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I frequently get questions about the home COVID tests that are now available at local pharmacies. I’ll answer the most common questions below.

PCR tests are the “gold standard” for COVID testing, typically are run through a lab, and produce results in 1-3 days. One is now available for home testing!!

Lucira Check It COVID-19 Test Kit, which uses PCR, gives results in 15-30 minutes. According to the manufacturer website, it is 98% sensitive. It can be purchased directly from Lucira’s website for $75. The test is able to detect alpha, beta, delta, gamma, lambda, mu and omicron variants of the virus

** THESE QUESTIONS REFER TO ANTIGEN TESTS WHICH ARE THE MOST COMMON **

· Are they any good? They are about 85-90% sensitive, meaning they will pick up COVID infection 85% of the time. That also means they’ll miss COVID infection 15% of the time. These tests are sold in boxes of two tests because if you take 2 tests, 24 hours apart, the sensitivity improves to about 95%.

· If they’re only 85-90% sensitive, are they even worth doing? Yes. Because they are readily available and inexpensive, it allows easy testing in many situations. For example, if everyone tests prior to arriving at your home for Christmas Dinner, you’ll pick up 85-95% of asymptomatic infected people. That’s better than picking up none!

· If I test positive, do I really have COVID? YES. False positive tests, (a test that’s positive when you actually don’t have COVID) are extremely rare. So, if you test positive, you have COVID and should isolate yourself.

· If I test negative, am I sure I don’t have COVID? NO. Remember, the tests are not perfect. A single test misses 15% of cases. 2 tests taken 24 hours apart miss around 5% of COVID cases. If you test negative, still use common sense and wear a mask in high-risk situations, practice social distancing, and wash hands frequently.

· When should I take a home COVID test? They’re useful in several situations: In the first 6 days of symptoms they are very good at picking up COVID in symptomatic people. If you’ve been exposed to someone with COVID – 3 to 5 days after exposure. If you’re going to a gathering with several people who are not in your household, the testing will provide some reassurance that infected people are not at the event. Personally, I am asking all 21 people coming to my house for Christmas to take a test prior to coming for dinner.

· Which test is best? ConsumerLab has reviewed many of the currently available tests:

Recommended

_{BinaxNow Self Test}

_QuickVue

_Flowflex

NOT Recommended

_{iHealth – more false negatives than most of the others}

_{BD Veritor – somewhat pricey, slightly more false negatives, requires an App}

_{On/Go – the most false negatives of any test. Expensive.}

_{AccessBio CareStart – same as On/Go, sold through Target at lower cost.}

_{InteliSwab – least expensive but least accurate. Hard to find in local stores}

_{Ellume – no longer seems to be on the market since it had a massive recall in October.}

· Will these tests pick up Omicron? Yes. All these home tests focus on the nucleocapsid antigen, so they should be able to pick up the Omicron variant.

· Are they expensive? CVS currently has BinaxNow box of 2 tests for $14 if you sign up for their frequent shopper program (free). Walmart also sells this test for around $14.

· Will insurance pay for home tests? Maybe. Currently, it’s hit or miss. However, President Biden has mandated that insurance cover the cost of home testing starting January 1.

· Will being vaccinated change the results of a home test? No. Being vaccinated gives you antibodies. These tests are NOT testing for antibodies. They’re testing for antigen – a piece of the virus itself.

The first flu cases are arriving, and Influenza A (H3N2) is the dominant strain so far. Although flu symptoms are similar no matter the strain, Influenza A (H3N2) seasons tend to be more severe. See What You Should Know About H3N2 Flu – https://www.verywellhealth.com/what-you-should-know-about-h3n2-flu-770301

The early flu activity is currently most common in young adults and in college and universities. As they come home for the holidays, they will likely spread it to older friends and family members.

If you or someone you know is not vaccinated against flu this year, I strongly encourage you to get the flu shot. It’s not too late!

There are also other things you can do to reduce your risk of getting the flu:

· Wear a mask in high risk settings – indoors, lots of people

· Stay home when sick for at least 24 hours after symptoms resolve

· Cough or sneeze into your elbow, arm or tissue

· Wash hands frequently or use alcohol-based hand sanitizer

· Avoid touching your eyes, nose and mouth

See Tips for Protecting Yourself and Others This Holiday Season – https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/Tips-for-Protecting-Yourself-and-Others-This-Holiday-Season.aspx

Healthcare workers on the front lines have had a front row seat for the worst pandemic in 100 years.  Although I’m not on the front lines in the hospital anymore, I can tell you it’s taking its toll.  Healthcare workers are compassionate and empathetic people by nature.  Each death hits us hard, regardless of the cause or age. 

