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Should we be swabbing our noses or our throats for at-home tests? Do rapid tests even detect omicron at all? Are PCR tests the only results we can trust right now?
Guidance about how to approach testing in the omicron era seems to be evolving by the day. A recent real-world study that followed 30 subjects likely exposed to omicron found that PCR saliva tests can catch Covid-19 cases three days before rapid antigen tests, which use nasal swabs.
These findings, which have not been peer reviewed, follow the Food and Drug Administration’s announcement in late December that, while they do detect omicron, rapid antigen tests may now have “reduced sensitivity.” But that doesn’t mean rapid tests don’t play a key role in our pandemic response going forward.
This is all confusing to a public that’s been pulled in several directions over the course of the pandemic when it comes to guidance and testing. Long delays for PCR test results, a shortage of at-home rapid tests, and the wait for more definitive science about the omicron variant have all made it more difficult to figure out when and how to to get tested. Nevertheless, public health experts say that, as more become available, rapid tests will be an increasingly vital tool for diagnosing Covid-19 and reducing its spread.
“We don’t want the perfect to be the enemy of the good”
So you might be wondering: What’s the point if rapid tests aren’t as accurate as PCR tests? Well, rapid antigen tests, which look for a specific protein on the Covid-19 virus, remain extremely effective at confirming positive cases. Put simply, if you test positive on a rapid test, you almost certainly have Covid-19.
If you test negative, in some cases, you might still test positive on a PCR test, which is much more sensitive because it tests for genetic evidence of the virus. Rapid tests may not pick up positive cases in people who have been vaccinated or who have recently recovered from Covid-19, since they may produce less virus, one expert told Recode.
Rapid tests can also reveal a positive case faster than the labs that process PCR tests, since they can take several days to share results with patients, especially during big waves of infection. Perhaps more importantly, rapid tests can indicate whether someone is contagious enough to spread the virus to others, which is what many people are most worried about.
“Given that a rapid antigen test is often the most feasible or available option for many, we don’t want the perfect to be the enemy of the good,” Joshua Michaud, the associate director for global health policy at the Kaiser Family Foundation, told Recode. He explained that every Covid-19 case that’s caught by someone who could take a rapid antigen test but not a PCR test is a win for public health.
Taking rapid tests more frequently also makes them more effective. Most at-home rapid test kits are designed to be conducted over the course of two days, which is why kits typically include two tests. Because each test is a snapshot of the moment it’s taken, multiple tests help reduce the chance of receiving a false negative.
Of course, all of this is assuming that you can get your hands on a rapid test. In the weeks since omicron started to spread, rapid tests have been incredibly hard to find in some parts of the country. These tests are out of stock because neither test manufacturers nor the Biden administration anticipated record levels of Covid-19 cases, which have boosted the demand for rapid tests.
To confront the shortage, the White House plans to buy and distribute 500 million free rapid tests in the coming weeks. When that happens, these tests could help catch more positive cases and lower the number of people infected with Covid-19.
How accurate are rapid tests when it comes to omicron?
The accuracy of a rapid test depends on how often you’re testing yourself and whether you want to identify a Covid-19 infection or measure your contagiousness. But if you test positive on a rapid test, you should trust the result, assume you’re infectious, and isolate for at least five days. If you test positive again after five days, the CDC recommends isolating for five more.
Rapid tests, however, are not perfect. Research indicates that antigen tests are less accurate than PCR tests — this has been the case since the beginning of the pandemic. PCR tests are processed in a lab, where sophisticated equipment can identify and amplify even the tiniest genetic evidence of the virus that causes Covid-19.
These tests are so precise that patients can actually test positive for weeks after they’ve recovered and are no longer contagious. The results of rapid tests, meanwhile, can vary based on how much virus is in a patient’s nose at the time the sample is taken and how far along they are in their infection.
Scientists explain the difference between rapid tests and PCR tests in two ways: specificity, which reflects a test’s false-positive rate, and sensitivity, which reflects a test’s false-negative rate. Both PCR and rapid tests have high specificity, which means that their positive results are very trustworthy. But while PCR tests tend to have near-perfect sensitivity, rapid antigen tests tend to have a sensitivity around 80 to 90 percent. This means that rapid tests tend to produce more false negatives than PCR tests do.
“Most at-home tests are still able to detect infection by omicron because they target a part of the virus that doesn’t mutate that much”Omicron makes testing even trickier. The sensitivity of rapid tests may be even lower for omicron cases, according to early research from the FDA and other scientists.
