If you thought the vaccine might reduce the demand for COVID-19 testing, think again. The Delta variant is on the rise and so is COVID-19 testing in hospitals, long-term care and other residential facilities.
Home COVID-19 test kits are flying off the shelves for people hoping for rapid results and peace of mind. Have symptoms? Get tested.
Schools are offering testing to keep kids and teachers safe, sports teams are testing players and staff to prevent team-wide coronavirus clusters and employers want to make sure that workers aren’t bringing the virus to the office.
Here’s what you should know about COVID-19 testing for you and your family.
Who Gets Tested?
COVID-19 viral or diagnostic testing tells you whether you’re infected with the coronavirus. People are tested for a variety of reasons including:
— COVID-19 symptoms. Shortness of breath, dry cough, fever, unusual fatigue, nasal congestion, runny nose, sore throat, diarrhea and lost sense of taste or smell are reasons to get tested (and contact your health care provider).
— Close contact with someone with confirmed COVID-19. Anyone who has been within 6 feet of an infected person for a combined 15 minutes over a 24-hour period is considered a close contact. Contract tracing typically leads to a referral for testing.
— Sports participation. Professional sports organizations including the NFL, NBA and NHL have strict COVID-19 testing requirements, and testing protocols were a key issue in Tokyo Olympics planning. Many university, public and private school sports programs require periodic testing to participate.
— In-person school attendance. As schools transition back from virtual classrooms to in-person learning, some offer COVID-19 testing. Many college campuses are mandating testing for students.
— Working in health care facilities. Health care workers who have COVID-19 symptoms or have not been vaccinated need to be tested.
— Long-term care, group home and other facility residence. Staving off COVID-19 outbreaks continues to be a challenge in residential facilities for older adults and others.
— Vaccination exemption requirements. “A lot of employers are putting in place vaccination mandates and testing employees who get religious or medical exemptions or exceptions to that policy,” says Dr. Lisa Maragakis, senior director of infection prevention for the Johns Hopkins Health System and an associate professor of medicine at Johns Hopkins Medicine in Baltimore.
— Participating in high-risk activities. That includes mass gatherings like rallies, or crowded indoor settings like concerts or social functions — while unvaccinated.
— Air travelers returning to the U.S. from abroad. International travelers must meet testing requirements ordered by the Centers for Disease Control and Prevention, as well as requirements at their individual destinations.
How Testing Works
“The main two types of coronavirus testing for the public are PCR and antigen testing,” Maragakis says. “PCR — the polymerase chain reaction test — remains the gold standard for making the diagnosis of COVID-19. The other type that’s available is an antigen test. Those are generally less sensitive at detecting the virus but it’s much faster to get results.”
Prescription tests are ordered by health care providers who identify that you need a test, determine the appropriate type of testing and explain what your results mean. Prescription tests can be done in settings such as a doctor’s office, drive-thru testing facility or health department. Some prescription tests involve home sample collection or at-home tests.
Nonprescription tests, with either at-home sample collection or testing, are purchased online or over the counter.
Different Types of Coronavirus Tests
— PCR testing.
— Antigen testing.
— Pooled testing.
— Antibody testing.
PCR testing has the ability to extract and amplify genetic material from the coronavirus, so even tiny amounts of the viral RNA can be detected. A positive PCR result means you have the virus and are likely to be contagious.
The sample for a PCR test is typically obtained by a nose swab. The swab is quickly placed in your nose to collect a sample from your respiratory tract. Viral RNA extraction and testing is then performed in a specialized laboratory. PCR itself is a long-established lab technique, although the specific PCR test to detect the coronavirus is new.
COVID-19 testing has become a standard, ongoing hospital service. “Our testing operation at Stamford Hospital hasn’t really changed since the get-go,” says Dr. Asha Shah, director in the department of infectious diseases with Stamford Health and hospital epidemiologist at Stamford Hospital in Connecticut. “We continue to provide PCR testing at one of our main hospital facilities. We also do a fair amount of testing here in our emergency room and immediate care center. So, we try to make it as accessible as possible to the community.”
