You don't need to visit a doctor to get tested for COVID-19. For under $150, you can buy a diagnostic test to do largely in the privacy of your own home.
It's not as sketchy as it might sound — Stephen M. Hahn, commissioner of the U.S. Food and Drug Administration, has said home coronavirus tests "will be a game changer in our fight against COVID-19." Iowa Gov. Kim Reynolds recently recommended purchasing one. Even Costco is selling them.
Under the Families First Coronavirus Response and CARES acts, COVID-19 tests are supposed to be free (admittedly, there have been reports of people being billed). No-cost tests are available at pharmacy chains like CVS Health, Rite Aid, Walgreens and Walmart as well as community centers throughout the country. The Associated Press reports that about 1.5 million Americans are being tested for the coronavirus every day.
But demand fluctuates, often leading to long lines and wait times at testing sites. In places like New York City, the cold weather and crowds make it a particularly unappealing prospect, as does the fact that it can take several days for results. With cases spiking and the holidays approaching, home collection coronavirus tests are sure to soar in popularity.
Are they worth the money? Are the results accurate? Here's what you need to know.
The FDA has approved a bunch of COVID-19 tests
The government authorized the first coronavirus diagnostic test with a home collection option back in April; it later released a template aimed at helping companies develop and get approved for "tests that can be performed entirely at home or in other settings besides a lab."
As of last week, the FDA has greenlit nearly 290 tests through emergency use authorizations. On Nov. 17, it authorized the first at-home COVID-19 test that gives rapid results. (More on that later.)
There are two major kinds of coronavirus diagnostic tests: molecular and antigen. Molecular tests identify viral genetic material in a sample from a person's nose or throat, while antigen tests look for proteins associated with the virus. Molecular tests are generally more sensitive than antigen tests.
The kit available at Costco is the P23 TaqPath SARS-CoV-2 Assay. Customers order it one or two weeks before they need it. Upon receipt, they use a coupon code to register on Azova's website, schedule a video call with a doctor (if applicable), take the test on-camera and then ship the sample overnight to a lab. Results are promised in 12 to 48 hours once the lab gets the sample.
Dr. Thomas Russo, professor and chief of the infectious diseases division at the University of Buffalo, says he can see how a home collection test might be a good option if "you're in some sort of scenario where you're unable to get out of the house or testing is very challenging to get in your part of the world." It's also nice because you're not going out into the world and potentially exposing other people to infection.
But most buyers are probably using them to comply with travel restrictions.
"People say, 'OK, I'm going to order this test, I'm going to send it in, so I can control the timeline a little bit better ... If I'm negative, I'm good for Thanksgiving, I'm good for the dinner party, or whatever activity,'" Russo adds. "[But] a test is just a single point in time."
Home Collection Coronavirus Tests: How Much They Cost
Although the FDA warns on its website that "no test is 100% accurate," its emergency use authorization process is rigorous. As a result, Michael Teng, an associate professor of medicine at the University of South Florida, says the products themselves "are very good." The clinical labs evaluating samples collected at home are held to high standards, too.
"It's not like these tests are fly-by-night operations. They're actually reasonable," Teng says. "As long as you've followed instructions, taken the sample right and put it in the pouch or whatever solution necessary, the test is going to be as good as a diagnostic test is."
Taking a coronavirus test without leaving your house may be convenient, but it's not cheap. Costco has two versions; one is $129.99, and the other is $139.99. Everlywell sells an at-home COVID-19 test for $109. Phosphorus offers one for $140, and so on.
They may be covered by your insurance or eligible for purchase with your Flexible Spending Account dollars. LabCorp offers a $0 upfront billing option. But again — tests conducted by your local health department or pharmacy are free, so it's up to you.
"If people want to spend money doing that, it's a completely legitimate thing to do," Teng says.
At-Home Covid-19 Tests: What Are the Risks?
Even assuming you can afford and trust the results of home coronavirus tests, you should be aware of the risks.
The first is that you might not collect your sample right. To put it bluntly, you may be less likely to stick a Q-tip super far up your nose than a nurse might. Having an on-camera consultation mitigates some of this risk, but you still have to follow the instructions closely. (These directions, for example, advise people to not eat, drink, smoke or chew gum for 30 minutes before collecting their saliva.)
"When you go to a health care worker that's trained to do this and does hundreds a day, they know what they're doing," Teng says, adding that you might not be able to say the same for yourself.
Another, bigger challenge is that diagnostic tests only speak to what's happening at a single point in time. If you test positive and/or are showing symptoms, of course, you know to opt out of that trip to grandma's house for the holidays. But testing negative doesn't necessarily mean you won't test positive in the near future.
You could be asymptomatic. You could be pre-symptomatic. You could have a low level of infection that's not detectable at that moment in time. You could have messed up the collection of the sample. As WIRED points out, you could contract the virus while traveling.
It's just a snapshot.
"I worry about people going and taking a test [and saying], 'Oh, I'm negative so I can go and do whatever I want,'" Teng says. "It's not a get-out-of-jail-free card."
At-Home Covid-19 Tests: Turn Around Time
Joseph Petrosino, chairman of Baylor College of Medicine's molecular virology and microbiology department, points out that home collection tests face a delay just like pharmacy tests do. And you still have to quarantine for the duration.
"The time it takes to order or buy a test, collect and ship the sample, have the test analyzed, and have results reported back to the user can be three to five days or greater," he says, adding that most drive-thru sites target one- to four-day turnarounds. "This prolongs the period of time where the individual being tested will need to self-isolate while waiting for test results."
Because of this, Petrosino says to weigh testing options around you before buying a home collection COVID-19 test. If you can easily go to a pharmacy or drive-thru test site, that might be easier and quicker than ordering a kit. Petrosino says to also consider the timeline. How long will it take for the test to reach your mailbox? How long will it take to reach the lab? How long will it take to get the results?
"Read reviews from others who have used the test before. These can often provide valuable info as to how easy, fast and accurate the test was," Petrosino says.
From there, you'll want to make sure the test is the molecular kind. It should require a nasal or saliva sample. And finally, make sure you only buy a kit where you can call or otherwise contact the providers if you have questions or concerns.
Affordable, Widespread At-Home Coronavirus Tests Are the Eventual Goal
Now let's look to the future.
The Lucira COVID-19 All-In-One Test Kit recently authorized by the FDA is what Petrosino calls "a potential game changer." A person collects a nasal sample, stirs it into a vial and then places that into a little machine that gives a result within 30 minutes. It's a molecular test praised for its simplicity — users get a green light that indicates their status, much like a pregnancy test.
The Lucira test only costs about $50, but don't celebrate just yet. It requires a prescription and won't be widely available until spring or so.
"We'd love the cheap, rapid, easy-to-do test at home, and we're not there yet," Russo says. "Lucira is $50 — we want that at like $1 or $2, and ample availability so someone could order like 90 of them and do them daily between now and when they get vaccinated to make sure they're not infectious."
Inexpensive antigen tests could also prove useful in managing the coronavirus crisis. Petrosino predicts that soon, people could have several dozen at-home antigen tests — like this $5 version, currently only for health care professionals — on hand. They could test themselves a couple times per week, and possibly even in conjunction with molecular tests, to determine infection.
But remember: Repeated testing is only one part of the pandemic puzzle.
"Masks, hand-washing, social distancing and avoiding large gatherings, particularly indoors, are all important as we await the promise of effective vaccines to help things return to normal," Petrosino says.