Another problem is that omicron may propagate more in the throat than the lungs, and it could take longer for Covid-19 to show up in nasal samples, even if someone is symptomatic. It’s possible that vaccinated people and people who have recently recovered from Covid-19 are noticing more false negatives on rapid tests because they tend to produce less virus overall.
“At-home tests are mostly effective when the person has high viral loads, a time when the person is more likely to transmit the virus,” Pablo Penaloza-MacMaster, a viral immunologist at Northwestern’s medical school, told Recode, “Most at-home tests are still able to detect infection by omicron because they target a part of the virus that doesn’t mutate that much.”
Separate studies from both the UK’s Health Security Agency and researchers in Australia found that antigen tests are as sensitive to the omicron variant as they were to earlier strains of Covid-19. Again, the FDA does still recommend rapid tests to diagnose positive cases, and test manufacturers say they’re confident in their products’ ability to detect omicron.
While early research indicates saliva tests might detect Covid-19 more quickly, right now most of the PCR tests and all of the available rapid at-home tests that have emergency use authorizations from the FDA use nasal samples.
How to use rapid tests in less-than-ideal circumstances
Which brings us back to the question of whether you should be sticking nasal swabs in your throat. There is evidence that saliva samples may be a quicker indicator of Covid-19 cases, but that doesn’t mean you should stop following the directions that come with your test kit.
The FDA says that people should not use rapid antigen tests to swab their own mouths. Some experts say you might consider doing so anyway, and point out that other countries, including the UK, have approved rapid antigen tests that use throat swabs and released very careful directions about how to do so.
“I personally do swab my throat and my nose to get the best sensitivity when I use over-the-counter tests at home,” Michael Mina, an epidemiologist at Harvard, said at a Thursday press conference. “There are risks associated with that, but the biology does tell us that they might be getting better sensitivity earlier.”
But the concern with rapid test kits right now is not that people are swabbing their noses, but how often they’re swabbing their noses. A single test could miss a Covid-19 case and produce a false negative, but taking two tests over a 24 to 36 hour period reduces this risk.
The more rapid tests you take, the more you reduce your chances of a false negative, and the more times you test negative over multiple days, the more confident you can be that you’re not spreading Covid-19.
Still, the biggest problem right now is that rapid tests are pricey and hard to find. Pharmacies have limited the number of test kits people can buy, and many are completely sold out. A single test can also cost more than $10, which means that testing yourself regularly gets expensive quickly. Opportunists have even hoarded tests and engaged in price gouging, which has exacerbated the shortage.
If you don’t have enough tests to test yourself regularly, it’s best to test yourself right before seeing vulnerable people, says Mara Aspinall, a professor who leads Arizona State’s testing diagnostic commons and a board member for the test manufacturer Orasure, told Recode. “I’m heading to a vulnerable person [or] I’m going into a health care setting, and therefore need to test right beforehand.”
For now, the best test kit is the test you can get (Wired has a handy list of the brands currently available). If you’re planning to go somewhere and don’t want to spread the virus, you should take one rapid test the day before traveling, and then a second test immediately before you go. If you only have one rapid test, take it right before you see people.
Testing yourself should become easier as more rapid tests become available. In addition to the 500 million free rapid tests that the White House will distribute beginning later this month, people with private insurance will also be able to get their rapid test purchases reimbursed starting next week. You should also check with your local health department, as they might be distributing free tests.
Even though the rapid test situation is still less than ideal, there are other strategies we can use to protect both ourselves and other people from Covid-19, like getting vaccinated, getting boosted, and wearing a mask. And if you do happen to find some rapid tests, go ahead and grab them. They might just come in handy, especially if you use them correctly.
Correction, January 7, 10:30 am: An earlier version of this story misstated in one instance the kind of false results that might appear more often on rapid Covid-19 tests among vaccinated people and those with immunity from recent infection. The false results are false negatives, not false positives.
Rebecca Heilweil is a reporter for Open Sourced, covering emerging technologies, artificial intelligence, and logistics. Her Twitter handle is @rebheilweil.
As many of us rush around trying to find the perfect Thanksgiving turkey and holiday gifts, there’s another thing experts recommend we stock up on: at-home tests for Covid-19.
“At-home testing will be essential over the next few months,” said Leana Wen, an emergency physician and professor of health policy at George Washington University.
The most common form of at-home testing is the rapid antigen test — think BinaxNOW, QuickVue, or Ellume — where you swab your own nostrils and get results back in around 15 minutes. These can be found at your local pharmacy, though supply has been erratic (more on this below). Antigen tests are typically contrasted with molecular tests — think lab-based PCR — which are better at picking up the virus, though you have to get swabbed by a professional and then wait, sometimes several days, until results come back.