Testing volume throughout the system has been relatively stable over the past several weeks, Shah says, “but we did see a decline in the late spring and early summer, when our area of the country had a little bit of a reprieve,” she says. “People were getting tested for reasons such as for travel, or prior to going to school. As community transmissions started to rise, we saw a steady increase. This goes hand in hand: more exposures, more people with symptoms, more testing required. For the past month, we’ve been doing about 1,700 tests per week.”
Testing methods haven’t changed at Stamford Health, Shah says. “We prefer to do nasopharyngeal swabs for PCR, which continues to be the gold standard for the diagnosis of COVID,” she says. “We have different variations on that type of technology — different platforms that we use. We diversified so that we don’t put all of our eggs in one basket, so to speak.”
Platforms are the instruments used to process patients’ samples. Small, portable mobile platforms can be used at off-site points of care, while larger, facility-based devices are able to process many more tests at a time while still providing quick results.
PCR testing — with fewer false positives and false negatives and so less uncertainty than antigen testing — is preferable from Shah’s perspective. “I feel more comfortable knowing that our patients are only getting PCR testing through us,” she says. “And it also helps us in terms of interpreting the data, because we look at the testing results every week and we make institutional decisions based on the numbers and the percent positivity. We make decisions about keeping our patients, staff and community safe based on those numbers. It just makes me sleep better at night knowing that we’re using PCR here.”
Antigen testing for COVID-19 provides virtually instant results.
“Antigen tests are actually looking for a piece of viral protein,” explains Peter Mohler, chief scientific officer for the Ohio State University Wexner Medical Center and the Ohio State University health sciences colleges.
“The antigen test is similar to what you would get with a rapid flu or rapid strep test,” Mohler says. “These are very fast, and you might get an answer back in 15 minutes.”
Antigen testing is less sensitive than PCR, Mohler explains. While a positive result tells that you have coronavirus and it’s active, a negative result is not as definitive. “If it’s negative, the CDC is recommending that it really needs to be followed up with the PCR test,” he says.
Sometimes used for large groups where most results are expected to be negative — like college dorm residents — pooled testing combines samples obtained by swabbing to allow labs to test multiple samples at once. If the pooled test is positive, follow-up testing is done.
Although pooled testing minimizes total tests needed when the sample result comes back negative, a positive result requires each individual to undergo a second round of testing, since it’s unknown who in the group is or isn’t infected.
Antibody testing, also known as serology testing, requires a blood sample. It’s used to reveal whether someone has previously been exposed to and developed a response to COVID-19.
Antibody testing looks for the presence of antibodies, which are specific proteins your immune system produces in response to an infection. Some antibody tests are highly specific — they measure not only whether you’ve had an immune response, but the strength of your response by the amount of antibodies you produced.
“Antibody tests don’t really play a huge role for most people,” Maragakis notes. “There are certain circumstances where it could be helpful, if there’s some question about whether someone had COVID in the past. Particularly for immunosuppressed patients, it can be helpful to see if they have responded to vaccination, and, of course, that’s the group that’s now eligible to get a third dose.”
Nasal Swabs and Children
Although it just takes a few seconds, the nasal-swabbing part of COVID-19 testing gives many people pause. Children (and adults) may sometimes balk at nasal testing, making it more difficult for parents in this situation.
“Depending on the age, it can be very challenging,” says Dr. Diego Hijano, a pediatric infectious disease specialist at St. Jude Children’s Research Hospital in Memphis, Tennessee. “Certainly, it’s a conversation. If they have symptoms, really, there is no way around it. You really need to take that test, because you want to be sure you can go to school and do other things without spreading the virus.”
After all, “the swab is not something different than what we’ve done for other viruses before,” Hijano points out. “Many of these kids, when they were babies, actually got tested for other viruses, which of course they don’t remember.”
Hijano suggests that parents prep a bit in advance, by doing a little research and looking at resources for parents on talking to kids about testing and reducing their anxiety. Many children’s hospitals offer such parent information on their websites.
For kids who’ve been quarantined for COVID-related reasons, Hijano says, “The test becomes a tool that schools and families can use to get kids back into their lives sooner.”
