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.

Elite public schools SHOULD consider zip code + academic performance

Fourteen families in Boston recently brought suit against the Boston Public School district, alleging that the COVID-19 era adoption of zip code as a determining factor for admission to the city’s elite “exam schools” was a proxy for race.

I’m delighted that these parents lost their suit in federal court, though I’m sorry that the young scholars represented fear for their futures due to the state’s failure to supply appropriate educational opportunities.Boston Globe online edition with Civil Rights suit article circled

My reasoning? Human beings may tend to sort themselves by distinguishing characteristics—skin color or “race” amongst them—but, in spite of its history as a racist city, there are no formal color-based barriers to residence in any Boston neighborhood today. People who would like to improve their children’s odds of admission to the exam schools are free to live in neighborhoods with larger quotas assigned to them.

Even at the height of segregation, I’m not aware of any rule that ever prevented wealthier, more powerful groups from moving to areas with lower median income. Most efforts prevented the richest “undesirables” from inhabiting homes viewed as the exclusive domain of the then current “better classes” such as White Anglo-Saxon Protestants (WASPs.)NZ Botanic Garden Curator's House - 1

According to the Boston Globe, when the traditional entrance examinations were deemed unsafe due to the pandemic, BPS adopted the following policy for admission to its three elite institutions including the storied Boston Latin:

“…students will be admitted to the exam schools based largely on their grades and in some cases MCAS scores. Seats will also be allocated by ZIP code, giving top priority to areas with the lowest median household income. The number of seats per ZIP code will be proportionate to the share of school-age children living there.”

Quoted from article by James Vaznis updated April 15, 2021, 10:21 p.m. (emphasis mine)

Pardon me for pointing out the obvious, but nothing prevents families from moving to the suddenly more advantageous zip codes. Given that these people must live somewhere with a higher median income, affordability—by definition—can’t be a barrier. Preferring to live in a racially, ethnically, or fiscally homogeneous enclave is a choice; sometimes our choices have consequences we may not enjoy.

Richer families can afford private schools. The least well off families in higher income zip codes have the most reason to dislike the change in admissions criteria. Frankly, though, the truly objectionable reality of this case is that all students aren’t equally able to access high quality classrooms. Now that’s a worthy reason to bring a lawsuit. Backpack with textbooks and school supplies spilling out

But because of the tight link in the United States between home-ownership and wealth, those lower-middle income families are more likely to be renters. Renters can move more readily than people who own their own home. I’d call that yet another benefit to factoring zip code into BPS’ admissions criteria.

The fact that lower median household wealth correlates directly with skin color in America is an embarrassment to our nation. There is no evidence save the easily debunked rantings of white supremacists for any rational basis to this truth; it’s wholly a byproduct of long-standing cronyism and widespread, systemic bias on the part of both individuals and institutions.

In spite of the fairly obvious reality of systemic racism, the BPS admissions policy in question does not in any explicit way prefer to admit children with more, larger, and more pigmented melanosomes* over those with less. It does explicitly tie income to admission, but offering enhanced opportunities to the brightest, hardest working children in a city because they were born with the extra burden of poverty seems eminently reasonable to me.

According to the Census.gov analysis I pointed to earlier regarding household wealth, education is firmly linked to better financial outcomes.

“Higher education is associated with more wealth. Households in which the most educated member held a bachelor’s degree had a median wealth of $163,700, compared with $38,900 for households where the most educated member had a high school diploma.”

—2019 analysis of U.S. Census Bureau report and detailed tables on household wealth in 2015

I say, let’s give more children from our poorest districts the chance to prove their mettle. Let’s offer better tools to help our least advantaged young people outgrow poverty, for their own benefit, and for the benefit of our society as whole. There’s no evidence that education is a zero sum game though admission to Harvard may be.

This new—and, remember, temporary!—policy is admitting the best students from Boston’s public elementary schools into their best public high schools at a rate proportionate to how many children live in given neighborhoods. Those kids may not perform better than the second or third best students at another school in more expensive zones of the district, but so what? They remain kids who show up to class, work hard to please their teachers, and follow the rules. Great students are gaining those coveted admission slots.Binder page listing high school courses for grade 10

BPS is hardly admitting disinterested, failing students from poor schools at the expense of dutiful scholars from richer ones. The real issue is that a few kids enjoy exceptionally excellent free public education while the rest are left to endure in lower quality institutions due to the vagaries of circumstance.

Without extra household funds, the poorest kids in Boston can’t afford private tutoring. Their parents—the financial data from the Census suggests—are less likely to have been highly educated; they’re likely less able to assist their kids with their toughest assignments. In spite of that, these children excel academically at the school their limited circumstances proscribed prescribed for them. I’d argue that their success is the most deserving of acknowledgement and reward on the part of the school system because of how hard won it is.

Policies such as this one finally offer an incentive to encourage our cities to integrate. Integration benefits all of us, not just poor children or students of color. The wildly uneven quality of public schools has driven real estate bubbles and worsened multiple types of segregation, directly leading to many of the upheavals and protests that roiled America over the past year.

I applaud Boston Public Schools for taking this step toward becoming an agent of change in this dynamic. Now they—and the rest of us—should work on offering an equivalent caliber of education to those rarefied, elite “exam schools” to every child who wants it.

* Melanin is responsible for pigmentation of human skin, hair, and eyes; melanosomes are the cells in the body that synthesize the melanin responsible for darker skin tones