Now, however, companies like Cue Health and Detect are selling a new class of tests: molecular tests that can be performed entirely at home. They promise PCR-quality results in under an hour — all without ever having to get up off your couch.
If you can find and afford at-home tests — whether they’re the relatively cheap antigen tests or their more expensive molecular cousins — experts say it will be particularly useful for you to have them on hand this fall and winter, for a few reasons.
For Americans who got their first two doses this spring, immunity may well be waning. Data so far shows the vaccines’ effectiveness against infection tapers off around the six-month mark. And so far, only 18 percent of Americans have gotten a booster shot (though that may well rise now that all adults are eligible). That, together with the fact that infection rates are climbing in the US, means breakthrough cases are likely to rise here, as they’ve already begun to do in Europe. And with the weather getting colder and the holidays coming, we’re all going to be spending more time indoors with others.
To be clear, if you’re fully vaccinated, the data shows you’re still well protected from severe disease or death from Covid-19, and reported infections in the US are so far still mainly among unvaccinated people. But should you get a breakthrough infection, you could infect others who are unvaccinated, have waning immunity, or are elderly and thus more at risk for severe illness even if they are vaccinated. That’s what testing can prevent.
“We need to shift from thinking about at-home testing as just a diagnostic tool to thinking about it as a preventative tool,” said Wen, who recommends taking a test before an indoor social gathering even if you’re not feeling symptoms.
Neil Sehgal, a health policy professor at the University of Maryland School of Public Health, told me he’s about to fly from Washington, DC, to California to spend Thanksgiving with relatives there. Everyone in his family plans to take a rapid test before the holiday meal, he said, to help ensure they don’t pose a risk to others.
“The challenge right now is that even if you are vaccinated, your breakthrough infection is a link in a chain that may end up infecting somebody for whom consequences may be more serious than for you,” Sehgal told me. “We all have to make a decision about whether or not we want to participate in those chains of transmission.”
Likewise, Wen said she’s planning to use rapid tests for holiday get-togethers. She also finds them useful for birthday parties and dinner parties; now that it’s getting too cold for outdoor meals, her family and her invited guests test before gathering in her home.
Both experts noted that there’s an additional reason why it’s useful to keep a few tests in your house in the coming months: Antiviral pills for Covid-19, produced by Merck and Pfizer, will probably soon be available in the US under an emergency use authorization. But these treatments are most effective if you take them soon after you’ve become infected. That means it’s in your interest to catch the virus early on — and having a test close to hand can help you do that.
It shouldn’t be so hard to get at-home tests. Here’s what went wrong.
One issue clouds these expert recommendations: The availability of at-home test kits has been spotty at best.
An American, looking at how easy it is to snag a rapid test across the pond in the UK or Germany, could be forgiven for feeling a pang of envy — and a hefty dose of frustration. More than a year and a half into the pandemic, over-the-counter antigen tests are often sold out at stores like CVS or Walgreens.
Despite the Biden administration’s decision to invest $1 billion in rapid tests, the market remains constrained, in part because of regulatory hurdles. Early on, the US decided to categorize these tests as medical devices, which means they needed to pass a stringent FDA approval process, Sehgal explained. As a result, only a few companies’ tests squeezed through to market in 2021.
“We’ve been slow to adopt and approve them in the US because they’re not as sensitive as PCR tests,” Sehgal said. But even though antigen tests are not foolproof at detecting the virus, “they are sensitive enough to give you a pretty realistic sense of whether you pose a risk to the people you’re gathering with” — that is, of whether you’re actively contagious.
“I do think a more public-health-minded mental model would have led to quicker approval of more rapid antigen testing options,” Sehgal continued. In other words, the US should have conceived of the tests as a harm reduction measure: We know they’re not perfect, but if we deploy them at scale, they’ll reduce harm overall.
“The FDA would still have to approve them under an emergency use authorization to make it to market, but the urgency with which the FDA has acted with vaccines could have been similarly applied to testing. If so, I think we’d have seen earlier approvals for more domestic manufacturers of rapid tests,” he added.
Another reason for the low stock is simply that bigger purchasers snapped up a lot of the tests early on. Companies, sports teams, and school systems placed bulk orders in the spring and ate up a lot of the stock before the general public could get to it. “They made contracts because they knew that to resume in-person activity, this would be a good strategy,” Sehgal said.
The upshot is that when regular individuals walk into their drugstores to try and buy a couple boxes, there’s not much left on the shelf.
Under the Trump administration, officials at times appeared todiscourage testing, for fear that it would reveal more positive cases. Instead, the US focused on developing vaccines at warp speed, thinking of them as the silver bullet that would destroy the pandemic.
