What you need to know about rapid at-home COVID tests for your holiday gatherings
Vermont has seen COVID-19 infections and hospitalizations surge for months. With the Thanksgiving holiday approaching, health officials are recommending that people who plan to visit with friends or family get tested before and after gatherings.
But it can be hard to sort through the many rapid at-home tests now available, and understand how to use them effectively.
VPR’s Mitch Wertlieb spoke with Dr. Jessie Leyse, an infectious disease physician at Central Vermont Medical Center in Berlin. Their conversation has been edited and condensed for clarity.
Mitch Wertlieb: What can people expect once they open the box for a rapid test? How easy or hard is it to use?
Dr. Jessie Leyse: Most of the tests are antigen tests, which means that they check for some of the proteins on SARS-CoV-2. Usually, the box that you buy has two tests in it, because most of the time, you're going to want to test once, and then wait a few days, and then test again to increase the sensitivity.
So, you'll open the swab, follow the directions — because some of them need to be in one nostril, some of them are in both nostrils, and it tells you how long to keep them in there and twist them around — and then you put it into the base unit. Sometimes you have to break a liquid container, to help it process. Other times you just put it in there.
So, really, follow the directions. And then, after 15 minutes or so, you'll get a result.
"To be the safest, I think you should probably be tested two or three days before you're going to go to the holiday gathering, and then ideally, the morning of."
I remember, in the early days of the pandemic, people were getting the swabs they would often call them “brain ticklers,” because they had to go pretty deep up the nostril. But that's not the case with these rapid tests, is that right? When you're talking about, you know, getting into the nostril there, you're not really talking about shoving it way up in there?
Right, these aren't the “brain tickler” swabs, these are just right inside your nose, just to get some fluid from inside your nose. You don't have to go way up inside your nasal pharyngeal cavity.
I think it's gonna make people feel a little bit about better about doing them.
[Health Commissioner Dr. Mark] Levine said people ideally should get tested before they leave for a holiday gathering, and after. But when, exactly? How long before or after a gathering should these tests be done?
To be the safest, I think you should probably be tested two or three days before you're going to go to the holiday gathering, and then ideally, the morning of. Because some people can not have symptoms when they're infectious. You can be infectious 48 hours before you show symptoms.
And so, testing a couple of days before, and then also testing the morning of, just increases the likelihood that you're going to catch a positive if you are going to become sick in the next few days.
And then the same thing after the holiday. Once you leave, you can test right when you get home, and then two or three days afterwards, up to about five to seven days, would be ideal.
We do hear about “false positives” sometimes from these rapid tests. Has that been your experience? Is that something that people should be concerned about, that if you do test positive, it could be a false positive? I'm just trying to get a gauge on how reliable these rapid tests are.
Both in the antigen tests and the PCR tests, false positives are pretty rare. They can happen, but they're rare.
If you're feeling totally fine, and you haven't been exposed to anyone and you surprisingly get a positive on one of these tests, then it's completely fine to re-do the test and see if you still get a positive. Or, if you did an antigen test, you can go and get a PCR test, either at one of the [Department of Health] state sites, or one of the few PCR tests available for home.
Those [at-home PCR tests] are more expensive, and a little bit more difficult to get, so it might be better just to go to one of the state sites, and get a PCR test done. That’s if you get a positive, and you weren't expecting it.
Do you have any recommendations on brands or models of these rapid antigen tests that we're talking about, or are they generally all pretty good?
There's a lot of different tests, I would say six or seven different antigen tests that you can get, and it really just depends on where you buy it, if it's at the drugstore or online.
And they're pretty much the same. They all test for the proteins on the virus, and so, really, it doesn't matter.
You're probably going to get two tests in whichever kit you buy, so if you're going to be testing multiple people in the household, you'll need to get multiple kits. But all the antigen tests are pretty similar.
"If you're starting to have a runny nose or a slight fever, a cough, then the antigen tests are really reliable."
And are they generally pretty inexpensive compared to the [at-home] PCR tests?
Yeah, the antigen tests are anywhere between $20 to $40 for a two-pack.
I believe that the PCR tests are higher than that, what I saw was around $80 for one of the PCR tests. But again, that depends on where you get it.
And these tests do come with FDA emergency authorization. It sounds like you're saying they are pretty reliable, better to take one than not?
Yeah, absolutely. They're under emergency use authorization, so they're not fully approved by the FDA, but they're pretty good tests. Especially if you're starting to have symptoms, then the antigen tests are even better.
If you're starting to have a runny nose or a slight fever, a cough, then the antigen tests are really reliable.
Given everything we're seeing, wouldn't it be safer to cancel any Thanksgiving travel, or gathering plans, given these surging COVID cases that we're seeing in [Vermont]?
It's been a really tough couple of years for everyone, and I think we have to balance the risks of COVID versus the risks of isolation, and not seeing our family members.
So, if you're vaccinated, and you can test a couple of days before the gathering [and/or] the morning of, and then make sure that you're staying healthy during the time that you're together, I think it's fine to get together with family.
We all need that social interaction. So, I don't think it's necessary to cancel all our holiday plans, unless of course you get sick, and you are COVID positive. Then you should stay away from other people.
But we just have to balance the risks of it with making sure everybody stays mentally healthy, and sees their family when they need to.
And the other part of that is masking. Do you feel that's still an effective way of preventing transmission?
Absolutely. Masking is still one of — in addition to vaccination — one of the most important ways that we can prevent transmission between people.