The Parent's Guide To At-Home COVID-19 Tests
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At the beginning of the coronavirus pandemic, the idea of testing yourself or your children for COVID-19 at home seemed unimaginable. Today, improved access to self-testing kits has given parents the answers they need when they need them. You can test your loved ones as often as you like, and that provides comfort in a confusing time. But as new COVID-19 variants emerge, it's important to know how to use the tests correctly, and just how effective they really are. Consider this your guide to at-home COVID tests.
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Types of At-Home COVID-19 Tests
In early 2022, the U.S. government offered free rapid antigen test kits to American households, which increased use of this self-testing option nationwide. COVID antigen tests also became widely available at drugstores, clinics, and other outposts across the country.
Still, some families prefer PCR (or polymerase chain reaction) tests. This "molecular" type of test is generally given at doctor's offices and testing centers, but you can also take PCR tests at home. A lab will need to process your results. Here's how to make your choice between antigen and molecular at-home COVID tests.
Antigen Tests
The main type of at-home COVID test you will encounter is a rapid antigen test. These tests look for virus proteins in the body and return results in about 15 minutes. Testing is done at home, which is convenient for busy parents. However, some users struggle with administering tests correctly, leading to inaccurate results, says Jeffrey S. Dlott, M.D., MS, senior medical director, Diagnostic Services at Quest Diagnostics. "Rapid antigen tests are typically less sensitive than 'molecular' tests," he adds.
When they're in stock, antigen tests like BinaxNOW by Abbott can be found at major retailers like Walmart, CVS, Walgreens, Amazon, and Rite-Aid. Other manufacturers include BD, Ellume, OraSure and Quidel. There is a wide selection of tests approved by the Food and Drug Administration (FDA) under its emergency use authorization. A kit costs about $20 to $39 and comes with one or two tests.
Molecular Tests
You've probably already heard of PCR tests, the molecular option used by many doctors and testing centers to diagnose coronavirus infections. These look for small amounts of viral RNA, often through a sample taken with a nasal swab. Considered "the gold standard of COVID-19 testing," per Dr. Dlott, a PCR test can also be ordered through a service like QuestDirect, and taken at home. It's more reliable than an antigen test, but must be sent to a lab for processing, and can take at least 24 hours to get results.
For many, the wait is worth it. Even though at-home PCR collection tests may cost $100 or more, the patients who use them can be "confident that their tests are the same high quality molecular test ordered by their physicians, but with the convenience of specimen collection in their home," Dr. Dlott says. Alternative molecular tests, like Lucira Check It, promise PCR-level results with no lab in as little as 30 minutes, but require the use of a costly special device to read the tests.
NOTE: Antigen tests and molecular tests are only used to determine a current COVID-19 infection. Antibody tests are also available, but these indicate a previous infection or vaccination response, says Wendy Sue Swanson, M.D., MBE, FAAP, pediatrician and Chief Medical Officer at SpoonfulONE. Home antibody tests, such as Symbiotica, are available.
How to Take an At-Home COVID Test
It's important to follow the directions on your at-home COVID-19 test carefully; otherwise, you might receive a false result. Samples for diagnostic tests are typically collected with a nasal or throat swab, or saliva gathered by spitting into a tube, notes Dr. Swanson.
How to Take Antigen Tests: For most over-the-counter tests, parents will insert a nasal swab into their child's nose and move it around for several seconds. Then they'll put the snotty swab into a reservoir of test reagent, swirl it again, and drop the liquid mixture onto a test strip. Results are similar to a pregnancy test—a digital reading or lines indicating a positive or negative diagnosis, says Dr. Swanson.
How to Take Molecular Tests: PCR tests will include a tool (likely a swab) for collecting the sample. The kit will also have "a tube with a stabilizing material as well as detailed shipping information" for sending the sample to the lab, says Dr. Dlott. Some molecular at-home tests require you to stick that tube in a machine with an associated reader or smartphone app for results.
Are At-Home COVID Tests Accurate?
Antigen tests are less sensitive than molecular tests, which doesn't mean they're worse. A PCR test will pick up very low levels of viral RNA, and a person might show a positive PCR test for weeks, or even months, after having recovered from COVID-19. That's why the CDC doesn't recommend molecular testing for people who have had COVID-19 in the past 90 days unless they show symptoms again.
With new coronavirus variants regularly emerging, however, molecular tests provide important confirmation of a suspected infection. In December 2021, studies showed that at-home antigen tests weren't as good at detecting the Omicron variant—especially in people with low viral loads and no symptoms. (They're more accurate if you're showing symptoms several days after exposure.) According to the FDA, "Early data suggests that antigen tests do detect the Omicron variant but may have reduced sensitivity."
Some people have suggested using at-home antigen test swabs in the throat to better detect Omicron, which is believed to spread there instead of the lungs. But the FDA warns against it. That's because these tests weren't meant to be used in the throat, and it could impact their effectiveness.
