New ways of testing for COVID-19 bring promises of accessibility and fast results, but that doesn't diminish the need for consistent national data on case counts, experts say.

As Canada loses track of case counts, a variety of new COVID testing technologies are emerging across North America. In mid-April, the U.S. Food and Drug Administration (FDA) approved the first breath test for the virus, known as the InspectIR COVID-19 Breathalyzer. And in Canada, scientists from Waterloo, Ont., are developing a saliva test on paper.

The InspectIR breath test is the size of a carry-on suitcase. No swabs are required; instead, users blow into a straw for roughly 10 seconds, long enough to fill up a small balloon. It can detect a chemical signature of the virus and provide results within three minutes, according to a study performed across the U.S.

According to the FDA, the breathalyzer was validated in a large study of 2,409 people; some of the participants had symptoms of COVID-19, while others were asymptomatic. Data provided by InspectIR shows results have over 90 per cent accuracy in detecting the virus.

"Basically it's the equivalent of a breathalyzer you would take or an alcohol test you would take as a driver," said Dr. Vanessa Allen, medical microbiologist at the University Health Network/Mount Sinai Hospital microbiology lab.

Another type of test is promising: experts

Allen says the breath test is an example of testing that's becoming cheaper, faster and more accessible to people.

"It doesn't have the portability that I think we're looking for in terms of diagnostic tests, but still offers some promise in terms of being able to use it potentially in outpatient clinics, family practices," she said. "Overall, I think it's very exciting.

"This trend towards getting tests into the home I think will empower people to make safe decisions," said Allen.

It could take up to 10 more weeks for the first devices to hit the market, according to The New York Times. It's unclear whether the Texas-based company of five employees has plans to submit a request to Health Canada for approval of the device and whether it might eventually be available here.

Health Canada says as of April 15, it has not received an application for the InspectIR COVID-19 breathalyzer test.

But it's critical that Canada diversify ways in which people can get their infections confirmed quickly, so they can find out whether they're eligible for antivirals, said Dr. Catherine Hankins, co-chair of Canada's COVID-19 immunity task force.

"We need to look at the details and … understand what's going to be required for Health Canada approval, but this is promising," said Hankins.

Molecular tests — like a PCR test — have been considered the gold standard throughout the pandemic.

But while PCR tests are the most sensitive, they're also the most labour-intensive when it comes to health-care resources, said Dr. Lisa Barrett, an infectious disease physician and researcher at Halifax's Dalhousie University. Rapid antigen tests, meanwhile, might offer fast results but they aren't as accurate.

This new breath test might be a solution that falls somewhere in the middle, Barrett said.

"It has the potential to fill some gaps in the community but how much better it's going to be than a rapid antigen test is not entirely clear," said Barrett.

A greener testing option

Another potential test is under development at the University of Waterloo's Institute for Nanotechnology.

There, researchers led by Sushanta Mitra are working on a paper-based COVID-19 saliva test with some grant funding.

Mitra says the team wanted to develop a test that doesn't create environmental waste, like the current ones do. Their test works by placing saliva on a two-layer paper device, which uses nanoparticles that target the SARS-CoV-2 virus. If the paper turns red that indicates a positive test.

"That's why we started with paper, which is something very biodegradable, which is easy to use, which has minimal environmental impacts," he said.

So far, lab results show the strips are highly accurate, but human trials are still required.

"What we are trying to address here is the consciousness within our society to manage COVID in a more meaningful manner," Mitra said.

"That it becomes the responsibility of individual citizens to do this testing themselves, so that they are not only protecting themselves but also protecting the community around them."

PCR testing declining

Previously, experts have said that abandoning COVID-19 testing leaves us vulnerable to future variants. The level of PCR testing in Canada continues to drop dramatically, while the test positivity rate is sitting around 17 per cent.

In early January around 150,000 PCR tests were performed daily. On Wednesday, that number was around 65,000.

The first Omicron wave overwhelmed testing and provided rationale to constrain PCR availability, said Dr. David Naylor, who led the federal inquiry into the 2003 SARS epidemic and co-chairs the federal government's COVID-19 immunity task force.

"Now we have a self-justifying cycle of willful ignorance and passivity: no point testing because we can't keep up, and no point intervening because we can't contain it," he said.

Naylor said there is widespread public fatigue of restrictions, strong pressure from businesses to get the economy moving again and a belief from public health officials that background immunity from vaccinations and infections is likely to limit the impact of successive waves of COVID-19.

"I am very uneasy about the unmeasured toll of this phase of the pandemic. However, I don't see public health officials and political leaders changing course in the weeks ahead."

A need to keep testing and reporting: experts

This week, the head of the World Health Organization urged countries to keep surveilling coronavirus infections, Reuters reported.

"As many countries reduce testing, WHO is receiving less and less information about transmission and sequence," said Director-General Tedros Adhanom Ghebreyesus at the UN agency's headquarters in Geneva on Tuesday.

"This makes us increasingly blind to patterns of transmission and evolution," he said.

In Canada, testing is "very disjointed," Barrett said.

Current wastewater surveillance only indicates whether the virus levels are rising, and although home antigen tests are helpful, they don't offer public health officials any data.

Public testing and tracing reveals who should be isolating and allows quicker access to COVID-19 treatments, Barrett said.

"Very tough for people right now, especially if they want to have some of that potential power that comes with the knowledge of whether you're positive or not," she said.

"When we don't do that kind of tracking and [have] that kind of knowledge collection around testing, especially PCR and or reporting of antigens, then we do lose the ability to understand more about the virus."

Hankins said it's important to have a platform where people can report their test results.

"A device can make a difference if it includes a website where you report your results, which not all provinces do," she said. "That sure helps us get a better idea about what's going on in the population.

She predicts future testing will mostly be done for clinical purposes in order to provide people with access to antivirals quickly.

"So the test has to be accessible [and] it has to provide results immediately," she said.