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What's the Best At-Home COVID-19 Test? | by heidi


 


Since the beginning of the COVID-19 pandemic, more than 400 tests have received U.S. Food and Drug Administration (FDA) emergency use authorization.1 Most are the highly reliable molecular nucleic acid tests performed in hospitals and clinics.


However, there are now more than 60 at-home collection kits in which specimens are sent to a laboratory for analysis, and 13 at-home tests in which a person performs a swab, analyzes the sample, and receives a result within 15 to 30 minutes.1



This article discusses the accuracy of these at-home tests, the best options, and when you should take one.


At-home COVID Tests


How Accurate Are At-Home COVID-19 Tests?

At-home tests are performed at home, and anyone can use them, regardless of their symptoms or vaccination status. At-home COVID-19 tests are generally approved for use in people over the age of 2.


The testing options include self-collection kits or completely self-administered tests.2


Self-collection kits require specimens to be sent to a laboratory, and results return one to two days later. In contrast, the results of a completely self-administered test are available within 15–30 minutes.2 This is an important distinction for someone seeking a quick result.


The two at-home tests are the rapid antigen and molecular nucleic acid tests (also called PCR or RT-PCR). The rapid antigen tests look for viral proteins in the body, whereas the molecular PCR tests look for viral genetic material. Both can determine whether someone has an active COVID-19 infection.3


Collection Kits vs. Self-Administered Tests

Self-collection at-home kits are usually molecular PCR tests that are more accurate than rapid antigen at-home tests.2


Generally, molecular PCR COVID-19 tests are more accurate than rapid antigen tests, whether performed in a hospital or at home.4



One of the most important factors in getting an accurate result from at-home COVID-19 tests is the amount of virus in your body.5 If a lot of virus has built up in your body, you are more likely to accurately test positive.


The amount of virus in the body is determined by how long it’s been since you contracted the virus and whether you have COVID-19 symptoms. If you contracted the virus within one day, you will not have as much virus in your body compared to if you contracted the virus several days ago. Additionally, if a lot of virus has built up in your body, you are more likely to have symptoms.



If you test when you don't have symptoms, there's a greater chance of a false-negative result. A false negative is when the test indicates you do not have the disease, but you actually do. In general, when a person is infected with COVID-19, molecular PCR tests can accurately detect the virus 99% of the time. This is called the sensitivity of the test. The sensitivity of rapid antigen tests is lower, at 90%.5



Test Sensitivity

Researchers analyzed test accuracy in people with different amounts of virus in their bodies and in symptomatic people vs. asymptomatic people (those without symptoms). They found that both tests (molecular PCR and rapid antigen) more accurately detected virus in symptomatic people.


Altogether, the tests in this analysis had a sensitivity of approximately 55% in people without COVID-19 symptoms.5 They also found that the most important factor that influences test accuracy is the amount of virus in a person's system and not whether the person has symptoms.5


The accuracy of at-home COVID-19 tests can also depend on the type of specimen required, whether a nasal specimen, saliva specimen, or oral swab.



The nasal specimen can be obtained by swishing a cotton swab either in the deep nasopharyngeal area (high up inside the nostril) or the anterior (front) to middle part of the nose.2 Historically, the deep nasopharyngeal specimens have been more accurate, but the tests that use saliva have been steadily improving.


Scientists compared the collection methods and found that results from saliva samples were 74%–88% as consistent as nasopharyngeal samples.6 While this is not perfect, saliva samples are easier to use and allow more people to obtain testing.

High Suspicion for Infection

If you have a high suspicion that you are infected even when your COVID test result is negative, you should still quarantine to limit the spread of infection to others.


What's the Best At-Home COVID-19 Test?

There is not a perfect COVID-19 test, and the best at-home test depends on several factors unique to an individual's need, including the length of time to obtain a result and the cost.


At-home rapid antigen tests are widely available, and they provide results in about 15–30 minutes. Molecular PCR tests are considered the gold standard of COVID-19 testing, but they require more time to obtain a result. You will need to determine what timing works best for you.


