As the highly transmissible new omicron variant adds anxiety to the holiday season, even among people who are vaccinated, testing is crucial so that people who are infected don’t unknowingly spread the virus to others. Testing is also needed so scientists can understand the level of disease in a community and identify hotspots. The good news is there are now more coronavirus testing options than ever, including over-the-counter kits for home use that can provide results in minutes. While home kits are hard to come by in some areas of the United States, that may soon change as the federal government takes steps to battle omicron. On December 21, 2021 President Biden announced his administration’s plans to purchase 500 million at-home rapid tests to be distributed free to Americans who want them. People will be able to sign up online to get the tests delivered to their home, at no charge, beginning in January 2022. This is true not only for people who are unvaccinated but also for individuals who are immunized: “Breakthrough infections” appear to be more common with omicron than with the formerly dominant delta variant, although early evidence suggests these cases tend to be mild. I for one used home tests to make traveling and socializing safer last summer. My itinerary included attending a large indoor wedding in one city, followed by an outdoor baby shower in another city a week later. Even though I was fully vaccinated, I packed a home test kit and used it between stops, to help insure I didn’t inadvertently bring the disease to the pregnant couple or their friends. RELATED: Coronavirus Alert: The Latest News, Data, and Expert Insight on the COVID-19 Pandemic
New Home COVID-19 Tests Ease the Process
Early in the pandemic, if you wanted a COVID-19 test, you had to find a government testing site and stand in line — sometimes for hours — or locate a doctor’s office or medical center administering a test. While people in places like New York City are once again waiting in long lines for COVID-19 tests, the advent of home kits means there is another option. COVID-19 self-tests have been around since the FDA first authorized them in November 2020. But most of the early models required a doctor’s prescription, an expensive testing device, or the sending of a nasal-swab sample to a lab in the mail. In March 2021, the FDA granted emergency use authorization for a number of tests that don’t require a prescription, are relatively inexpensive, and yield rapid results. Since then the FDA has added even more options to the at-home testing line-up. RELATED: 7 Biggest COVID-19 Vaccine Myths
COVID-19 Home Testing Offers Convenience and Peace of Mind
Now that people are returning to many aspects of their pre-pandemic life, including traveling, socializing, going to school, and working in an office, rapid home tests may be especially useful. Guidance from the CDC calls for anyone who has COVID-19 symptoms to be tested whether or not they have been vaccinated; individuals who have been exposed to someone with known or suspected COVID-19 also need to be tested whether or not they have symptoms. The CDC says that the test can be conducted at home or by a healthcare provider. (You should also quarantine until you know the results.) “Home testing allows you to more conveniently find out if you’re contagious so you can isolate before passing the disease to someone else,” Dr. Gronvall says. RELATED: Is It a Cold, the Flu, or COVID-19?
COVID-19 Home Tests Can Be Useful for Travel
Certain home tests can be used to meet requirements for international travel. Currently anyone traveling by air into the United States must show a negative result from a test taken no more than one day before flying, or documentation of recovery from a recent case of COVID-19, notes the CDC. (Some other countries also require similar proof of a recent negative test.) Home tests that include a telehealth component, where the provider confirms your identity, virtually observes your taking your sample, confirms that your test result is negative, and issues a document to that effect, can be used to meet this requirement, the CDC says.
Three Different Types of COVID-19 Tests
When testing for COVID-19, there are several different technologies involved. Two main types can determine whether a person has an active infection: polymerase chain reaction tests (PCR) and antigen tests. PCR tests are considered the gold standard because they look for traces of the virus’s genetic material. These tests are used at testing sites, hospitals, doctor’s offices, and the like. A nasal-swab sample is examined in a lab, with results taking a day or longer. Antigen tests seek to detect the presence of a specific molecule that implies a current viral infection but do not document it directly. They can be performed in many settings, from a doctor’s office to a workplace, college, school, and now also at home. The sample is taken with a swab in the nose, and results are revealed quickly. Antigen tests are more prone to error than PCR tests. According to the CDC, antigen tests are less sensitive than PCR tests so they may miss an early infection that a PCR would detect. That means if you take an antigen test in the earliest stages of an infection, before the virus has replicated widely, the result could return a false negative. Using antigen tests repeatedly, however, can help compensate for lower sensitivity. In a study published in September 2021 in The Journal of Infectious Diseases, researchers found that when they tested infected college students and employees every three days, rapid antigen tests successfully identified 98 percent of infections, which is on par with PCR tests. A third type of COVID-19 test is an antibody test. This is a blood test that shows if you’ve had COVID-19 in the past. It does not measure if you are sick now. Having had COVID-19 in the past does not guarantee that you cannot get it again.
