BySeptember 30, 2020
When COVID-19 tests first appeared at doctors’ offices and health care facilities last spring, they didn’t have the best reputation. People who underwent testing told scary stories of having a long sterile swab shoved up their nose, while others described overrun testing sites with hours-long wait times. Some even reported receiving surprise medical bills—despite the federal government’s promise of free COVID-19 testing and treatment for all.
All of the above—compounded by shortages of test kits and testing supplies—contributed to the lack of coronavirus testing nationwide. Scientists say poor testing capacity also contributed to the spread of infection in the US, leading to nearly 7 million coronavirus cases and more than 200,000 deaths. While the nation’s testing infrastructure has improved since earlier in the pandemic, experts say we’re still not testing enough to contain the spread of the virus, with daily coronavirus testing at 73% of what’s needed, per New York Times reporting on September 30.
Now, an influx of at-home COVID testing kits are on the market, thanks the US Food and Drug Administration’s authority to make these tests available for emergency use. People simply collect their own specimen (mucus or saliva) and mail it off to a lab for analysis.
At present, a dozen or so at-home options have emergency use authorization, and all are designed to look for a piece of virus genetic material. Theses so-called molecular tests detect active coronavirus infection, and they’re also known as PCR tests (short for reverse-transcriptase polymerase chain reaction).
A few diagnostic testing companies are working on rapid at-home antigen tests. These tests, which look for the presence of viral proteins, are generally quick and easy but often less accurate than PCR tests. Antigen tests are meant to be run immediately after collection, so shipping and processing delays could decrease the sensitivity of the test if done at home. So far, none have been authorized by the FDA for emergency use.
At-home testing solves some of the problems with in-office testing. You don’t have to have health insurance or live near a testing site to get one, and you can do it at your convenience.
Frank Ong, MD, chief medical and scientific officer at Everlywell, a provider of at-home test kits, points out that many people are avoiding traditional health care facilities for fear of contracting or transmitting the coronavirus. “At-home sample collection tests for COVID-19 and other health conditions are a great way to relieve some of the burden from traditional health care facilities,” he tells Health.
In general, here’s how the home testing process works: Once a company receives your order—in most cases, there is no prescription or prior doctor’s authorization required—a collection kit is shipped to your door with supplies needed to take a sample from your nose or mouth. You ship the biohazard-safe package back to the brand the same day you take the test, the sample is analyzed by a certified lab, and then you receive your results within a few days.
Most brands go so far as to promise results within 72 hours and accurate ones at that—according to a recent study by Stanford Medicine, at-home test kits are just as accurate as those administered by medical professionals. Those identified as infected by these tests should then receive a confirmatory laboratory test as well as maintain home isolation, per CDC recommendations.
Here, we share more about six at-home test kits, including some expert tips and my personal experience sampling three of the tests. Keep in mind that the prices cited below reflect what you’ll pay upfront, but insurance may cover a portion of the test cost depending on your plan.
Collection method: nasal swab
Screening: In order to qualify to receive a test kit, people must take a screening questionnaire based on CDC guidelines, which asks basic questions about potential exposure and any symptoms someone may be experiencing.
How it works: The kit comes with a nasal swab designed to be inserted into the front part of your nostril. Before swabbing, blow your nose. Then tilt your head back 45 degrees and insert the swab into your left nostril, parallel to your mouth, until you meet resistance. Rotate the swab three times with slight pressure and then repeat the process in the right nostril.
Once you’re done, the swab goes into a biohazard-safe package for overnight delivery to a certified lab. Those with positive results will receive a telemedicine consult with a board-certified physician licensed to practice medicine in their state to discuss their diagnosis and next steps.
Turnaround time: Results are available within 24-72 hours of the sample arriving at the lab.
Tips: “The swab is several inches long, but it only needs to be inserted into the front part of your nostril—about one inch,” says Dr. Ong. “If you feel any pain or discomfort, you’re likely sticking it in too far.”
What it was like: “I had initially expected to prefer a saliva-based collection method versus a nasal swab but ultimately ended up much preferring the nasal swab. The nasal swab took me less than five minutes, and contrary to early reports did not hurt at all. Of all the kits I tested, I found Everlywell’s packaging and instructions to be easiest to follow, it was the least expensive, and I received my results in the shortest amount of time. I shipped my kit on a Thursday and received a negative result on Sunday.”
Collection method: saliva
Screening: You’ll be directed to enter relevant medical information, including any symptoms, into a medical intake form. A medical professional will review the information and virtually connect with you to determine if an at-home testing kit is recommended.
Only people who are experiencing symptoms of COVID-19, including dry cough, fever, chills and body aches, are eligible for the test kit provided by Hims & Hers. In addition, they are not offering the at-home test to pregnant women and recommend women who are pregnant receive direction regarding testing through the health care provider who is managing their pregnancy.
