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The home medical-testing company Everlywell recently announced it would be releasing the first at-home COVID-19 test in the US this week. The FDA, however, subsequently warned the public that it had not authorized the sale of any at-home coronavirus tests to consumers. In response to a flood of requests from hospitals and healthcare workers, Everlywell says, the company decided to sell its initial supply of COVID-19 testing kits “to hospitals and healthcare companies with workers on the frontlines only,” provided testing would be free for workers.
Everlywell says it still plans to make its COVID-19 testing kits available to consumers who meet the CDC’s testing criteria, but the company hasn’t announced a new release date. At least a few other startups, including Nurx and Lemonaid, have said they’ll also be offering at-home coronavirus tests.
The introduction of at-home tests is intended to give more Americans access to coronavirus testing, as well as reduce strain on overloaded healthcare professionals. Even so, taking testing into your own hands comes with a few caveats. Most importantly, the test can be tricky to perform correctly, which is necessary to guarantee reliable results.
“Increased testing is important for controlling the spread of the COVID-19 virus and identifying patients at risk for severe illness,” says Dr. Giuseppe Aragona, medical advisor at Prescription Doctor. “However, knowing the limitations of the test is important in order to prevent giving people a false sense of security or exacerbating their fear.”
We asked experts how COVID-19 spit kits work and what patients who take the DIY approach need to know before they start swabbing. Here’s what they had to say.
At-home tests work the same way as the tests doctors use
At some point soon, patients will be able to order COVID-19 tests directly from Everlywell’s site. The purchase won’t require a prescription or referral from a doctor, but buyers will need to fill out an eligibility questionnaire with information about their symptoms and coronavirus exposure. A physician will review the questionnaire before approving the purchase.
Like the majority of COVID-19 tests available across the country, Everlywell’s test is a “real-time PCR test.” That means it detects the RNA of the virus in a sample of mucus or saliva. An RT-PCR test can be used to diagnose current COVID-19 infections. The other main way to test for the coronavirus is an antibody test, a blood test that can tell a doctor whether a patient has ever encountered the virus, even if they aren’t currently infected. Antibody testing isn’t currently happening in the US.
The Everlywell test also relies on the same method used by healthcare providers across the country: A long plastic q-tip called a nasopharyngeal swab is inserted far into the nasal passages to collect mucus. The test is listed for $135, and consumers receive results online two days after the lab receives the sample. If you get tested at a doctor’s office, you’d probably have to wait three to four days after the lab received your sample to get your results.
First, know there’s a chance the test could be inaccurate
The Centers for Disease Control and Prevention has stringent guidelines for COVID-19 swab-testing. If you’re not getting tested by a medical professional trained in proper testing technique, your results might be wrong. “Following the instructions is really important with home-testing kits,” says Aragona. “If you don’t do something right, the test will not be accurate.”
For example, Dr. Jasper Schmidt, chief medical officer of ProofPilot, says it’s pretty easy to get a false negative result if you don’t send enough mucus in your sample, or if you conduct testing too early after contracting the virus.
“We can presume a positive test means the patient is highly likely to be in the middle of an active infection,” he says. “However, a negative test will not be able to fully rule out the disease. Stories of hospitalized patients show that on some days, they test positive, and on other days, they are negative, complicating the reliability of any kind of testing.”
Lawmakers are questioning home testing companies’ practices, saying the tests’ accuracy has “yet to be determined.” According to the New York Times, “all companies said that they had worked with accredited labs that had received FDA authorization to perform coronavirus testing and had followed federal standards for establishing the accuracy of their coronavirus tests.”
You need to stick the swab way past your nostril
You could also get a false negative if you don’t perform the actual swab test properly. If you’ve ever been tested for the flu, you know how uncomfortable it can be to have a long swab pushed up into your sinuses. Dr. Daniel Hart, director of infection prevention at Summit Medical Group/CityMD, says it’s likely that a lot of people will perform this part incorrectly.
“To obtain an appropriate swab of the nasopharynx (not the nostril), you have to go far back with the swab,” he says. “The majority of people at home will not go far enough back and will subsequently get a false negative result.”
Dr. Frank Ong, Everlywell’s chief scientific and medical officer, says Everlywell’s COVID-19 testing kit comes with easy-to-follow instructions for how to conduct the nasopharyngeal swab, as well as digital and video instructions online and via email.
You’re supposed to tilt your head back to a 45-degree angle, then insert a swab through your nostril and straight back toward your ear. The instructions emphasize inserting the swab straight back, not up, and continuing until you feel resistance (about 1.5 to 2.5 inches). Then, you use the same swab to repeat the process in the other nostril.
Even if the tip of the swab is well-moistened, you may not be able to see any mucus. So there’s no definitive way to know how much mucus is actually on it. The kit also instructs you to collect samples of saliva and sputum (phlegm), if you’re able to cough some up.
You shouldn’t do at-home testing before you have symptoms
If you’ve spent time around someone who’s tested positive for the coronavirus (and caught the virus from them), experts say you could be infected for two to 14 days before showing symptoms. Chances are, if you called your doctor and said you’d been in close contact with a COVID-19 patient, they wouldn’t recommend getting tested unless you’re symptomatic. Same goes for at-home testing.
“Sending a home test for those that are not currently symptomatic is not a good idea,” says Aragona. “If the patient is too early in their infection process, they may get back a negative test result even if they have an infection, causing a false sense of security.”
At-home testing during recovery is iffy too
People who’ve already been diagnosed with COVID-19 might want to take at-home tests to see if they’re still contagious. Experts urge caution.
“There’s evidence to suggest that when people are in the recovery stage, there may be some days they may test negative for the virus one day and positive on the next,” says Schmidt. “We don’t have enough evidence to know what this means in terms of infectivity.
“Patients who have recovered from COVID-19 may still feel short of breath because their lung tissues are healing, but they no longer test positive because their viral load has diminished,” he adds. “This will also give patients the ‘wrong answer’ if they are trying to know if they’ve infected the people around them.”
If you’re wondering when it’s OK to stop self-isolating, the CDC says anyone who gets COVID-19 should self-isolate until 72 hours have passed since recovery. You can consider yourself “recovered” once you meet both of the following criteria: 1) Your respiratory symptoms and fever are gone, without the use of fever-reducing meds. 2) It’s been at least seven days since your symptoms first appeared. The CDC also lists a second way to determine when isolation is over, but it’s not a feasible option until (or maybe unless) we have an abundance of tests and no limits on our capacity to process them. By this measure, isolation should last until you get two negative test results, at least 24 hours apart.
Talk to a doctor first
If you have any symptoms, like shortness of breath, a fever or a dry cough, it’s always a good idea to talk to a doctor before doing anything else — and ideally to get tested by a healthcare professional if possible.
“It’s best to have a test done under the care and evaluation of a clinician, who can make sure they are appropriately looking at your clinical history along with your test results,” says Dr. Tania Elliott, an internal medicine doctor specializing in immunology. “A clinician will also make sure you’re taking the right next steps.”
Ong says every at-home user who tests positive for the coronavirus will be contacted by an independent, board-certified physician to discuss their results and advise them on appropriate next steps. All positive results will be communicated to mandated federal and state reporting agencies, the same way results from in-person testing are.
While at-home testing comes with caveats, Elliott says it may be a helpful solution for people who live in badly affected areas where testing sites are inundated or in rural areas without nearby testing, or for people who can’t drive themselves to get tested and don’t want to risk exposing others. But if you have severe symptoms, she urges calling a doctor right away rather than going the self-testing route.