Here’s What to Know About At-Home COVID-19 Tests

How accurate are they really?
covid home test swab in vial

As the coronavirus (COVID-19) pandemic continues to unfold and testing remains a key priority, there are now at least three at-home tests consumers can utilize from the comfort and relative safety of their own homes.

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Those three at-home tests received emergency clearance from the U.S. Food and Drug Administration (FDA) to be sold for anyone to use at home. Two of the tests use nasal swabs that are then sent back to a lab for results while the third uses a saliva sample.

But there are concerns about these tests, especially if they’re designed to generate accurate results. For instance, the swabs included in the nasal passage tests are significantly shorter than a swab used in the typical COVID-19 test which may affect test results.

We spoke to pathologist Gary Procop, MD, about the pros and cons of these at-home tests and what consumers should keep in mind when considering using one.

Doing it right

The key challenge in these at-home tests, according to Dr. Procop, is making sure you get a good sample. “A good specimen is the linchpin for any test. You can have the best test in the world but if you have a poor specimen, the results will be off.”

In terms of these at-home tests, one big challenge is the do-it-yourself aspect with no direct advice from a healthcare provider. “I do worry about the adequacy of specimen collection in unobserved home collections,” Dr. Procop says.

He points to a recent study (yet to be peer-reviewed) out of UCLA’s Fielding School of Public Health that examined the success rate of self-test samples taken under doctor supervision versus those taken alone with no doctor input.

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The study examined multiple test samples taken from 45 participants; 29 of those participants had at least one positive result for COVID-19. The best result came from the clinician-supervised, self-administered oral swabs which detected 90% (26 of 29) individuals. Clinician-supervised, self-administered nasal swabs had an 85% success rate while the clinician-collected nasal swabs had a 79% success rate of detecting positive tests.

Meanwhile, the self-collected oral swab tests with no clinician supervision only detected 66% of positive tests, a difference from the supervised tests that Dr. Procop calls “night and day.” (The study did not include unmonitored nasal swab tests.)

Having a clinician present is a big advantage in terms of helping a patient correctly administer the test, according to Dr. Procop. For instance, in the UCLA study, patients collecting an oral fluid sample were instructed to cough 3-to-5 times to collect saliva and phlegm in their mouth before swabbing. Researchers noted that several of the unmonitored patients didn’t perform this crucial first step without a clinician there to remind them.

“If there are particular directions,” Dr. Procop says, “this study shows that there could be consequences.”

Dr. Procop is concerned that if the patient self-collects from only that front-most portion of the nose, rather than inserting the swab more deeply to the appropriate location, that the results will not be as accurate compared with a deeper collection. “We want to get back to where the virus lives,” he says.

The advantage of an at-home test

That’s not to say there aren’t reasons that an at-home test is a good option. “What we want to do is make sure we get the right answer,” Dr. Procop says. “Ideally, it’d be great to have self-collection with video monitoring where a clinician can offer instructions. Whether it’s making sure a patient follows all the instructions or just offering helpful tips, that monitoring can help ensure a good specimen.”

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The home tests are also safer in a few ways, according to Dr. Procop. “If a person thinks they may be sick, it’s good that they don’t want to go out and risk further exposure,” he says. “And If they’re sick, we don’t want them to expose others to the virus.”

An added bonus, he says, is that more home tests means healthcare workers might also conserve some personal protective equipment (PPE) used for onsite, clinician-administered tests. “If there’s a way we can get a high-quality specimen without using PPE and exposing other people, it’s so much the better.”

Should you get an at-home test?

While the decision to get an at-home COVID-19 test is ultimately up to each individual, Dr. Procop says it’s definitely an option with several upsides as previously pointed out. But, he adds, “There’s the chance you might get a wrong result if a high-quality specimen isn’t submitted.”

If you do decide to get an at-home test, be sure to check with the test provider and your insurance company about cost and coverage. While some tests are covered, others may not be and could cost over $100.

Dr. Procop adds, “I wouldn’t advise testing simply out of curiosity.” And, he notes, “With or without a test, if you are showing any potential COVID-19 symptoms, you need to be following the guidelines, including self-isolating and wearing a mask.”

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