Molecular PCR tests are generally more expensive than rapid antigen tests, but insurance should cover testing for symptomatic and asymptomatic people with a possible COVID-19 exposure.7 Insurance programs may not cover employee-required testing. Speak with your insurance company about coverage and rates. Certain tests are available for purchase over-the-counter.


Some of the best at-home testing options include:


The Lucira Check It COVID-19 Test Kit is an at-home test that looks for genetic material similar to the molecular PCR test. It is FDA-approved and, since April 2021, does not require a prescription. It uses an anterior nasal swab, and results are available at home in approximately 30 minutes.8 It correctly identifies positive cases 92% of the time and correctly identifies negative cases 98% of the time.8 It costs roughly $90.

Abbott’s BinaxNOW COVID-19 Antigen Self-Test is an FDA-approved test for viral antigens (proteins) and does not require a prescription. It uses an anterior nasal swab, and results are available at home in approximately 15 minutes.9 It correctly identifies positive cases 91.7% of the time and correctly identifies negative cases 100% of the time.9 It costs roughly $25.

The LabCorp Pixel COVID-19 PCR Test Home Collection Kit is an FDA-approved molecular PCR test and does not require a prescription. It uses an anterior nasal swab. However, it is a self-collection testing kit, so specimens are collected at home and shipped to LabCorp. Results are available in one to two days. It is the most reliable COVID-19 test, with 100% accuracy.10 It costs approximately $120, but insurance may cover the cost.

The DxTerity COVID-19 At-Home Collection Kit is an FDA-approved molecular PCR test and does not require a prescription. The collection is simple and obtained by using a saliva swab. However, it is a self-collection testing kit, so specimens are collected at home and shipped to a laboratory. Results are available in one to two days.11 It correctly identifies positive cases 97% of the time and correctly identifies negative cases 90% of the time in symptomatic people. It costs approximately $100.

The Lucira test is a reliable at-home test, but it is expensive. BinaxNOW is cheaper, but rapid antigen tests are not as accurate as molecular PCR tests. The LabCorp Pixel test is the most accurate, but it takes two days to receive a result. DxTerity can be more comfortable for users, since it uses a saliva swab.



These are just some of the factors to consider when choosing an at-home test.

Recall of Ellume

Although it has been a popular choice, in October 2021, Ellume’s COVID-19 Home Test was recalled by the FDA because of too many false-positive results, indicating people had COVID-19 when they actually did not. The Ellume test is a rapid antigen test available without a prescription. The FDA notes that the reliability of a negative test result is not affected.12


When Should You Order an At-Home COVID-19 Test?

Testing for COVID-19 is an essential public health tool that helps prevent the spread of disease.


The best time to order an at-home test is when a person develops symptoms. At-home testing provides a safe, fast option for people with symptoms of infection or who have been exposed to someone with COVID-19.


However, testing can also help people in high-risk professions keep their families safe. It also provides some reassurance for people traveling to see family members who may be at risk for severe illness.


At-home tests are widely available now and are easy to use, giving people who don't have access to hospitals or clinics testing options.


The FDA recently updated its policies regarding COVID-19 tests, aiming to increase access to at-home tests.13 The agency believes that testing plays a central role in helping people return to work, school, and important activities, particularly over the holiday season.


Not everyone can obtain testing at a hospital or clinic, so at-home options provide improved access to COVID-19 screening.

Know the Test You Are Purchasing

Understand which at-home test you are using to ensure your desired accuracy, method of specimen collection, and timing of results.


What's the Best Way to Take an At-Home COVID-19 Test?

People can perform at-home COVID-19 testing at any time. The kits evaluate for all COVID-19 variants, including the Delta variant. All at-home tests come with detailed instructions and required materials.


Molecular PCR tests with nasopharyngeal swabs are the most reliable COVID-19 tests and can provide reassurance about a test result. However, developers have made specimen collection easier, more comfortable, and fairly reliable with saliva tests.


Rapid antigen tests are quick and affordable, and they should be adequate for many situations.


If you think you have COVID-19, obtain testing. At-home testing options have come a long way and are designed to be safe and easy to use for all people. Speak to your healthcare provider for more information about the best at-home testing option for you.

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