COVID-19 testing options: What you should know before you get tested
We’ve all heard the stories. Painful, long swabs that “touch your brain,” expensive out-of-pocket costs, and surprise bills that surface weeks after you’ve taken a test. You’ve either heard about COVID-19 testing experiences from others or maybe you’ve had one yourself.
With COVID-19 continuing to impact communities everywhere in 2021, getting tested after potential exposure or if you’re experiencing symptoms is more important than ever. With the national cases surpassing 25 million in the U.S., it’s important to know how, when, and where you can get access to fast, accurate, and affordable testing if you need it.
If you’re wondering who should get tested for COVID-19, what the cheapest options are, and which tests are approved for travel, you’re in the right place.
To streamline the information around COVID-19 testing, we’ve decided to compare the different options out there, so you don’t have to.
Let’s first break down the basics of COVID-19 testing.
What exactly is a COVID-19 test?
There are two types of COVID-19 tests: diagnostic tests (also known as viral or molecular tests) and antibody tests.
Diagnostic tests can tell you if you are currently infected with the coronavirus, whereas antibody tests detect if you were previously infected with the virus.
What is the difference between RT-PCR, antigen, and antibody COVID-19 tests?
The diagnostic COVID-19 tests labeled as “PCR” and “RT-PCR” (reverse transcription polymerase chain reaction) tests are widely regarded as the “gold standard” for COVID-19 testing and the Everlywell COVID-19 Test Home Collection Kit DTC is this type of test.
Molecular tests (RT-PCR), like the Everlywell COVID-19 Home Test Collection Kit DTC, look for the coronavirus’ genetic material in your body by taking a sample from you. The sample is normally sent to and processed at a lab, but it may also be analyzed on-sight at a doctor’s office or clinic. FDA-authorized tests are very accurate, and results can be delivered in anywhere from a few hours to a few days.
Antigen tests, or rapid antigen tests, are another type of molecular testing that measures the presence of viral proteins in a sample taken from your nose using a swab. This type of test is often simpler and can provide faster results, but they can be less accurate, especially for asymptomatic carriers or those presenting 5-7 days after symptom onset.
Antibody tests, or serology tests, detect the presence of antibodies for the coronavirus in your blood. If results confirm that you have coronavirus antibodies in your blood, this indicates you've been previously infected with the virus. While antibody tests are not capable of detecting if you are actively infected with COVID-19, they are used to help scientists identify and understand the virus better.
How many days should people wait (after possible exposure) to get tested for COVID-19?
Well, it depends. According to the CDC, the incubation period (the time between when you were exposed to the virus and you developing symptoms yourself) of COVID-19 is between four and 14 days.
“It is difficult to provide an exact number of days one should wait after possible exposure to get tested, as it depends on each individual's immune system as well as the amount of virus they were exposed to and the duration of that exposure,” said Dr. Frank Ong, Chief Medical and Scientific Officer at Everlywell.
“Other factors include how close or far away the individual was to the exposure, the extent of viral seeding or location (nasal cavity or into the lungs) as well as extent of exposure (a few seconds vs. several hours in enclosed space). A recent CDC-funded study recommended a median incubation period for COVID-19 of approximately 5 days, similar to SARS.”
Now let’s break down the chart. How does Everlywell compare to other COVID-19 testing options?
Who should take a COVID-19 test?
Although COVID-19 testing is more widespread and accessible now than it was at the beginning of the pandemic, not everyone needs to be tested. According to the Centers for Disease Control and Prevention (CDC), people who are experiencing symptoms, who have been in close contact with someone who has a confirmed infection, or those who have been referred by a healthcare provider need to get tested.
Most rt-PCR testing options for COVID-19 are intended for those experiencing symptoms or who have been exposed to COVID-19.
Public health officials or a healthcare provider may recommend routine testing for individuals with a high risk of exposure or severe illness. When or if you do get tested, you should consider taking measures to self-quarantine until you know your results.
What is measured?
RT-PCR tests are diagnostic tests—they measure the presence or absence of RNA from SARS-CoV-2—which helps identify an active COVID-19 infection in your body.
Rapid antigen tests, similar to PCR tests, identify an active infection with SARS-CoV-2. They do this by detecting the presence of virus-specific proteins, called antigens. Antigen tests are less sensitive than PCR testing and there is an increased possibility of false-negative results.