Getting the Sample
Whether you’re getting tested at a drive-thru site or going the DIY route at home, here’s what to know about COVID-19 testing samples:
— Nasal swabs. Going through the nose to obtain mucus is the most-established method. If you’re testing at home, the CDC has illustrated, step-by-step instructions for collecting your anterior nasal swab (right inside the nostrils) or nasal mid-turbinate swab (farther up the nose) sample.
— Oropharyngeal (throat) swabs. These are done through the mouth, with the sample taken from the middle part of the throat.
— Saliva samples. In saliva-based testing, you spit into a test tube. Although it’s slightly less able to pick up the virus, it offers a more comfortable choice for some people. PCR testing using a saliva sample is almost as accurate as the standard nose-and-throat swab, according to a study from the Royal College of Surgeons in Ireland, published September 8 in HRB Open Research.
If you’re looking for convenience and privacy, options for at-home testing for COVID-19 are increasing.
These are a few examples of tests with FDA emergency use authorization. for which you either collect and submit the sample for testing or actually complete the testing at home:
— Abbott BinaxNOW COVID-19 Self-Test OR Ag Card Home Test. The Abbott BinaxNOW rapid antigen tests use a nasal swab and a test card. The self-test version can be done completely at home, with results in about 15 minutes.
— DxTerity COVID-19 Saliva At-Home Collection Kit. The DxTerity saliva test, which requires a prescription, uses RT-PCR (a variation of PCR testing) on the sample, which is sent in by users from home, with results reported to users in 24 to 72 hours.
— Ellume COVID-19 Home Test. The Ellume test, which uses a nasal swab, is processed at home. The digital results appear through a smartphone app in about 15 minutes.
— Lucira COVID-19 All-In-One Test Kit. The Lucira All-in-One test, available by prescription, uses a nasal swab and laboratory-like testing. The at-home result appears on the battery-operated testing unit in about 30 minutes.
Take note: Home-testing COVID-19 tests are in high demand, with some retailers limiting the number of kits that customers can purchase in-pharmacy or online, and you can run into out-of-stock notices and possible delivery delays.
“It’s great that home testing is becoming widely available now,” Maragakis says. For the majority of home tests that are antigen tests, “they are not as sensitive or as specific for COVID-19. It’s not something you want to completely rely on, especially if you have severe or progressing symptoms. It would definitely be best to get to a medical facility and have a PCR test done for those circumstances. But it can be helpful in certain situations to reassure people and get faster results and to do more widespread testing.”
Newer products will ideally be fast and easy to administer, but more sensitive in picking up the virus, Maragakis says. “These tests have been in development for some time, so I expect the products to continue to become available and to get better and better. But you do have to be careful. One thing I would say is, with an antigen test, they are often helpful if they are positive. They are less helpful when they’re negative, especially for someone at higher risk of having COVID. That’s when it’s helpful to follow up with a polymerase chain reaction test. ”
“Ask questions” when making decisions about testing, Maragakis says. “Think about where you’re getting tested.”
Find out the following:
— What kind of test am I getting? That way “you can understand the results and what that may mean, especially if the test is negative,” Maragakis says. “You want to make sure that you had a high-quality test, and follow up with another one if you continue to have symptoms.”
— When should I get tested? Timing is important. “A lot of times after people are exposed, they’re rightly concerned about that and may run out and get tested that day or the next day,” Maragakis says. However, you have to think about when the exposure happened and wait a few days to get the most out of the test.
— What should I do while waiting to be tested? If you’ve been exposed, “that’s the period of quarantine when you’re careful not to be around others in case you develop symptoms of the virus,” Maragakis says. “Typically, day 4 or 5 is the time to start thinking about getting the test.”
Anyone could need testing at some point. “We are seeing an increasing number of breakthrough infections in fully vaccinated people,” Maragakis says. “So, even if you’ve been fully vaccinated and you develop symptoms — even if they’re mild symptoms — it is worth getting a test for COVID-19. We know that one of the challenges with this virus is the spread from asymptomatic or mildly symptomatic people that can transmit the virus to others who may get much more sick.”
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Update 09/10/21: This story was previously published at an earlier date and has been updated with new information.