Covid-19 At-Home Tests: Types, Cost, and Effectiveness
With a rise in Covid-19 cases across the country, and the holidays fast approaching, consumers consider the pros and cons of using at-home Covid-19 tests.
Testing for the holidays
As the holidays approach, many people are considering getting tested for Covid-19 before potentially exposing their loved ones to the coronavirus. Luckily, options for testing have expanded: Waiting in a long line at a drive-up testing location or in a crowded urgent care aren’t the only options anymore.
The Food and Drug Administration (FDA) has approved at least 25 companies to sell at-home tests, ranging from $109-$155 each, with varying amounts of coverage from insurance, based on state and provider. The tests have been approved with Emergency Authorization Use status: Due to the public health crisis, the FDA is allowing the tests to be sold without undergoing the usual scrutiny the agency demands.
Some people are selecting the home-testing option for safety and convenience, to ease holiday stress, and to ensure the only thing they are spreading around the family table is comfort and joy. Here’s all you need to know about Covid-19 testing at home.
How do at-home tests work?
You perform your own test at home using a saliva or nasal (mucus) swab, depending on the test. These types of tests are called PCR (polymerase chain reaction) tests. That means that they are looking for the presence of the genetic code of the virus as opposed to the presence of antibodies or an immune response to an illness. These diagnostic tests are all molecular tests. Serological tests look for antibodies in the blood.
“Viruses are not an entity per se that we can test for (the presence of), so we test for the genetics of the virus and use it as a surrogate for the presence of the virus,” says MarkAlain Déry, DO, medical director of infectious diseases and chief innovation officer at Access Health Louisiana. “But it doesn’t tell us if the virus is alive or dead. The next step is a culture to see if it’s a live virus.”
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Why would someone want to test at home?
In a word: Convenience. If you’re experiencing Covid symptoms, the last thing you want to do is get dressed and go somewhere to wait for a Covid-19 test. Plus, many testing locations use the longer nasal swabs, which feel like you’re being poked in the brain. At-home tests, on the other hand, work with saliva samples or nasal swabs that are inserted only about an inch.
The at-home tests also can increase accessibility to those who are unable to drive, can’t find childcare, or are unable to miss work to spend time waiting in an office or drive-through.
How do I select a test?
Currently, at least 25 tests—from companies such as Pixel by LabCorp, Quest, and Kaiser Permanente— have been approved through an Emergency Use Authorization (EUA) by the FDA.
To keep up with the FDA’s list of approved tests, visit its website. You can narrow down the kits you are looking for by typing “home” in the first table, then sort by “authorized setting.” Anything blank or “N/A” is not a test, but a collection kit. So be sure to look only at the ones with “H” in that column.
A true home test emerges
In mid-November, the FDA authorized the first totally at-home Covid-19 test. The Lucira COVID-19 All-In-One Test Kit will be available shortly by prescription for in-home diagnosis of the virus in Florida and California. It should be available for widespread use in spring for people age 14 and up. It comes with a nasal swab, a sample vial, and a battery-operated test unit that analyzes the sample. The results are available in 30 minutes or less, according to the FDA.
Déry recommends selecting a test based on which one your insurance provider will cover, if any.
You can also consider selecting a test based on price. EverlyWell has sold nearly half a million collection kits, at a competitive rate of $109, mainly because it doesn’t profit from the at-home test, according to Christina Song, director of communications at EverlyWell. Looking for companies that aren’t profiting from the tests can reduce the out-of-pocket cost.
In addition, look for various “extras.” Does the test you selected include a telemedicine appointment with a doctor? Is the virtual visit during the testing process? Or only if you test positive? These additional offers can be the difference between a cheaper and more expensive test.
How long does the test take?
With the exception of the 30-minute, completely-at-home Lucira test, you collect the sample then return it to the company’s lab via the enclosed mailer. Most have to be returned within 24 hours.
Like an in-person Covid-19 test, many of the tests claim to return your results in 24 to 48 hours. Others promise 72 hours. In-person testing can range from just under 24 hours to up to five days, depending on how many tests are being processed and how quickly labs return results. So the time it takes to receive results is comparable.
Are the at-home tests accurate?
You can trust an at-home Covid-19 test as much as a test at a testing center or doctor’s office, says Déry, echoing the FDA’s conclusions. Research looking at the reliability of testing yourself suggests the same. One study comparing the physician-administered test to self-administered tests, published in June 2020 in JAMA, found that patient-collected tests are “an acceptable specimen collection method.”
Déry agrees, saying there’s “no con (of testing at home) with respect to false positives or negatives,” and that the numbers the at-home testing companies offer are “quite good.”
What should I do if my at-home test is positive?
If you get a positive result, the testing company will likely reach out and have you talk to contact tracers and report your case to the health department. This will register your case with the state and then you’ll receive guidance on what to do moving forward. The process is meant to warn those you’ve come in contact with who may be contagious.
After that, you should self-isolate. How long? It depends on “whether you are transmitting the virus or not—and that’s complicated,” says Déry. “There’s a fair number of studies that indicate (you are no longer contagious) about 10 days after your symptoms start. It’s made even more complicated with asymptomatic people (because) they do not have a starting point. The date you are taking the test is the start.” (Here’s more on how long you can test positive for Covid-19 after infection.)
Most importantly, he adds, if you are suffering from any severe symptoms, such as “trouble breathing, persistent pain or pressure in the chest, new confusion, the inability to wake or stay awake, or bluish lips or face,” seek immediate medical care.
- Centers for Disease Control and Prevention: "Symptoms of Coronavirus"
- Food and Drug Administration: "What is an EUA?"
- Food and Drug Administration: "In Vitro Diagnostics EUAs"
- Food and Drug Administration: "Coronavirus (COVID-19) Update: FDA Authorizes First COVID-19 Test for Self-Testing at Home"
- JAMA: "Assessment of Sensitivity and Specificity of Patient-Collected Lower Nasal Specimens for Severe Acute Respiratory Syndrome Coronavirus 2 Testing"
- MarkAlain Déry, DO, an infectious disease physician and epidemiologist with Access Health Louisiana, where he serves as the medical director of infectious diseases and chief innovation officer
- USA Today: "This airline will let you swap airline miles for a free at-home COVID-19 test"