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Monkeypox can’t use the same at-home testing playbook as COVID-19 - The Verge

Monkeypox testing still requires swabbing lesions, and researchers don’t have a good understanding of how the virus appears in saliva. It can’t follow the same trajectory as COVID-19 tests.

After two years of COVID-19, the conversation around monkeypox testing gives off an unnerving sense of deja-vu. The similarities are right there: painful swabs, the struggle to even find a test, bottlenecks, and a long wait for results. But the diseases are different enough that experience with COVID-19 didn’t give researchers much of a leg up in their efforts to improve the monkeypox testing process.

In the early days of the COVID-19 pandemic, experts bemoaned the lack of investment in rapid, at-home testing for various diseases in the United States. The thought was that if the infrastructure had been in place before the coronavirus emerged, it would have been easier to scale up testing — and maybe help control the pandemic. Eventually, that scale-up happened anyway. Money and resources flooded into testing projects, and soon, at-home COVID-19 tests became ubiquitous. That experience was supposed to set the stage for a future with easy access to home tests for any number of diseases once they popped onto the scene.

Against that backdrop, it would seem that monkeypox might offer a perfect test case. It’s an unfamiliar disease spreading rapidly, and there’s high demand for tests. But monkeypox isn’t the best benchmark for whether that future is going to materialize, says Ben Pinsky, the medical co-director for point of care testing at Stanford Health Care. “It’s a different enough infection,” he says.

Monkeypox isn’t a respiratory disease like COVID-19, where the nose and mouth are the clear targets — both for the virus and for testing. Monkeypox’s telltale signs are painful, blister-like sores, and it can come with other symptoms like fever and muscle aches. Right now, monkeypox tests involve swabbing the sores that appear over the course of an infection. There aren’t at-home tests for other lesions — like herpes, for example, Pinsky says. There is still a lot of work to do to figure out if people are able to successfully swab their own lesions, which could be painful or difficult, he says.

The reliance on lesions means that patients can only be tested once the telltale signs of the disease appear — which is a sign they probably should be isolated from others anyway. Someone who was exposed to monkeypox and has a fever but no lesions wouldn’t be able to take a test. People can test for COVID-19, on the other hand, without waiting for any specific symptoms to appear. “I’m a strong advocate for home testing of diseases, but you have to have the right sample at the right time, and we aren’t there yet,” says Paul Yager, a professor in the department of bioengineering at the University of Washington, in an email to The Verge.

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