At-home Covid-19 tests offer promises — and questions

Three new completely at-home Covid-19 tests are hitting the market soon, promising to deliver results within minutes.

The BinaxNow, Lucira and Ellume tests all offer slight variations on a similar approach: swab, insert and get results without even leaving your kitchen table, in 30 minutes or less.

While one offers same-day results, others will require jumping through a few hoops.

Patients can walk into a drug store and buy the Ellume test without a prescription. Available later this spring, it will cost about $30 and also be sold online. Since it can be used by patients not showing symptoms, it can be a useful tool to screen before going to school, work or traveling.

The Lucira is more sensitive, using molecular technology that can better detect positive cases, which is important to prevent transmission of the virus, but is only available by prescription. It will cost about $50.

The BinaxNow also requires a prescription. Patients answer questions through an app to confirm they are exhibiting coronavirus symptoms. The kit is then shipped to their door for a cost of about $25, plus overnight shipping.

These all-in one tests will add more badly needed testing options and reduce barriers. While at-home collection kits have been available for months, patients need to order them, collect a sample and send them to a lab for results.

The at-home tests all offer a version of nasal swabbing and testing using a small kit to check for the presence of specific antigens, which would indicate a coronavirus infection. They aren’t as accurate as the “gold standard” PCR test, but they allow patients to quickly and easily see if they should isolate and consult with their doctor. Experts say they are best used about 5 to 7 days after exposure to the virus.

The test offers promising accessibility. No visits to a doctor or clinic, or scheduling a drive-through at a pharmacy. And, since patients don’t have to leave home, it’s easier for them to take the test, decreasing the risk they might infect others.

Michael Mina, an epidemiologist at Harvard University and Brigham and Women’s hospital who has studied dozens of Covid-19 rapid tests, said cheap and rapid at-home testing would be a powerful tool in beating back the pandemic.

“If millions of Americans tested themselves at home twice a week we would start to see dramatic reductions in cases within a month or two,” Mina told NBC News.

Even if the test is negative, that still doesn’t mean it’s okay to go to a big family party. Patients should then consult with a medical professional to interpret their results in the context of their exposure history, the FDA warns.

Each test is a little different and will take some patient training. For instance, the BinaxNow, available by prescription, is about the size of a credit card. Patients open the card, then squeeze six drops of an included reagent liquid onto a small hole on the card, according to the device’s FDA emergency use authorization. Then they swab inside their nose, insert the swab into a hole on the card, and rotate it clockwise three times. Then they peel off an adhesive and seal the card. Wait 15 minutes and a test result window shows the result: A single pink or purple line means negative. A second pink or purple line means positive.

If you get a positive result, isolate, don’t go out, Mina said. It’s a “red light.”

At-home collection tests

As of right now, there are over a dozen at-home coronavirus tests that have been on the market for months under emergency use authorization. Patients answer a few symptom-screening questions, order a sample collection kit, gather the sample by nasal swab or saliva collection, seal it, and ship it to a lab for results in about 3-5 days. The test costs about $100 to $200 and, if prescribed by a doctor, insurers have generally provided reimbursement.

They’re sold by several different labs, including Quest diagnostics, Everlywell, LetsGetChecked, RapidRona, Binx health, Pixel, Picture by Fulgent Genetics, and a Spectrum Solutions test sold through Forhims.com.

One, the DxTerity, is available on Amazon. The company says it provides over 95 percent of results within 24 hours.

Because of the time delay to get results, these kits are best used by individuals who already have a high chance they’ve caught Covid and are already isolating, Mina said.

Direct-to-consumer tests are designed to be patient friendly, but according to a paper published in the Journal of Law and the Biosciences, they can have more accuracy challenges compared to tests performed by a medical professional. If a patient is doing a saliva test and drinks a big glass of water beforehand, that can dilute the sample, for example.

After hitting new record highs at the end of the year, the U.S. is seeing declining cases. Could at-home testing prevent or mitigate another surge?

“It’s not a silver bullet, but it is a massively powerful tool that we’re not yet using,” Mina said.