FACT: When it comes to at-home rapid antigen #COVID19 tests, those swabs are for your nose and not your throat. https://t.co/WpgTKrGV4q pic.twitter.com/eyZHADezYB
— U.S. FDA (@US_FDA) January 7, 2022
It's useful to think of antigen tests as "contagiousness tests," says epidemiologist Michael Mina, M.D., the chief science officer of eMed Digital Healthcare, a company that provides at-home testing support and results validation for consumers. In an October 2021 op-ed for The New York Times, Mina urged the U.S. to "embrace rapid testing." For people with symptoms, after all, antigen tests work fairly well.
Molecular tests are incredibly sensitive, so they're useful for confirming an infection after a positive antigen test. They're highly unlikely to return false negatives, so a positive antigen test followed by a negative PCR test means that the first result was probably an error. The goal of testing is to identify cases as soon as possible so people can avoid exposing others, and antigen tests are useful for this.
When Should My Child Take an At-Home COVID Test?
Because at-home antigen tests return results quickly, they're ideal for situations that don't allow for molecular tests. They can be used before entering an event like a wedding, seeing an elderly family member, or going to school after an exposure. That strategy, called test-to-stay, has been adopted in some places as a way to reduce student quarantine.
Ideally, you'd use a few antigen tests for surveillance testing of asymptomatic infections, or any time a person in the household has COVID symptoms, including a sore throat, fever, or runny nose. Unfortunately, buying enough at-home tests can be expensive, so it's not always a workable option.
If you can get at-home tests, however, Dr. Swanson advises you to use them. "The more we test, the more we know where COVID infections—especially those that are asymptomatic—arise," she says. "After any high-risk behavior [involving crowds, travel, or being unmasked indoors], I strongly recommend testing multiple times over the next seven to ten days." But remember: Rapid antigen tests don't always pick up asymptomatic infections, especially those related to the Omicron variant.
PCR collection kits and other molecular tests offer a higher degree of accuracy than antigen tests, but results can take longer. If you aren't pressed for a diagnosis (say, your child is staying home from school anyway, and you don't want to take them to the doctor), these are a better way to confirm a COVID infection. As always, consult your pediatrician for advice.
Getting Access to At-Home Tests
In January 2022, the White House sought to ease the difficulties families have faced in obtaining tests by ordering a billion rapid antigen test kits for dispersal. Households who signed up that month were sent their first batch of four free tests, with a second round available in March. If you want to get tested in your community, you can also visit one of more than 20,000 free testing sites nationwide; at-home tests are also being distributed through many health centers, rural clinics, and school offices.
By federal mandate, private insurance companies must reimburse families for at-home COVID tests; each covered individual is eligible for eight tests per month, available from local pharmacies and retailers. In March 2022, Walgreens announced it would start offering free at-home PCR collection kits from Labcorp.
Can My Kids Swab Their Own Noses?
The specimen for an at-home test is usually taken from the front part of the nose, not the back like early testing in a doctor's office required. Parents may need to swab a young child's nose to ensure a good sample (and have another person assist), but kids age 3 and up can learn to take their own samples, says Shawna Marino, head of policy and communications for test manufacturer Detect. This is often what older kids do if they're tested at school as part of a surveillance testing routine.
It's important to be upfront about the testing process with your child. "It's not 'painless' because the swabs are truly uncomfortable, but the discomfort is very temporary and only lasts the five to 10 seconds you need to get the sample," says Dr. Swanson. The specific steps are different for each test, but kids handle it better when parents remain calm and positive. It helps to provide distractions (a super fun game or show) and rewards (like ice cream) when the test is over, Dr. Swanson adds.
Can I Use An At-Home Test on Babies or Toddlers?
While official guidelines discourage at-home tests for those under 2, Marino says that parents should check with their pediatricians. She used antigen tests off-label to test her child from the time she was 12 months old. If you can afford it, at-home molecular tests may work better because they quickly pick up even small amounts of the virus—which can prove helpful when your kid is resisting.
What Happens If My Kid's At-Home COVID Test is Positive?
No one wants to get this result, but don't panic. Isolate your child and assume they have COVID-19, especially if you take a second rapid test that also comes back positive. Ideally, you'll schedule a confirmatory PCR test at a doctor's office. If that also comes back positive, they definitely have COVID-19. If the PCR test comes back negative, however, then it's likely that the antigen tests were false positives and your kid doesn't have COVID-19.
"If the test is positive, follow the CDC guidance for quarantine and isolation," says Dr. Swanson. Keep little ones with COVID at home, hydrate them, monitor their symptoms, and make sure they stay away from un-immunized individuals, those at high risk, and other children for the full quarantine period.
Christine Coppa contributed to this report.
