A Parents Guide to Home COVID Testing

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You’ve probably seen home COVID tests, often referred to as “rapid tests,” at your local pharmacy. They can detect cases of infectious coronavirus without the need for PCR testing at the doctor’s office. But how do you use these home tests and can you trust the results for children? Here’s everything parents need to know.

An image of a woman taking a COVID-19 test at home.

Getty Images.

Types of home COVID-19 tests

When it comes to COVID-19 testing, most parents are familiar with PCR (polymerase chain reaction) varieties. These “molecular” tests are done in a doctor’s office or testing center to diagnose a current coronavirus infection. They look for small amounts of viral RNA, often through a sample taken with a nasal swab. The sample almost always needs to be processed in a lab, so it usually takes at least 24 hours to get the results. PCR testing is considered the “gold standard for COVID-19 testing,” says Jeffrey S. Dlott, MD, MS, senior medical director, Medical Affairs, Diagnostic Services at QuestDirect and Quest Diagnostics.

As the pandemic continues, more companies are releasing rapid COVID tests that can be performed at home. There are two main types: rapid over-the-counter antigen tests and home collection kits.

Antigen tests

The main type of home COVID test that parents will encounter is called an antigen test. These tests look for viral proteins and usually return a result in about 15 minutes (which is why they are also called rapid tests). The whole process is done at home, which is extremely convenient for busy parents. However, as a downside, some people may have difficulty following the instructions and performing the test, leading to inaccurate results, Dr. Dlott says. “In addition, rapid antigenic tests are generally less sensitive than molecular tests. “

When in stock, antigen tests like Abbott’s BinaxNOW are available at major retailers like Walmart, CVS, Walgreens, Amazon, and Rite-Aid. Other manufacturers include Becton Dickinson, Ellume, OraSure, and Quidel. The complete list of antigen tests approved for emergency use authorization is available from the Food and Drug Administration (FDA). They typically cost around $ 20 to $ 35 each.

Home collection kits

You can also schedule a home PCR sample collection through a service such as QuestDirect, which is part of Quest Diagnostics. The sample taken at home is then mailed to a lab for processing, says Dr Dlott. Patients using this option can be “confident that their tests are the same high-quality molecular tests ordered by their doctors, but with the convenience of taking samples at home,” he adds. After the lab receives the sample, patients typically get test results within a day or two. These home collection tests cost $ 100 or more.

REMARK: Antigen tests and molecular tests are diagnostic tests used to determine a current infection with COVID-19. Antibody tests are also available, but they indicate an infection or a previous vaccine response, says Wendy Sue Swanson, MD, MBE, FAAP, pediatrician and chief physician at SpoonfulONE. These are usually blood tests and cannot be done at home.

How to take a COVID test at home

It is important to carefully follow the instructions for your COVID-19 home test; otherwise, you might receive a false result. Samples for diagnostic testing are usually taken with a nasal or throat swab, or saliva collected by spitting into a tube, notes Dr Swanson.

How to do antigen tests: For most rapid over-the-counter antigen tests, parents must insert a nasal swab into their child’s nose and move it for several seconds. Then they’ll put the snotty swab in a reservoir of test reagent and wait. The results will be similar to a pregnancy test – a digital reading or lines indicating a positive or negative diagnosis, says Dr Swanson.

How to take home collection tests: These will include a tool (probably a swab) to collect the sample. The kit will also contain “a tube with stabilizing material along with detailed shipping information” for sending the sample to the lab, adds Dr Dlott.

Are Home COVID Tests Accurate?

Antigen tests are less sensitive than PCR tests, which doesn’t mean they are worse. A PCR test will detect very low levels of viral RNA, and a person can test positive for weeks or even months after recovering from COVID-19. That’s why the CDC doesn’t recommend testing people who have had COVID-19 in the past 90 days, unless they start showing symptoms again.

It is helpful to think of antigen tests as “contagiousness tests,” said Michael Mina, MD, Ph.D, associate professor of epidemiology at Harvard TH Chan School of Public Health, throughout the pandemic, the more recently in an editorial for The New York Times arguing for a wider use of tests. For people with symptoms, antigen tests work exceptionally well.

PCR tests are incredibly sensitive, so they are useful in confirming an infection after a positive antigen test. They are very unlikely to return false negatives, so a positive antigen test followed by a negative PCR test means the first result was probably an error. The goal of testing is to identify cases as early as possible so people can avoid exposing others, and antigen testing is a great tool to do this, assuming they are available.

Home collection kits usually rely on PCR testing, so they are more accurate than varieties of antigens.

When should my child have a home COVID antigen test?

Because home antigen testing is easy to use and returns results quickly, they are ideal for situations that do not allow PCR testing. For example, rapid antigenic tests can be used before attending an event such as a wedding, seeing an elderly family member, or going to school after an exposure. This strategy, called test-to-stay, has been adopted in the UK and Massachusetts as a way to reduce student quarantines.

Ideally, you would use an antigen test for surveillance testing for asymptomatic infections, or whenever someone in the household has COVID symptoms, including a sore throat, fever, or runny nose. In practice, these tests have been difficult to find in the United States, and they tend to be expensive, so few private citizens can afford to do so.

Dr Swanson suggests testing repeatedly after any high-risk behavior, such as attending a crowded event or indoors. “Home testing is a great way to protect your family and others. The more we test, the more we know where COVID infections occur, especially those that are asymptomatic, ”she says. “After any high risk behavior (crowds, indoors and unmasked, travel, etc.), I highly recommend testing several times over the next seven to ten days. Home testing may make this more likely.”

Home collection kits have a higher degree of accuracy than antigen tests, but you have to wait longer for results. These can indicate a COVID-19 infection if you are in no rush for a diagnosis; for example, if your child has symptoms and stays home from school anyway, and you’d rather not take him to a doctor for a test. Always consult your pediatrician for advice.

Can my children clean their noses?

The sample for a home test is often taken from the front part of the nose, and not the back as the first tests required. Parents may need to swab their young child’s nose to ensure a good sample (or seek help from another parent or guardian), but children 3 and older can learn to take their own samples, which also helps them feel more in control of the process, says Shawna Marino, advisor to Dr. Mina’s home PCR testing startup. This is often what older children do if they are tested at school as part of a surveillance testing routine.

Either way, it’s important to be upfront about the testing process with your child. “It’s not ‘painless’ because the swabs are really uncomfortable, but the discomfort is very temporary and only lasts for the five to ten seconds you need to collect the sample,” says Dr Swanson. “The specific steps are different for each test: Parents can stay calm, keep a positive attitude while doing it, share true expectations for their child, and provide distraction (a super fun game or show) and rewards (like ice cream) when completed. “

Can I use a home test on babies or toddlers?

While official guidelines discourage home testing for children under 2, Marino says parents should check with their pediatricians. She uses off-label antigen testing to test her 15 month old baby and has been doing so for 12 months. Not all PCR test sites will test children, and those that do often have shorter hours than general test sites.

What happens if my child’s home COVID test is positive?

What to do if your child’s home COVID test comes back positive? Isolate them and assume they have COVID-19, especially if you take a second quick test which also comes back positive. Ideally, you would schedule a confirmatory PCR test in a doctor’s office. If that also comes back positive, they certainly have COVID-19. However, if the PCR test comes back negative, it is likely that the antigen tests are false positives and your child does not have COVID-19.

“If the test is positive, follow CDC guidelines for quarantine and isolation,” says Dr. Swanson. “Stay home. Stay hydrated. Watch your symptoms. Stay away from unimmunized people, high risk people, and children as best you can during the entire quarantine period.”

Christine Coppa contributed to this report.

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