But this fall, the Biden administration decided to make testing a more integral part of its pandemic strategy. White House coronavirus response coordinator Jeff Zients said in October that the $1 billion investment “puts us on track to quadruple the amount of at-home, rapid tests available for Americans by December. So that means we’ll have available supply of 200 million rapid, at-home tests per month starting in December.”
Many experts hailed it as a welcome, if overdue, commitment.
“What rapid tests do is they allow us to live more peacefully with this virus — to actually be able to not have it be so disruptive to society,” Michael Mina, an epidemiologist who’s been one of the most vocal proponents of rapid tests, told the Washington Post. These tests can make quarantines unnecessary, allowing us “to keep students in school, to keep businesses running and to stop the need for shutdowns, even amid outbreaks.”
The next generation of at-home tests
Up till now, at-home testing has been pretty much synonymous with antigen tests, such as BinaxNOW or QuickVue. Overall, these tests’ sensitivity tends to be in the range of 85 percent, meaning they miss about 15 percent of people who are infected. That said, they’re very good at detecting an infection when people have high viral loads, which is when they’re likeliest to infect others.
Molecular tests are considered the gold standard in Covid-19 testing. They take your sample and amplify the genetic material in it many times over, so if there’s even a tiny shred of virus in it, they will almost certainly detect it. Traditionally, the downside has been that you need a professional to swab you and a lab to process your results.
At-home molecular testing is starting to change that. This month, the health tech company Cue Health began selling directly to consumers a molecular test that can be performed entirely at home. You can buy it online, no prescription needed, and get lab-quality results without leaving home, according to the company. The Cue test shows results in line with lab PCR results 97.8 percent of the time, as verified in an independent study conducted by the Mayo Clinic.
And it’s quick, offering results in 20 minutes, similar to the wait time for antigen tests. There’s a catch, though: It’s not cheap. A three-pack of single-use tests will run you $225, and that’s not counting the reusable reader, which costs $250. At that price point, it’s far from ripe for equitable access. (For comparison, antigen tests are priced from about $10 to $40 per test.)
“We’re not priced like an antigen test, but we don’t perform like an antigen test,” said Clint Sever, Cue’s co-founder and chief product officer, adding that the test is used by the likes of Google, NASA, and the NBA. “It’s a breakthrough technology.”
Detect is another health tech company offering an at-home molecular test (the product will be available soon). This one will also come with a reusable hub and single-use individual tests. With the hub priced at $39 and each test at $49, Detect’s system will be more affordable than Cue’s, though still pricier than an antigen test. The Detect test is 97.3 percent accurate, similar to a PCR lab test, according to Axios. It returns results in one hour.
Both Cue’s and Detect’s tests have earned an emergency use authorization from the FDA, and both companies have their sights set on much more than just Covid-19 testing. With a bit of tweaking, their platforms should be able to test for other health issues, too.
Detect’s plan “is that you’ll be able to get a flu test or a Covid test or whatever you need, at home,” Owen Kaye-Kauderer, the company’s chief business officer, told Axios.
Cue envisions a future where its reader will be able to test you for everything from the flu and strep throat to chlamydia and gonorrhea. “Covid has basically accelerated the transition to virtual care services and connected diagnostics,” Sever told me.
The fundamental innovation here — giving your humble home the diagnostic capabilities of a professional lab — will likely become popular in many areas of health care over the next few years. That helps explain why companies like Cue and Detect are eager to get into the game, even though many experts say that as we approach springtime, Covid-19 will likely be entering the endemic phase: It’ll keep circulating in parts of the population, but its prevalence and impact will come down to relatively manageable levels, so it becomes more like the flu than a world-stopping disease.
“When we get to the point where transmission has slowed and we enter the endemic phase,” Sehgal said, “at-home testing becomes much less important.”
In the meantime, Wen recommends that each family keep a few at-home tests in the house. Don’t fret too much about whether they’re antigen or molecular; get what you can find and afford.
“This is a case of ‘don’t let the perfect be the enemy of the good,’” she said. “These tests can allow us to go from Covid-19 as a threat that feels almost existential to just another risk among all the risks we take into account every day. They can let us get back the normalcy we’re craving.”
“Test for Past Infection”. U.S. Centers for Disease Control and Prevention (CDC). 2020. Archived from the original on 16 May 2020. Retrieved 19 May 2020. Antibody blood tests, also called antibody tests, check your blood by looking for antibodies, which show if you had a previous infection with the virus.
Centers for Disease Control and Prevention (CDC). 20 May 2020. Archived from the original on 19 May 2020. Retrieved 20 May 2020. Two kinds of tests are available for COVID-19: viral tests and antibody tests.
