tax collection—though I believe most of us should be paying more than we do now to reflect the true cost of operating private vehicles—but for the choice of vehicle combined with actual miles driven to dictate the total tax burden per driver.

Allowing these rates to rise gradually over time would protect commuters from a sudden financial shock while allowing for desperately needed infrastructure improvements to begin across America. Escalating costs for operating outmoded, oversize vehicles in inappropriate environments would also nudge manufacturers and consumers toward more rational conveyances designed specifically for the types of trip actually being made day in and day out.

That Camry I mentioned occupies about 96.6 square feet (192.1″ x 72.4″ per Toyota’s specs) standing still. I’m pretty broad in the beam, yet my own standing square footage requirements are about 1.5′ × 1′ or 1.5 sq. ft.  math working out square footage of Toyota Camry

For reference: An average bicycle is 68″ long by roughly 24″ wide; therefore, a bike occupies about 11 ¹⁄3 sq. ft.

Here’s a quick visual comparison of the relative square footage occupied by a human body (lady) vs. an average bike vs. that same Toyota Camry. Remember to consider this graphic should be multiplied by the almost 8 billion human inhabitants of planet Earth to fully grasp the big picture.sketch on graph paper showing relative sizes of lady, bike, car

As a person with some physical disabilities, I’m hardly suggesting that all of us should walk or bike everywhere instead of using powered machines we’ve improved for that purpose over the course of millennia. Still, I’d argue that the ideal single person vehicle should be much closer to the size and weight of a bike if not the human body itself vs. a Heavy Duty pickup truck or even a sedan like that Camry on which I keep picking.

Even “compact” private vehicles operating with single passengers are a wildly inefficient use of space. That’s a more noticeable issue in dense cities, but the inappropriateness is blatant in any context given a modicum of though.two children stand next to blue hatchback

Again, as a person with physical limitations, I remain loathe to ban passenger cars outright from most spaces—even urban cores—but I absolutely support governmental policies that reflect the full, true costs of our dependence upon personal vehicles sized to hold entire families or a small sports team yet routinely carrying individual bodies.

A preposterous percentage of Americans—who carry multiple occupants on a given vehicular trip only 49% of the time, on average, per 2011 data from the U.S. Department of Transportation Bureau of Transportation Statistics—elects to drive something rather larger than a sedan.

According to Edmunds, in 2020, four of the top ten “Most Popular Cars in America” were full size trucks; three others were SUVs. That makes 70% of the favorite American choices for mostly carrying one human body even larger than the Camry I’ve been offering as an example of a standard passenger car.

According to this Bloomberg City Lab article, “Since 1990, U.S. pickup trucks have added almost 1,300 pounds on average. … the biggest vehicles on the market now weigh almost 7,000 pounds.” It would appear that human bodies in America aren’t the only ones experiencing an obesity epidemic.

The way that larger trucks have regulatory status as commercial machines, not passenger vehicles, making them exempt from EPA fuel economy reporting rules must be addressed. A solo commuter to an office should pay—literally, via her tax bill—for inefficient choices that affect others.

Those hauling heavy machinery or farm equipment may be reasonably held to a different standard of taxation. Differentiating between legitimate commercial vehicles and passenger use in calculating VMT strikes me as wise.

Major popular objections to VMT as implemented in 2021

Returning to the specifics of the states currently enacting—or testing— VMT in 2021, two major objections are noted (from the same Post article from paragraph one, bolded emphasis mine):

“Surveys of drivers involved in pilot programs revealed questions of privacy and data security as top concerns. Many environmentalists also are opposed, saying that taxing gasoline also[sic] is also an effective tax on carbon dioxide emissions. Under a miles-driven system, the highest-emission vehicles stand to gain a tax break.”

I see simple solutions to both of these non-problems with implementing a sensible VMT.

Environmental solution via VMT: factor in weight

To address the concern that fuel-guzzling trucks and SUVs will be under-taxed given their tendency to pollute, the miles driven tax rate ought to be multiplied by the weight of the vehicle.

