At-home test could prove critical in controlling spread of COVID-19, experts say

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Renatta Signorini
| Pittsburgh Tribune-Review

Sue Lovgren’s family member was sick with COVID-like symptoms the week after Thanksgiving. They had decisions to make, depending on what the result was.

“We were waiting on a (polymerase chain reaction) test and it was taking too much time, and so we wanted to know in a quicker amount of time,” the West Deer Township, Allegheny County, woman said.

Lovgren looked around online to see if any nearby stores had at-home COVID tests on the shelf.

When she found that she would have quite a drive to locate one, she got one from a friend. The at-home test came back positive — a result later confirmed by the PCR test, Lovgren said.

Having a test kit on hand at home could be useful in the future if the she’s faced with a similar situation, she said.

Others are looking for peace of mind around the holidays, before deciding to gather with friends and family — especially as COVID cases continue to increase.

Way to reduce harm

At-home COVID testing should have been commonplace long before this point, said Amesh Adalja, M.D., a Pittsburgh-based infectious disease expert and critical care physician.

“This technology has existed since the early months of the pandemic; however, it has not been deployed until late in the pandemic,” he said. “Even now, while available, they are not being used optimally as they are cumbersome to find, expensive and regulated in a manner that makes their development costs high.”

Adalja likened the at-home tests to fentanyl test strips, which act as a harm-reduction and mitigation measure. Fentanyl test strips indicate whether the powerful and often deadly opioid is present in a drug.

“That type of harm-reduction paradigm is how we should be approaching COVID,” Adalja said, noting such tests should be available “everywhere you look” as opposed to being scarce.

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Since the start of the pandemic, the U.S. Food and Drug Administration has issued emergency-use authorizations for more than 400 testing and collection kits, including more than a dozen at-home tests. At-home tests include the rapid antigen tests that give results within minutes and tests in which you overnight the sample to a lab.

During that same time span, the FDA has received more than 4,500 emergency-use authorization requests related to at-home tests, spokesman Jim McKinney recently told PBS NewsHour. The FDA has prioritized reviews of tests that can be produced en masse.

The latest at-home test to receive emergency authorization came Dec. 15 when the Ellume COVID-19 Home Test was approved for people 2 and older.

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The FDA noted “all tests can experience false negative and false positive results.” Those with positive results are urged to self-isolate and contact a health provider.

Some of the at-home tests are proving to be accurate in catching about 85% of people who are infected with the virus, the New York Times reported last month.

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A case for at-home tests

In addition to vaccinations, testing is one of the most effective ways to track and reduce the spread of COVID-19, Nathaniel Hafer, a molecular biologist at the University of Massachusetts medical school, said in The Conversation, a nonprofit news organization “dedicated to unlocking the knowledge of experts for the public good.”

For nearly two years, Hafer has been part of a program funded by the National Institutes of Health to help companies develop rapid tests to detect employees infected with COVID.

Here is some of what he had to say, edited for brevity:

How rapid antigen tests work

Rapid antigen tests are designed to detect a portion of protein — known as an antigen — of SARS-CoV-2.

First, you take a sample from your nose or mouth with a swab, as directed. You mix the sample with liquid that breaks apart the virus. You then apply the liquid to a test strip that has antibodies specific for SARS-CoV-2 painted on it in a thin line.

If the antibodies bind to the virus proteins, or antigens, a colored line appears on the test strip, indicating the presence of SARS-CoV-2.

Tests are easy to use and provide results typically within 15 minutes. Another benefit is that antigen tests can be relatively inexpensive, at about $10 to $15 per test.

When to use rapid tests

If you have any COVID-19 symptoms, regardless of whether you’ve been vaccinated, you should get tested right away with either a PCR or antigen test.

The faster you can determine if you have COVID-19, the sooner you can isolate yourself.

Early testing is also critical because new drugs like those from Merck and Pfizer are most effective if given early in the course of infection, soon after symptoms appear.

If you get a negative antigen test but still feel sick, it is possible that you received a false negative test. If you get a positive test, you should isolate yourself at home and contact your health care provider as soon as possible.

If you don’t have symptoms but have had close contact with someone with covid-19, what to do depends on your vaccine status.

If you’re fully vaccinated, the CDC currently recommends that you wait five to seven days after your exposure and then get a PCR or rapid antigen test. If you’re not fully vaccinated, get tested right away.

Studies have shown that serial antigen testing — typically two to three tests in one week — is on par with a single PCR test.

Tribune-Review staff writer Megan Guza and The Associated Press contributed to this report.