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OTC Rapid COVID-19 Tests — Are They Even Worth It?

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Over-the-counter (OTC) COVID-19 tests are widely accessible, affordable, and offer fast results — but they are nowhere near as accurate as molecular tests. Here is the low-down on the pros and cons of the OTC tests, with insight from MD+DI editors who recently tried them.

Remember when you could only get a COVID-19 test if you were showing certain symptoms of infection? Now 18 months into the pandemic, the progress we've seen in terms of COVID-19 tests is nothing short of amazing.

Today, you can buy a COVID-19 test over-the-counter (OTC) for under $35 (in most cases), perform the test on yourself at home, and get results in about 15 minutes, regardless of symptoms. As of this week, each of MD+DI's editors have purchased and taken OTC COVID-19 tests, so it seemed a good time to weigh the pros and cons of at-home testing versus the gold standard, which is a polymerase chain reaction (PCR) test, also known as a molecular test, which is administered by a trained professional and analyzed using lab equipment.

All three of our editors took BinaxNow OTC COVID-19 tests, manufactured by Abbott, which FDA authorized for OTC at-home use in April. It's also worth noting that each of us are fully vaccinated.

Editors share their experience with Abbott BinaxNow OTC COVID-19 tests

I'll go first. My husband woke up Sunday morning with dry heaves, followed by a severe headache, fatigue, and fever. I myself had a bout of nausea that day, although I am fairly sure it was caused by overexertion during exercise. Still, the question weighed on us throughout the day; could it be COVID-19?

Before heading to the pharmacy, I first did some online recon to find out which tests were available locally. I found the following options:

  • QuickVue At-Home test manufactured by Quidel 
  • BinaxNow manufactured by Abbott
  • Ellume COVID-19 home test manufactured by Ellume Health

After some quick research, including a review of this study as well as consumer reviews, I headed to the nearest Walgreens and purchased the BinaxNow test, which includes two tests per box. The test was easy to use, and my husband and I both appreciated the convenience of being able to take the test at home without a professional present. Below is a picture of his test, taken immediatly after coollecting the sample and inserting the swab into the card reader. It's important to note that this image is not of the actual reading, as the instructions clearly state that the test should be read no sooner than 15 minutes and no later than 30 minutes after the swab is inserted, so this is just to show you what it looks like upon immediately taking the test. If you look closely, you can see where a faint control line is beginning to appear (this line later became more distinctive).

Image by Amanda PedersenOTC COVID-19 tests

We read the test 15 minutes later and, to our relief, both were negative. I already knew and explained to my husband prior to taking the test that there is a higher risk of false negative results with the OTC COVID-19 tests compared to a laboratory-based test because the sample you collect must contain more of the virus in order for the rapid test to correctly show a positive result. Still, we are fairly confident that the results of our tests were accurate and decided it was not neccessary to seek additional testing to confirm the negative results. Instead, we concluded that he had a sinus infection, as his symptoms improved within 48 hours.

Managing Editor Omar Ford took the BinaxNow test about four weeks ago. Ford said that by the time he took his first BinaxNow OTC Covid-19 test, he and his wife both had "full-blown symptoms" and had also been notified that they were exposed to someone who tested positive.

"So the test was a confirmation of what we already knew," he said.

Ford also took a second test administered at Urgent Care, which came back negative, despite his obvious symptoms. That was a day before his wife's symptoms became significantly worse (her test was positive and the result was confirmed by a lab test).

"I think the OTC tests help you out in a pinch and confirm suspicions you might have," he said. "I would take an in-person test if there was any doubt I had surrounding the outcome of an OTC test."

Editor-in-Chief Daphne Allen has also used the BinaxNow OTC COVID-19 test, and found it to be easy to use and she appreciated the convenience of being able to take the test at home. She had taken the test more or less for peace of mind, and was asymptomatic.

"I did not take another test or go to a lab, so I don’t have any feedback on the accuracy," she said. "I will say the result was pretty easy to understand."

Weighing the pros and cons of OTC COVID-19 tests

The primary drawback of using an OTC COVID-19 test is that the accuracy varies greatly from one brand to another, and there is a significant chance of getting a false negative result. This means the test could show that you do not have the SARS-CoV-2 virus, when you actually do.

A study published in April comparing four OTC COVID-19 tests found that all four tests correctly identified a positive COVID-19 case roughly half the time, and almost always correctly identified a negative case. The researchers reported that Abbott's BinaxNow test correctly identified a positive COVID-19 case 44.6% of the time, and the test confirmed a negative case 100% of the time. Knowing this, I spent most of Sunday wondering if an OTC COVID-19 test would even be worth the $24 I ended up sending on it.

Despite the high risk of false negative results, there are benefits to using an OTC COVID-19 test.

The most obvious advantage of rapid tests is that they can provide super fast results (typically 15 minutes or less). You can take the test in the privacy of your own home, without a clinician or lab equipment. Rapid tests are widely available (in my mid-sized town, I could have picked up a test at one of three pharmacies within 2 miles of my house). Although my community does still offer free COVID-19 tests through the local health department, $24 for two tests seems like a pretty good deal for getting some peace of mind in minutes rather than days.

TAGS: IVD
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