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Beginning tomorrow, Jan. 19, every home in the U.S. will be able to order up to four at-home Rapid antigen COVID-19 tests from the federal government. The tests will be completely free, and no other information is required other than a name and address. Shipping is free through the USPS.

COVID-19 tests have been in short supply with the advent of the Omicron variant. As part of the Biden-Harris Administration’s “Path Out of the Pandemic” COVID-19 Action Plan, at-home tests are now required to be covered by insurance companies as of Jan. 15. (Read the full story here.)

Tests ordered from this program will ship in 7-12 days, per the website. While this isn’t suitable for someone needing a test right away, being able to order tests now is a step in the right direction for future preparedness. For those without internet access, a telephone number will be made available for ordering tests but has not yet been published.

To kick off this campaign, the government purchased 420 million FDA-approved test kits from different suppliers. Therefore, not everyone will receive the same brand of test, however, each brand carries the same approval rating.

COVID-19 Tests: Proper Testing Procedures

There are numerous opinions on tests – from accuracy to efficacy – that are volleyed across the internet and media on a daily basis. This can lead to confusion and frustration, so much that some may give up and not pursue a test at all. The following information comes from an exclusive Racine County Eye interview with Dr. Michael O. Frank, Chief of the Division of Infectious Disease at the Medical College of Wisconsin.

Collect a Good Specimen

It is widely known that the rapid tests are much less accurate than the PCR tests offered. But when faced with a pandemic of these proportions, we must use everything available to us to achieve the best outcome. The rapid tests are a good first line of testing on such a large scale.

The biggest problem lies in how the sample is collected. When people collect the sample, “they swab the nose rather than going back in and getting the back of the nasal pharynx — the back of the throat through the nose,” said Dr. Frank. “So that’s why you’ll hear stories about how uncomfortable that is for people. If it’s not uncomfortable when it’s done, it probably wasn’t done right.”

Another new development that has been circulating on social media is swabbing the back of the throat as well as the nasal cavity to collect a better specimen. The National Institutes of Health had found evidence of this and reported on it in March 2021 that the virus is found in saliva and the mouth’s cells.

The Omicron variant has been found even more prevalent in saliva samples than its predecessors and some scientists are finding that throat swabbing is proving more accurate. This practice has not been approved by the CDC or FDA and nothing has been made official, however, it looks like we may see this change being officially adopted soon enough.

False Negatives

Why do so many people have a negative test, only to test positive later?

There are a few reasons why this happens.

  1. The specimen was collected improperly. As noted above, in order to reach an accurate result, the specimen must be collected from the correct location inside the nasal cavity.
  2. The test was administered too early for an accurate reading. Even when the virus is present, there needs to be a large enough amount of the virus to be “captured” in the specimen. Therefore the specimen may show a negative result when the rest of the body would say otherwise.
  3. A person’s viral load can be different from one day to the next. Viruses must reproduce inside cells of its host. Once it replicates, the new viruses either invade other cells, or they leave the body through the airways (nose and mouth) which is called shedding. When a person has a larger amount of “viral shed,” they are more likely to have a positive result. If the virus is in more of a dormant state, the test may show a negative result because there wasn’t enough of the virus in the sample that was collected.

When should I test?

If you have been exposed to someone who has tested positive for the SARS-CoV-2 virus, the CDC recommendation is to monitor yourself and test either when symptoms appear, or 5-7 days after the exposure. Testing any sooner than this increases the chance of a false negative.

Anecdotal evidence has shown that the Omicron variant is responsible for false-negative test results even two days after symptoms have begun, so waiting a few extra days (and isolating during that time) will most likely reflect a more accurate test result.

How Often Should I test?

One major factor that is often missed is “serial testing.” Simply put, rapid tests give overall better results when used a few days apart. Simply doing one rapid test and seeing a negative result is extremely shortsighted and dangerous.

The CDC recommends testing twice, a few days apart from each other. Typically the best times to test are days five and seven after exposure, or after the onset of symptoms followed by another test two days later, should the first result show negative.

“Any test is a snapshot of what’s happening in the part of your body that was sampled at that moment. That’s all it tells you,” said Susan Butler-Wu, associate professor of Clinical Pathology at the Keck School of Medicine at the University of Southern California. “So, yes, PCR is more sensitive in that it can detect lower amounts of the virus. But if you’re in the very early stages of incubating an infection and haven’t reached what we call the ‘limit of detection,’ that too, can be negative.”

What About False Positives?

False-positive test results, while possible, are quite rare. The American Society for Microbiology reported in November that false positives – and the misinformation that spread like wildfire across social media – were largely due to contamination of the specimens (like fruit juice) and/or testing supplies, or failure to follow the package guidelines.

Now that tests are becoming more widely available, proper technique is just as important as having them. With patience and practice, rapid COVID-19 tests can help us safely diminish infection rates.

The Racine County Eye and Kenosha Lens is committed to publishing the most current and accurate information regarding the COVID-19 pandemic in our Coronavirus section. View both the Racine County COVID-19 Dashboard and Kenosha County COVID-19 Dashboard offering real-time (updated Monday – Friday) statistical reporting for Racine and Kenosha Counties.