An antibody test is nondiagnostic, which means it does not indicate if a person is currently infected. Antibody tests detect the presence of antibodies in your system that have been produced in response to SARS-CoV-2. It can take one to three weeks to develop antibodies to SARS-CoV-2 which is why it is not recommended for diagnosing COVID-19, but may help you learn if you’ve been previously infected.
How is the sample collected?
At-home test kits for COVID-19 can be either swab or saliva tests. While saliva tests may sound more favorable, they can take longer to complete, and you can’t eat or drink for 30 minutes beforehand. If having to salivate enough to spit into a tube for several minutes doesn’t sound appealing, one of the swab options may be a better method for you.
Both PCR and rapid antigen COVID-19 testing at clinic locations typically use the deep nasopharyngeal swab. While it’s safely administered, some people have described it as painful and uncomfortable.
How much does a COVID-19 test cost?
If you have health insurance, any test needed to detect or diagnose COVID-19 is required to be reimbursable by your provider, as part of the CARES Act. If you don’t have health insurance or decide to pay for a test out of pocket, you may be looking for the most affordable prices if you need to get tested.
How long does it take to get my results?
At-home test kit results can take up to 5 days and are typically sent to your device.
In-clinic PCR test results are available the same day at some locations or could take up to a week or longer at some locations with many tests, depending on lab capacity. Results are often shared by phone call.
In-clinic rapid antigen test results can be delivered within 20 minutes and are delivered on-site verbally or in a printed form.
(Related: How long does it take to get coronavirus test results?)
How accurate is the test?
At-home and in-clinic test kits in the PCR category are expected to exceed the FDAs 95% sensitivity benchmark.
In-clinic rapid antigen testing meets the minimum benchmark for accuracy; however, it’s important to consider that this type of test is most appropriate in the early stages of infection when SARS-CoV-2 viral load (the amount of virus in your body) is generally highest. Specimens from asymptomatic individuals or individuals presenting 5-7 days after symptom onset may be below the limit of detection for the test, this means you may receive a falsely negative result. It is also important to note that the samples used to test the accuracy of rapid antigen testing were mostly collected by a healthcare professional, not with at-home collection methods.
Is the test accepted for travel requirements?
Generally, all RT-PCR COVID-19 tests are accepted (and preferred) for travel. Many states have specific requirements for the time period between receiving a negative test result and traveling to the area, so consider researching the requirements and getting tested for COVID-19 ahead of time.
We recommend regularly checking the CDC’s recommended guidelines and researching the areas you plan to visit ahead of time, as local, state, and national travel requirements or recommendations are constantly updating.
While rapid antigen testing is a quicker, more affordable option for those in need of more immediate results, it’s less accurate than PCR testing and may not be accepted for travel. Some states list only molecular tests as acceptable pre-travel COVID-19 tests, so you should confirm the testing requirements for your destination before you book your flight.
Best overall experience
What COVID-19 test has the best overall experience? Well, it depends on your preferences. Nasal swab or saliva? Long swab or 1-inch collection? Need results quickly or have some leeway?
If you prefer to stray away from any nasal swabs, saliva tests may be more comfortable for you. And if you’d rather have someone else perform the sample collection for you, consider finding an in-person testing option at a drive-through clinic or doctor’s office in your area.
Are you currently experiencing mild symptoms and need access to testing as soon as possible? In that case, rapid antigen testing at an in-person clinic may be a good option for you. Remember that rapid antigen tests are generally less sensitive and therefore more likely to produce a false negative (particularly in individuals who are asymptomatic or who present 5-7 days after symptom onset). Learn more about the difference between a PCR test and rapid COVID-19 test.
Experiencing symptoms of COVID-19? Get COVID-19 treatment online via Everlywell's Virtual Care option.
References
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2. Test for Current Infection. Centers for Disease Control and Prevention. URL. Accessed November 12, 2020.
3. COVID-19 Testing: Molecular, Antigen, and Antibody Tests Explained. Texas Department of State Health Services. URL. Accessed November 12, 2020.
4. Wassie GT, Azene AG, Bantie GM, Dessie G, Aragaw AM. Incubation Period of Severe Acute Respiratory Syndrome Novel Coronavirus 2 that Causes Coronavirus Disease 2019: A Systematic Review and Meta-Analysis. Current Therapeutic Research. URL.Accessed November 12, 2020.
5. How to Obtain a Nasopharyngeal Swab Specimen. The New England Journal of Medicine. URL. Accessed November 12, 2020.
6. Interim Guidance for Rapid Antigen Testing for SARS-CoV-2. Centers for Disease Control and Prevention. URL. Accessed November 12, 2020.
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