But with COVID-19, it’s different.  Death of this magnitude is unthinkable with modern medicine.  Because of COVID visitor restrictions, patients are often very sick and separated from their families.  Healthcare workers are trying to fill the void.  We’re trying to be there for those who are alone in the hospital and help them talk to loved ones on the phone or have a video chat by FaceTime or Zoom.  

Doctors are retiring, nurses are quitting, and hospitals and clinics are struggling to hire more staff.  What makes this wave of the coronavirus even more tragic is that the severe illness and deaths it’s causing are preventable. Public health officials say nearly 100% of mortalities since January could have been avoided with covid-19 vaccinations.

COVID-19 is a real disease and real people are getting sick, it’s stressing our healthcare system.  Healthcare workers are a limited precious resource.  Please do all you can to avoid getting COVID.

A common misconception is that COVID-19 is mild, its “just a flu”.  Although many cases of COVID are mild or asymptomatic, serious disease and death do happen in higher numbers than many realize.

First of all, Influenza is actually quite serious and can be deadly.  Anyone who has had it will tell you they feel lousy, much worse than the “common cold”. For the 2019-2020 United States influenza season (the last one before COVID), there were 35 million cases of influenza, 491,000 hospitalizations, and about 34,000 deaths. That’s a 1.5% hospitalization rate and 0.09% death rate across all ages. 

COVID has much higher rates of severe illness than Influenza.  According to the CDC, there have been about 35 million cases of COVID in the United States.  There have been about 2.3 million hospitalizations (7%) and just over 600,000 deaths (1.7%).  Someone with COVID in the US is 4 times as likely to end up in the hospital and nearly twice as likely to die as someone who has Influenza.  Although many people with serious illness have underlying health conditions, many do not.

In addition, there is something called “Long COVID” that doesn’t occur with Influenza.  It’s an array of debilitating symptoms that can persist for weeks or months after an infection ends. Typically, these include fatigue, shortness of breath, heart palpitations, and “brain fog”. Some people develop more severe issues across multiple organs, including the lungs, heart, and brain.  It has made the return to work impossible for some survivors.

Please recognize that COVID is not a political issue, keep yourself and others safe!

With the rise of the Delta variant, there is renewed interest in COVID vaccine efficacy and whether boosters are needed. 

First, let’s clarify what is meant by “booster”.  A booster could be another shot of the existing vaccines – for example, if you got 2 shots of Pfizer vaccine, a booster might be a 3^rd shot.  So far however, most data show there are still high levels of neutralizing antibodies at 6 months after completion of the vaccine series for all three vaccines available in the US (Johnson & Johnson, Pfizer, and Moderna).

However, special populations who had a less robust immune response (e.g. those on immunosuppressive medications, cancer patients, etc.) produce less antibodies and immunity. They might benefit from an extra dose. 

There is also an ethical issue of giving booster doses to people who are fully vaccinated in the United States before others worldwide even get a first dose. The World Health Organization recently called on wealthy nations to stop the distribution of Covid-19 booster shots, citing vaccine inequity around the world. The agency said the halt should last at least two months, to give the world a chance to meet the Director-General’s goal of vaccinating 10% of the population of every country by the end of September.

Another type of “booster” is a vaccine that is tweaked to include coverage specifically against the newer strains (e.g. Alpha, Beta, Delta, etc.).  Both Pfizer and Moderna are working on these boosters.  But they are at least 6 months away from being ready for public consumption. It takes time to develop, test, get approval and mass produce the new vaccines.

There are ongoing studies looking at mixing vaccines.  For example, if you completed the 2nd dose Pfizer series, can you get a booster of the Moderna vaccine?  Is it safe?  Does it confer any additional immunity?  Those trials started in June so we won’t know until at least October 2021.

TAKE HOME MESSAGE:  Currently not enough data to support booster doses, except possibly in special populations. And we should not give boosters until at least 10% of the population population of every country is vaccinated.