What’s the impact on digital fraud as countries ease COVID-19 lockdown restrictions? We recently analyzed billions of transactions in our flagship identity proofing, risk-based authentication and fraud analytics solution suite — TransUnion TruValidate™ — and found the rate of suspected digital fraud attempts across industries rose 16.5% globally when comparing Q2 2020 and Q2 2021.1 In the US, the percentage of digital fraud attempts increased at a similar rate of 17.1% during the same time period.
As fraud attempts on businesses and consumers continue to rise, fraudsters are pivoting to target industries with growing markets. “It’s quite common for fraudsters to shift focus every few months from one industry to another,” said Shai Cohen, Senior Vice President of Global Fraud Solutions at TransUnion.
For example, when looking at financial services, online fraud attempt rates had risen 149% when comparing the last four months of 2020 to the first four months of 2021. Yet, when comparing Q2 2021 to Q2 2020, the rate of suspected online financial services fraud attempts has risen at a much lower rate of 38.3% in the US (18.8% globally).
Where are fraudsters turning their efforts globally? We found gaming, and travel and leisure rose 393.0% and 155.9%, respectively when comparing the percent of suspected digital fraud in Q2 this year and last. In the US, during the same time periods, these rates rose 261.9% for gaming and 136.6% for travel and leisure.
Global Industry Year-over-Year Suspected Digital Fraud Attempt Rate Increases and Declines in Q2 2021
Industry
Suspected fraud percentage change
Top type of fraud
Largest percentage increases
Gaming
393.0%
Gold farming
Travel & Leisure
155.9%
Credit card fraud
Gambling
36.2%
Policy/License agreement violations
Largest percentage declines
Logistics
-32.74%
Shipping fraud
Telecommunications
-16.35%
True identity theft
Insurance
-8.33%
Suspected ghost broker
Fraudsters capitalize on new opportunities as travel begins to reopen
While volumes remain lower than pre-pandemic levels, travel has seen a significant increase. The daily US Transportation Security Administration (TSA) screenings for many days in April 2020 were below 100,000. However, the busiest day in April 2021 had 1,572,383 screenings, reflecting the growing number of travelers.
Cybercriminals are taking note and acting accordingly. “Fraudsters tend to seek out industries that may be seeing an immense growth in transactions. This quarter, as countries began to open more from their COVID-19 lockdowns, and travel and other leisure activities became more mainstream, fraudsters clearly made this industry a top target,” noted Cohen.
In addition to leveraging credit card fraud (the top type of digital fraud reported to TransUnion by its travel and leisure customers), fraudsters are also quickly adapting to target desperate travelers. Recently, the US State Department temporarily shut down their online booking system for all urgent passport appointments in response to a group of scammers using bots to book all available appointments and sell them for as high as $3,000 to applicants with urgent travel needs.
More than one-third of consumers say they’ve been targeted by COVID-19-related digital fraud
While travel and leisure, and gaming saw the largest increases in suspected digital fraud, 36% of consumers participating in TransUnion’s Consumer Pulse study said they’d been targeted by a digital fraud scheme related to COVID-19 — across all industries — during Q2 2021.
Phishing was the leading type of COVID-19-related digital fraud impacting consumers in Q2 2021. Stolen credit card or fraudulent charges was the second most cited type of COVID-19-related online fraud, affecting 24% of global consumers.
“One in three people globally have been targeted by or fallen victim to digital fraud during the pandemic, placing even more pressure on businesses to ensure their customers are confident in transacting with them,” said Melissa Gaddis, Senior Director of Customer Success, Global Fraud Solutions at TransUnion. “As fraudsters continue to target consumers, it’s incumbent on businesses to do all that they can to ensure their customers have an appropriate level of security to trust their transaction is safe all while having a friction-right experience to avoid shopping cart abandonment.”
How our TruValidate suite helps businesses detect and prevent fraud
TransUnion Global Fraud Solutions unite consumer and device identities to detect threats across markets while ensuring friction-right user experiences. The solutions, all part of the TransUnion TruValidate™ suite, fuse traditional data science with machine learning to provide businesses unique insights about consumer transactions, safeguarding tens of millions of transactions each day.
As long as a business has an online presence, you can spy on them and collect their assets within MeetDonna. The business can be old, or started as early as this morning – you can soon plug into their emails, ads and funnels – as they build them. We show you how.
Email marketing is always evolving. MeetDonna gives you the ability to keep both bird’s eye, and microscopic view of your competitors’ newsletters. Figure out what they are up to and adapt faster! You can now find out ALL the emails your competitors are sending. Just subscribe to their newsletter, and we do the rest!
