By now, most of us have waited on line at a COVID-19 testing site, and then waited again for the results. Our testing capacity and infrastructure are clearly not where they need to be to handle the COVID-19 pandemic. But at-home tests are proliferating, making it easy (in theory) to take a coronavirus test within your own four walls.
The most recent win there was the FDA authorization, on December 15, of the first over-the-counter COVID-19 test that can be completed entirely at home. That means that — unlike the existing at-home tests, and more along the lines of a home pregnancy test — you don’t need to send your sample in to get results.
The Ellume COVID-19 Home Test uses a self-collected nasal swab and returns results in just 20 minutes. It’s an antigen test, which is slightly less accurate than gold standard PCR tests, but it is authorized for both people with and without symptoms. The test is expected to cost $30 and should be available in the first half of 2021. Only one other rapid result, completely at-home test is available in the U.S. However, that one, the Lucira COVID-19 All-in-One Test Kit is only available at health clinics or with a prescription. The Lucira test was not examined for efficacy in asymptomatic people and some experts say it should only be used in people with COVID-19 symptoms. It costs about $50 and can be used at home by those aged 14 and up.
That leaves us, for now, with the mail-in COVID-19 tests. These coronavirus tests come in the mail, provide collection units for either a nasal swab or saliva sample, and include pre-paid return packaging for you to mail back to a lab. Results typically arrive in 72 hours, according to the companies (although one may take up to five days). So far, so good. But are these kinds of at-home COVID-19 tests legit?
You can feel pretty confident that your results from an at-home coronavirus test are as accurate as one you’d receive from a medical professional at one of the COVID-19 testing sites. In one study published in the Journal of the American Medical Association, researchers from Stanford University found that out of 30 people who were tested clinically for the novel coronavirus, only one had differing results from a self-test. That’s roughly a 96.7 percent agreement rate. And in a larger-scale study by UnitedHealth Group, published in the New England Journal of Medicine, researchers found that self-administered tests (in the presence of a healthcare worker) accurately detected the virus in more than 90 percent of people who were positive with COVID-19.
“Self-administered tests performed as well as samples collected by providers,” says Ethan Berke, M.D., co-author of the UnitedHealth Group study. Moreover, the study found that self-administered tests that swabbed the lower portion of the nose (as opposed to the deep swabs during provider tests) might yield more accurate results because patients were less likely to pull back in discomfort and thus compromise the quality of the test. That said, if you’re not showing symptoms and want to get tested, make sure the at-home test you’re looking into has been cleared for use in asymptomatic people.
Most of the at-home tests currently available have not been vetted through the Food and Drug Administration’s usual stringent approval process. Rather, in a rush to get self-testing options out to the public, the FDA used its Emergency Use Authorization powers to “authorize” these tests (meaning they are deemed safe to use), but have not “approved” them, so they have not been subjected to the intensive process that requires extensive, independent testing.
The expediency of at-home tests makes them an attractive option in areas where getting results can take forever or where there are shortages of tests themselves. “The important message here is that the more choices people have for safe, effective testing, the better,” says Dr. Berke. “If you are completely capable of doing it at home and there is no doctor or testing site available, then it makes sense. If you aren’t comfortable doing it yourself, then see your doctor. It all comes down to your situation and capacity of the healthcare system in your area.”
At-Home COVID Tests
If you do decide to go with a COVID-19 self-test, a few things to keep in mind. If you’re feeling extremely ill, see your doctor or head to the ER instead. (The at-home test companies themselves will redirect you there if you have serious symptoms.) If you’re using an antigen test and get a positive result, consider following up with a gold standard PCR test. Antigen tests can give false positive results, and you don’t want to isolate if you aren’t really sick. And you can’t leave your swab baking in the back of your hot car for a day before mailing it back: “If it sits for too long or it’s not at the right temperature, the RNA starts to degrade in the sample and the virus becomes undetectable or more difficult to detect,” says Dr. Berke.
Plus, these tests cost money. While potentially reimbursable by insurance if you submit your paperwork to your carrier, only one of the companies submits a claim for you. But if you’d rather avoid the circus surrounding testing sites or don’t feel comfortable going to a doctor’s office, then these at-home tests are worth considering.
Quest Diagnostics processes many of the tests taken nationwide. Now it has one you can take at home. You get a collection kit sent to your home and you collect an upper respiratory nasal sample. You also get a prepaid FedEx overnight shipping label and envelope that you can use to securely ship your sample to our lab for testing. Test results are usually available 24-48 hours from the time the collected sample arrives in the Quest lab. After you get your results, you can speak to a doctor who can answer any questions you may have about your test results; this costs an added $9.30.
This saliva test originated in partnership with the world’s largest university-based biorepository at Rutgers University. It was the first approved saliva test by the FDA, and eliminated the need for that tricky nostril insertion thing you’ve undoubtedly seen videos of. To get the test, you fill out your personal details, then the company sends you a collection kit. This is not DIY in the classic sense: Instead, you sign up for a Zoom video appointment with a Vault lab worker, who instructs you on the nitty-gritty of getting your spit into the test tube, which is then mailed back to the provider via pre-paid packaging. The company estimates 48–72 hours for results.
Developed using the same detection methods as Vault, Vitagene is a true DIY experience—the company sends you the saliva collection kit, you follow the instructions, and send your sample back via pre-paid mail. Your results will be sent to a secure online account within 72 hours.
The first step with Everlywell is to answer a series of questions about your risk level for COVID. If you fall into the not-seriously-ill category, the company will ship you a test in two to five days, and, once received, you’ll swab your nose with a provided implement, seal up the specimen, and send it back to the lab for analysis. Secure, digital results take 72 hours.
After completing a brief online questionnaire about your symptoms, customers have an optional consultation with a company-provided medical professional, then receive the at-home saliva test through the mail. The test is made by the same group that produces Vault and Vitagene, and works in the same way: Take a sample of your saliva, place it in a collection tube with sealed cap, and send it back to the lab in a pre-paid envelope. Results take three to five days.
If you pass Picture's online eligibility screening test, the company will mail you your test kit. Follow the instructions to take a nasal swab, then seal it in the pre-paid envelope and overnight it back to the lab. A secure digital report will appear in the online portal you set up, with the option for a telemedicine appointment to review your results. Results are ready in 24–48 hours.
After answering a few questions online, customers receive the test kit next-day via UPS, with all the info needed to perform the popular nasal swab test. This test, however, requires swabbing only the “lower” nasal cavity, avoiding some of the unpleasant deep insertion of other tests. You mail your sample back in the pre-paid package, and the company posts your test result to a secure online account in 24–72 hours.
A short online questionnaire about symptoms determines whether or not you qualify for a test. Once accepted, they send you a kit, you collect a sample of your mucus with a test-kit nasal swab, then pack it up and mail it back to the lab for analysis (shipping is pre-paid). The lab will post your results via a private online link in two to three days. The company bills your insurance (no upfront cost to you); if your insurance provider accepts, you’re good. If it doesn’t (or you don’t have insurance or wish to pay out of pocket), the cost is $119.
You can sign up to get your saliva sample kit in the mail after filling out an online screening test. You then follow instructions to fill a vial with your saliva, seal it and send back to the lab. The company will post your results to a secure online account within 72 hours.
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