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Health


PEOPLE ARE FED UP WITH RAPID TESTS

At-home swabbing still works just fine, but we can’t seem to escape false
negatives. What gives?

By Zoya Qureshi

Getty; The Atlantic
December 29, 2022
Share


Max Hamilton found out that his roommate had been exposed to the coronavirus
shortly after Thanksgiving. The dread set in, and then, so did her symptoms.
Wanting to be cautious, she tested continuously, remaining masked in all common
areas at home. But after three negative rapid tests in a row, she and Hamilton
felt like the worst had passed. At the very least, they could chat safely across
the kitchen table, right?

Wrong. More than a week later, another test finally sprouted a second line:
bright, pink, positive. Five days after that, Hamilton was testing positive as
well. This was his second bout of COVID since the start of the pandemic, and he
wasn’t feeling so great. Congestion and fatigue aside, he was “just very
frustrated,” he told me. He felt like they had done everything right. “If we
have no idea if someone has COVID, how are we supposed to avoid it?” Now he has
a different take on rapid tests: They aren’t guarantees. When he and his
roommate return from their Christmas and New Year’s holidays, he said, they’ll
steer clear of friends who show any symptoms whatsoever.



Hamilton and his roommate are just two of many who have been wronged by the
rapid. Since the onset of Omicron, for one reason or another, false negatives
seem to be popping up with greater frequency. That leaves people stuck trying to
figure out when, and if, to bank on the simplest, easiest way to check one’s
COVID status. At this point, even people who work in health care are throwing up
their hands. Alex Meshkin, the CEO of the medical laboratory Flow Health, told
me that he spent the first two years of the pandemic carefully masking in social
situations and asking others to get tested before meeting with him. Then he came
down with COVID shortly after visiting a friend who didn’t think that she was
sick. Turns out, she’d only taken a rapid test. “That’s my wonderful personal
experience,” Meshkin told me. His takeaway? “I don’t trust the antigen test at
all.”

Read: Should everyone be masking again?

That might be a bit extreme. Rapid antigen tests still work, and we’ve known
about the problem of delayed positivity for ages. In fact, the tests are about
as good at picking up the SARS-CoV-2 virus now as they’ve ever been, Susan
Butler-Wu, a clinical microbiologist at the University of Southern California’s
Keck School of Medicine, told me. Their limit of detection––the lowest quantity
of viral antigen that will register reliably as a positive result––didn’t really
change as new variants emerged. At the same time, the Omicron variant and its
offshoots seem to take longer, after the onset of infection, to accumulate that
amount of virus in the nose, says Wilbur Lam, a professor of pediatrics and
biomedical engineering at Emory University who is also one of the lead
investigators assessing COVID diagnostic tests for the federal government. Lam
told me that this delay, between getting sick and reaching the minimum
detectable concentration of the viral antigen, could be contributing to the
spate of false-negative results.

That problem isn’t likely to be solved anytime soon. The same basic technology
behind COVID rapid tests, called “lateral flow,” has been around for years; it’s
even used for standard pregnancy tests, Emily Landon, an infectious-disease
physician at the University of Chicago, told me. Oliver Keppler, a virology
researcher at the Ludwig Maximilian University of Munich who was involved in a
study comparing the performance of rapid tests between variants, says there
isn’t really a way to tweak the tests so that they’ll be any more sensitive to
newer variants. “Conceptually, there’s little we can do.” In the meantime, he
told me, we have to accept that “in the first one or two days of infection with
Omicron, on average, antigen tests are very poor.”



Of course, Hamilton (and his roommate) would point out that the tests can fail
even several days after symptoms start. That’s why he and others are feeling
hesitant to trust them again. “It’s not just about the utility or accuracy of
the test. It’s also about the willingness to even do the test,” Ng Qin Xiang, a
resident in preventative medicine at Singapore General Hospital who was involved
in a study examining the performance of rapid antigen tests, told me. “Even
within my circle of friends, a lot of people, when they have respiratory
symptoms, just stay home and rest,” he said. They just don’t see the point of
testing.

Read: COVID science is moving backwards

Landon recently got COVID for the first time since the start of the pandemic.
When her son came home with the virus, she decided to perform her own
experiment. She kept track of her rapids, testing every 12 hours and even taking
pictures for proof. Her symptoms started on a Friday night and her initial test
was negative. So was Saturday morning’s. By Saturday evening, though, a faint
line had begun to emerge, and the next morning—36 hours after symptom onset—the
second line was dark. Her advice for those who want the most accurate result and
don’t have as many tests to spare is to wait until you’ve had symptoms for two
days before testing. And if you’ve been exposed, have symptoms, and only have
one test? “You don’t even need to bother. You probably have COVID.”






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