- A shortage of diagnostic novel coronavirus tests in the U.S. has led private companies to roll out at-home COVID-19 test kits, but they are not currently approved by the FDA.
- Doctors say the swab that the kits require can be difficult to perform on yourself, which means home testing may not be accurate.
- The FDA also warns about fraudulent companies marketing tests that could pose health risks.
By now, you're more than aware that cases of COVID-19 keep climbing in the U.S. There are 44,183 confirmed or presumptively positive cases in the country, according to the March 23 report from the Centers for Disease Control and Prevention (CDC)—and that number is only expected to increase.
Here’s the thing: The numbers only reflect the positive and likely positive cases that the CDC knows about, and there’s a shortage of novel coronavirus tests in the U.S. “The real number of novel coronavirus cases is likely much higher,” says William Schaffner, MD, an infectious disease specialist and professor at the Vanderbilt University School of Medicine.
Social media is filled with comments from people who say they have a fever, dry cough, and shortness of breath—classic COVID-19 symptoms—but can’t get tested due to the test-kit shortage. It's true: Doctors are rationing tests, so if you aren't in an area where cases have been detected, you might be turned away, even if you have all the tell-tale symptoms.
Now, private companies like EverlyWell and Nurx are hoping to fill the gap with at-home novel coronavirus test kits. Yup, you may be able to test yourself for novel coronavirus at home...which raises a lot of questions. Here’s everything you need to know about whether or not it's worth ordering an at-home COVID-19 test kit, according to medical experts.
Why are private companies developing at-home tests right now?
Fact: There are not enough novel coronavirus tests currently available from the government to meet testing needs. So, in times like these, it's not uncommon for private companies to step up to help manufacture tests, says Amesh Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security.
"Government labs often play a role early in an outbreak but, as it evolves, private companies usually step in and manufacture tests at scale," Dr. Adalja says. At-home tests are just another way for private companies to reach consumers faster, he says. The catch: If you get a test through your doctor's office, it's free. If you acquire one through an at-home testing kit, it's going to cost you. (More on that in a sec.)
How would an at-home novel coronavirus test kit work, anyway?
The at-home test kits being rolled out by private health-care companies including EverlyWell and Nurx seem to function similarly. Typically, you request the COVID-19 test online on the company's website after answering questions about your basic health, symptoms, and risk factors. From there, a telemedicine doctor will review your answers to determine if you qualify for testing, based on criteria established by the Centers for Disease Control and Prevention (CDC). (Essentially, they want to rule out the possibility that you might have something like the flu first.)
If you get cleared by the doctor, you'll be sent the test kit, which likely will cost upward of $100 (for instance, it's $135 for an EverlyWell kit and $181 for a Nurx kit). Once you have it, you’ll need to use a special swab to take samples from the back of your nose and throat area (this is called a nasoparyngeal swab, which an EverlyWell spokesperson told WH is "like a longer nasal swab"). Then, you'll seal the swab and send it back to the company. You can also provide a spit and sputum (a mixture of saliva and mucus coughed up from the respiratory tract) sample as a backup.
The sample is then processed in a lab where it gets tested for novel coronavirus within anywhere from 48 to 72 hours. These nasoparyngeal swabs are one of the ways you could be tested at a doctor's office too, though they have other options available as well. You'll get your results digitally, and a telemedicine provider would be available to help you figure out next steps if your results do come back positive.
Are these at-home novel coronavirus tests accurate and trustworthy?
It's hard to say. None of these tests are currently approved by the U.S. Food and Drug Administration (FDA). While the FDA has granted emergency use authorization for several companies to manufacture new types of COVID-19 tests, no at-home test kits have received this stamp of approval yet.
EverlyWell and Nurx both have experience with other at-home medical testing, though. EverlyWell has test kits for food sensitivities, Lyme disease, and STDs, among others, while Nurx offers STI and HPV tests. And it's possible the FDA will approve certain at-home tests in the future. "The FDA sees the public health value in expanding the availability of COVID-19 testing through safe and accurate tests that may include home collection, and we are actively working with test developers in this space," the agency said in a statement released March 20.
But there are also some clear scams that have popped up, such as phony websites charging people for at-home test kits that either don't work or straight-up don't exist. In regards to these scam companies, the FDA said in the same statement: "The FDA will take appropriate action to protect consumers from bad actors who take advantage of a crisis to deceive the public by marketing tests that pose risks to patient health."
Even if the test comes from a reputable company, though, it's *still* tough to say whether an at-home test would give you accurate results or not. “I’m skeptical,” says Dr. Schaffner (he has not interacted with one of the new at-home tests firsthand). The reason: “A nasoparyngeal swab takes training to do properly and is uncomfortable,” he says.
If you've ever been tested for the flu at the doctor's office, you've had one of these nasoparyngeal tests (which involves putting a swab up your nose to the point that it reaches your throat), and you probably remember how unpleasant they are. And, with these at-home novel coronavirus tests, you have to try to pull that off on yourself. “You could have the virus but, if you don’t get a good sample, you could run the risk of a false negative reading,” Dr. Schaffner says.
Still, at-home testing has become the go-to form of COVID-19 tracking in some communities. For example, the Greater Seattle Coronavirus Assessment Network (SCAN), a group tracking COVID-19 cases in the area in partnership with Seattle and King County Public Health, relies heavily on nasal swabs from at-home testing.
What's the difference between trying to obtain an at-home kit versus just going through my doctor?
Not much, other than it will cost you more and you'll have to do the swab yourself, Dr. Schaffner says. Novel coronavirus tests are now free when you go through a doctor, but you typically need to physically go to a doctor's office to get the prescription for the test—if they decide you qualify for it. If your doctor doesn't do the test in their office, they'll refer you to a local lab or hospital for the test, Dr. Schaffner notes.
The kits are essentially an alternative route that offer more testing options for people who are willing to pay more for the convenience of doing a test in their own home. You still need to get an Rx through a doctor via telemedicine before the kit will be mailed to you, so the process is actually very similar to what you'd go through if you went to your doctor—you just don't ~actually~ go to the doctor.
Given the shortage of available tests, EverlyWell said in an email to WH that the first round of tests would be allocated "to hospitals and health-care systems only in order to get these tests in the hands of those who need them most urgently."
Should I use one of these tests?
The choice is ultimately yours. But if you *can* get tested through your doctor, Dr. Schaffner says that’s really the best way to go. But again, since docs are rationing tests due to availability, it may be difficult to even get a prescription (in person or over the phone if you're going the telemedicine/at-home test kit route) unless you've come into contact with someone who has a confirmed case of COVID-19.
Keep in mind, too, that having a confirmed case of novel coronavirus doesn’t change how you’d treat your symptoms. It’s just an indication that you really should be staying put in your home and doing your best to avoid contact with anyone—something that you should have already been doing anyway if you had symptoms, Dr. Schaffner points out.
What should I do if I take an at-home test and the results are positive?
If you test positive, you should do your best to keep your distance from everyone else (including loved ones) and stay in your house, except to get medical care, per the CDC’s recommendations. You’ll also want to monitor your symptoms and call your doctor if your symptoms get worse.
The CDC currently says that you can stop your home isolation after you meet the following criteria:
- You have had no fever for at least 72 hours without the help of fever-reducing medication
- Your other symptoms have improved
- At least seven days have passed since your symptoms first appeared
Ultimately, based on the nature of these at-home tests, it’s still possible that you could have COVID-19 if you test negative, Dr. Schaffner notes. And keep in mind that you could still contract COVID-19 later, even after testing negative, so you’ll want to do your best to continue with social distancing and to practice good hand hygiene.
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