Brands of Rapid COVID-19 Tests for Home Use
The FDA has authorized a number of COVID-19 antigen tests for home use without a prescription. These include:
Abbott BinaxNOW is sold in a package of two tests for about $24. After swabbing both nostrils, you place the sample on a reactive strip in a test card, as shown in a video made by Abbott. Like with a pregnancy test, two lines appearing on the card indicate the test is positive, meaning you have COVID-19; one line means you don’t. Because antigen tests can give a false negative result if you test too early after being exposed, instructions call for using the second test in the package within three days for a more accurate result.Quidel QuickVue works similarly to the BinaxNOW but uses a tube of solution instead of a card to develop results; the company offers a step-by-step video. Results are available in 10 minutes. This test also costs about $24 and is similarly sold as a package of two, with instructions to repeat a negative test within three days.Ellume requires a sample to be taken with a nasal swab and transferred to a strip filled with processing fluid. The strip communicates via Bluetooth with an app, with results displayed on that app within 15 minutes. Ellume is available for about $40, with one test included in each kit. However, the FDA has ordered a recall of over 2 million Ellume tests — first on Oct. 5 and then again on Nov. 11, 2021 — due to an unacceptably high number of false positives. Affected lots were manufactured between Feb. 24 and Aug. 11, 2021. You can check if your test kit came from a recalled lot at the FDA’s Medical Device Recall Database Entry.Flowflex by Acon Laboratories comes with nasal swabs, a chemical solution, and a testing strip, and yields results in 15 minutes. The Flowflex comes one to a kit and does not require serial testing; it is available for about $10.
If you take a home test and get a positive result, you should reach out to your physician and also stay home and isolate away from others. To help local officials keep track of possible infection surges, many health departments also request that you inform them of a positive result.
COVID-19 Home Tests That Involve a Professional
Other tests are conducted at home but also involve a healthcare professional in some way. The Abbott BinaxNOW Ag Card Home Test is performed similarly to the BinaxNOW and is also available without a prescription. Here, though, a telehealth professional accessed via an app guides the taker through the test and verifies the results. Because of this oversight, this test can generally be used to document negative test results for international travel to the United States. The cost for this test is about $35 for one test or $70 for two. Pixel is a PCR test where a person swabs their own nose at home and sends the sample in an enclosed package to LabCorp for processing, generally within two days. If you have insurance and meet certain testing criteria, such as exposure to a person with COVID-19, you can get this test for free, with LabCorp billing your insurance company. Or you can pay $119. As with other home tests, this does not require a doctor’s prescription.
COVID-19 Home Tests Have Limitations
Home COVID-19 tests offer a great deal of convenience at a relatively low cost. But they do have downsides. Because most home tests are antigen tests, they can miss an active coronavirus infection, especially when it is in the early stages. Although the tests are relatively simple to perform, it is possible that a person will complete it incorrectly, invalidating the results. Most home tests provide results within minutes, but those that require sending a sample to a lab for analysis still take days to get results. And if people don’t take it upon themselves to notify public health experts in their community of a positive test, officials may not learn when a disease hot spot is arising.
Home Tests Are Relatively Inexpensive, But They May Not Be Free
Currently most home tests for COVID-19 involve an upfront cost to the consumer, with the Biden administration announcing it would soon require private health insurers to offer reimbursement. If you live in an area where PCR tests from the health department, pharmacy, or other providers are readily available, you might choose that over a home test, says Richard Martinello, MD, an infectious diseases specialist at Yale Medicine and associate professor of medicine at the Yale School of Medicine in New Haven, Connecticut. “It may be cheaper to seek out one of these options because there is no cost to get tested at many locations,” Dr. Martinello says. According to the White House, there are now 20,000 free testing sites across the U.S.
The Government Is Evaluating Home Test Benefits
The federal government is currently evaluating whether regular home testing can be used to limit the spread of the virus. The FDA already knows that for group care settings like nursing homes, “repeated use of rapid point-of-care testing may be superior for overall infection control compared with less frequent, highly sensitive tests with prolonged turnaround times.” Now the CDC and National Institutes of Health (NIH) have started a community health initiative called Say Yes! COVID Test. Home test kits are being made available free to residents in select communities, as part of a research project. The study will determine whether frequent home testing not only keeps an individual safer but also protects the whole community. Additional reporting by Julia Califano.