How it works: Collection requires a sample of saliva. The kit will include everything needed to return the test to the lab for review. You will be able to view your results in your Hims & Hers online account, and a medical provider will be in touch with recommended next steps. Those recommendations will be based on the currently accepted guidelines for treatment of the virus and could include seeking in-person care or self-isolation.
Turnaround time: You will receive results in 3-5 days.
Tips: “Make sure you thoroughly wash your hands and the space around you before beginning the collection,” Leah Millheiser, MD, senior vice president of medical affairs at Hims & Hers, tells Health. “I also learn best by seeing, so I created this video to show our social media followers how to use the test kit.”
Collection method: nasal swab
Screening: The test kit can be obtained via the Pixel by LabCorp online platform following a health screening questionnaire, which determines your eligibility for testing.
How it works: The test kit includes everything needed for self-collection: cotton swabs, a collection tube, and biohazard specimen bag. The cotton swab is inserted into one nostril and placed into the collection tube to be returned to LabCorp. An infographic of the process and a video of the process are available.
Turnaround time: The average time to deliver results is 1-3 days from specimen pickup. At this time, based on US Department of Health and Human Services guidance, LabCorp is prioritizing testing for residents and staff from nursing homes in “hot spot” states, in addition to hospitalized patients. All other testing for patients is performed in the order in which they are received.
Collection method: saliva
Screening: The test is available to anyone, with physician authorization. Phosphorus works with an independent physician network to review symptoms and exposure history.
How it works: “Whether being ordered by an individual or for a large organization, saliva collection kits are shipped along with simple instructions,” Gabriel Lazarin, vice president of marketing and medical affairs at Phosphorus, tells Health. “Tests are authorized by independent physicians in order to ensure proper follow up. The saliva is collected when convenient and shipped back to our laboratory in Secaucus, New Jersey.”
Turnaround time: 24-72 hours from when the sample is received at the laboratory.
Collection method: saliva
Screening: No, although you do need to answer a few basic demographic questions. “We are working around the clock to deliver tests to any and everyone who needs them. Right now, we are focusing on schools and universities to safely open up their campuses,” Vault Health Founder and Chief Executive Officer Jason Feldman, tells Health.
How it works: The test is overnighted to your home with instructions about entering a Zoom room to meet with a medical practitioner. The practitioner will confirm your identity and test serial number, monitor your sample collection, and watch as you properly seal up the test and return to its packaging. Then the test is shipped overnight to the lab.
Turnaround time: 48-72 hours
Tips: “The biggest tip is to not eat, drink, smoke, or chew gum at least 30 minutes before you plan to take the test,” says Feldman.
What it was like: “I did not particularly enjoy the saliva-based collection method. You have to gather enough spit to fill the tube up to a wavy line (about an inch or two), which took me upwards of 30 minutes. You are advised that any bubbles—which you will certainly have—do not count and that you should be wary of overfilling the tube. You’re also advised not to eat or drink beforehand, so I found myself with a dry mouth almost immediately.
Doing the test also requires you to Zoom with a medical professional who oversees the administration of the test. I joined a virtual waiting room at 4 p.m. on a Thursday and waited 60-plus minutes. The medical professional I spoke with was friendly and helpful, although I found the experience of having someone watch/listen to me spit into a tube for 30 minutes to be awkward.
That said, I did find the one-on-one consultation helpful, as the pro advised me to tap the tube to break up bubbles, which I would otherwise have not known to do. I shipped my kit on a Thursday and received a negative result a full week later.”
Collection method: saliva
Screening: Yes. Before getting approved to receive an at-home saliva test, you must complete a COVID-19 symptom assessment that determines your risk of having the SARS-CoV-2 virus.
How it works: Once approved, received, and registered, follow the onscreen instruction and proceed to collect your saliva into the provided tube.
Turnaround time: 48 hours
Tips: “Follow instructions to not eat or drink 30 minutes before providing your saliva sample for the best results,” Mehdi Maghsoodnia, chief executive officer of 1Health.io, Vitagene’s parent company, tells Health.
What it was like: “This test was identical to the Vault test but without the addition of a required Zoom call. I took this test before taking the Vault test and had an issue with spit bubbles that I think led to an overfilled tube. Once you fill the tube, you screw on a cap until it’s tight enough for a blue stabilizing solution to be released. Then you shake it for five seconds.
With Vault, the blue solution released easily. With this test, it did not, probably because there were too many bubbles. The tip from the Vault medical pro to break up the bubbles proved helpful! I shipped my kit on a Thursday and received a negative result the following Monday.”
The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it’s possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.