Accounting for actual weight corrects for the environmental damage done by over-sized SUVs and pickups used frivolously in place of fuel efficient passenger cars for urban commuting. A Gross Vehicle Weight Rating (GVWR) is already required of all manufacturers. Use that information to tax drivers based upon their chosen vehicle multiplied by the number of miles s/he drives. That result offers a pretty reasonable assessment of how much wear and tear one individual puts on our public roads.

I believe the best policy in a free society is to allow the real price of operating even the most bloated conveyance to convince drivers to make better choices when conscience fails. I wouldn’t ban Hummers, but I’d like to see their owners pay for more of what they’re currently getting away with stealing from future generations.

Allow people to continue to “express their individuality” by driving one of the most popular “cars” i.e., full sized trucks if they wish, just make them pay their fair share of what they’re using.

Privacy objection to VMT: read the odometer, stupid

The privacy issue is hugely important to me, but carrying an intrusive GPS tracking device at all times is hardly the only option for implementing VMT.

You don’t need location data to assess miles driven. There’s an odometer built into every modern vehicle.

States like mine already require annual safety inspections of any vehicle operating on public roads. Adding an odometer reading to that process—done in state-certified facilities in every community—would add only a trivial amount of time and effort to that process. Remitting one’s “actual miles driven” tax after an annual safety or emissions inspection could be required before new window or license plate stickers were provided.

States could offer tracking devices like those used in Oregon’s program to those who prefer to pay smaller, more manageable, more frequent periodic bills, but also allow drivers to accrue billable mileage with collection due quarterly, annually, when registrations are renewed, or simply upon sale of the vehicle. That could lead to a large tax bill for someone making the latter election, but it effectively removes all privacy issues from the tax.

Odometer readings could be self-reported or taken at government facilities or in approved private garages such as car dealerships or service stations; any discrepancies could be caught upon sale or transfer of the vehicle. Deposits based upon averages—the individual’s historic mileage as these programs persist over the years or from data captured by auto insurance actuarial tables—could be held in escrow by the state if necessary.

In the longer term, odometers could be designed to transmit readings without coupling that information to GPS location data. Data transmission of this type is well within the bounds of current technology.

In short, there are no insurmountable technical or privacy obstacles to implementing a fair, cost-effective collection of VMT in 2021.

Bigger, heavier vehicles take up more than their fair share of space, they cause roads to deteriorate faster, and they represent a greater threat to the health and safety of pedestrians, cyclists, and other motorists. A properly designed VMT should tax individuals for their choice of vehicle in combination with the quantity of miles driven. That would be by far the most fair and reasonable option I can imagine.

* Though this may not be a universal position, I believe that every human has the right to navigate the world under his or her own power without taxation. Bicycles and skateboards probably do exert a small toll upon the surfaces they transit, but I suspect their effects are negligible compared with that of most powered conveyances.

The electric bike pictured in the photo to the right of the construction trucks was used by my father to commute to his last full-time professional job before retirement. He was in his 60’s at the time and found the electric motor assist necessary to cope with a particularly steep hill between home and office. To be fair, he always had access to a car for days when the Oregon weather made cycling miserable or unsafe, but Dad makes a fair proxy for a non-young, not-above-average-in-fitness commuter.

Again, from the same Washington Post article, here’s a description of how Oregon is currently implementing its VMT program:

“Participants in the state have three ways to sign up — two privately run systems and one administered by the state Department of Transportation. The private companies send drivers a device that logs where and how much they drive or pull the data directly from vehicles. Then they send out bills and turn over the revenue to the state. Drivers get reimbursed for gas taxes they pay at the pump.

The companies keep drivers’ data for 30 days, and participants have options that include not sharing information about their locations.”

Have Segway; will travel… into the Alps

My first Segway tour of San Francisco’s Golden Gate Park was a lot of fun and well worth the fairly high hourly cost. My second Segway tour, along an Alpine trail from the Austrian resort town Seefeld in Tirol, was positively magnificent.

At €78 per person for a two hour tour, the cost of entry was lower. With the option to follow a scenic trail to a kitschy-charming Alpine inn otherwise closed to me due to pain and fatigue, the experience turned out to be invaluable.

Training to use Segway

Segway training before a tour takes between five and 20 minutes

My teen said this excursion was the most fun thing he did during our two weeks in Europe. And, by the way, I let him select most of our activities after I chose the cities we would visit.

Maybe I shouldn’t tell the friendly owner-operator Maximilian this, but I would have paid a lot more for such a wonderful experience. If you find yourself in Seefeld, definitely give him a call and take one of his Segway scooters for a spin!

I discovered Segway Tirol on TripAdvisor, but here’s the website and contact email: info@segway-tirol.info *

I’m extolling the virtues of the Segway today because I live with chronic pain as part and parcel of an autoimmune condition. Aside from arthritis, I also broke a bone in the sole of one foot many years ago… and now it feels like I’m always walking with a pebble in my shoe. I.e., annoying

Before my foot injury, my major occupation when visiting new places was to wander. I could happily lose myself for hours along the twisting byways of an historic city. I don’t enjoy driving, and I hate doing it in an unfamiliar, crowded place.

Public transit is hit and miss for me. I’ll use it, but unfamiliar fare systems provoke anxiety. Did I stamp my ticket correctly? Do I have exact change? With buses, I fear taking the wrong line; on subways, I compulsively check the map at each stop to confirm I’ve headed in the correct direction.

I also fear not getting a seat and falling down on lurching trains and buses. At times—sometimes unexpectedly—my weak hand and wrist joints won’t cooperate with my clinging to a post. Then again, I don’t appear deserving of special treatment or priority seating. Autoimmune conditions are often invisible to the casual glances of strangers.

I prefer the freedom and pace of walking… but I can’t go very far by foot any more.

Riding a Segway scooter does require one to stand. It wouldn’t be suitable for anyone with major foot or knee, or ankle problems. My pain seems to be exacerbated by the striking motion of stepping, however, so standing on the Segway is pretty much all right, most of the time.

I do have days where even my knees are affected by my arthritis, but most of my issues, most often, involve the small joints in my hands and feet. I wouldn’t try to ride a Segway if I were having a major flare, but the fatigue would probably stop me before joint stiffness anyway.

Stepping aboard a Segway scooter is like stepping back to a healthier, more able time and condition for me. It feels like freedom.

Mobility is a key component of personal empowerment. That’s true for the ability to afford a car in many American suburbs, and even more so for the giant leap from total dependence upon others or being housebound to the liberty of self-conducted, autonomous activity for those who can’t walk in the average way.

You get a taste of the utility of curb cuts, ramps, and automatic doors as a parent pushing a baby stroller, but it is hard to appreciate all the little motions a healthy body allows until some aspect of “what’s typical” is removed from your arsenal.

I didn’t stop grinning for a single moment I was aboard Segway Tirol’s scooter. The scenery was beautiful. The guide was kind and accommodating. Mostly, though, I was exhilarated to be conducting myself along an Alpine path without pain or fear of going too far and then succumbing to fatigue in an inconvenient place.

Some people think Segways are goofy looking toys for nerds; others consider them a sidewalk nuisance that should be banned. I’d guess most of those people are fully physically able and have no idea how poor the options are for those who aren’t.

For myself, I will be spending more time on two low, gyroscopically balanced, electrically powered Segway wheels in the future. I will seek out tours and rentals of these stable, easily controlled mobility devices. I may look goofy, but I will be grinning like a fiend.

It’s hard not to be happy when you’ve been set free.

Around $150 pp for 90 minutes, if memory serves.

*I booked our tour just the day before we took it. Maximilian was quick to respond and very flexible. Our “group” was just the two of us. There was no upcharge for the creation of a tour at our convenience!