Everyone should be stocking up on at-home rapid COVID-19 tests right now ahead of a likely surge in cases over the holidays, according to experts.
After a lull in COVID-19 during the fall, the United States is seeing a post-Thanksgiving jump in cases and hospitalizations. Dec. 8 data show the past two weeks saw a 14.5% increase in average daily COVID cases in the U.S., according to an NBC News tally.
Compared to the last two years, this winter in the U.S. will look very different. In addition to COVID-19, flu cases have already surpassed the total number from the entire 2021-2022 season, and respiratory syncytial virus, aka RSV, which largely sickens young kids and older adults, has stretched the health system to the brink. (In fact, Centers for Disease Control and Prevention director Dr. Rochelle Walensky recommended wearing masks again in a Dec. 5 press briefing.)
Experts warned about a winter wave of COVID-19 fueled by the new omicron variants, TODAY previously reported. As people gather for holiday festivities this month — largely without any COVID-19 precautions — cases are expected to keep climbing, and testing will be an important tool to help keep you and your loved ones safe.
“COVID is not gone. We have just seen a reduction in the number of cases," Dr. Yvonne Maldonado, professor of pediatric infectious diseases, epidemiology and population health at Stanford Medicine, told TODAY.com. "There’s still a lot of COVID circulating,”
The U.S. is still logging over 300 deaths a day from COVID-19, which adds up to more than 110,000 people a year, said Maldonado. “We also have to remember that the omicron variants are highly transmissible, and the newer variants of omicron showing up are even more transmissible," Maldonado added.
Additionally, an increasing number of people are losing immunity from prior infection or vaccination, said Maldonado. The best way to protect yourself against severe illness is to make sure you're up to date on your COVID-19 vaccinations and boosters, the experts noted. But testing can also help keep people safe.
So even if COVID-19 isn't on your mind right now, stocking up on at-home rapid COVID-19 tests should be, especially because you can still get them for free or at a low cost. So, when Christmas, Hanukkah, Kwanza and New Year's arrive, you can use testing to feel more confident the only thing you're spreading is holiday cheer.
Why should you stock up on at-home tests?
It’s important for people to be proactive, said Maldonado, which means testing every time you have COVID-19 symptoms or an exposure, as well as ahead of gatherings with people at risk of severe illness — such as people over 65, or with an underlying condition or who are immunocompromised.
Another reason to stock up on rapid COVID-19 tests? Flu, which is already off to an early start in the U.S. and more severe than typical pre-pandemic seasons, TODAY previously reported.
“The reason that (flu) has something to do with COVID testing is because it may not always be obvious whether someone has COVID or influenza,” Dr. Thomas Murray, associate medical director for infection prevention at Yale New Haven Children’s Hospital in Connecticut, told TODAY.com.
The symptoms of flu, COVID-19 and RSV are often indistinguishable, especially at the beginning — these include a cough, runny nose, sore throat, headache and fatigue, says Murray.
Flu and RSV tests are typically done by a healthcare provider, according to the U.S. Centers for Disease Control and Prevention. But an at-home rapid antigen test can be used to rule out COVID-19, said Murray, adding that it's important to know if you have COVID so you can isolate or be prescribed an antiviral, like Paxlovid, if you're eligible.
“We may see the (influenza and COVID-19) peaking around the same time, so that’s why it’s important to differentiate what you have,” Dr. Georges C. Benjamin, executive director of the American Public Health Association, told TODAY.com.
“I encourage people to order (rapid tests) early because when everybody has flu-like symptoms, there will be a run on those tests, and you want to get them now before they run out," he said.
While there is no reported shortage of rapid COVID-19 tests right now, last winter’s omicron surge is a reminder of what can happen when demand goes into overdrive.
“At this point, the supply out there appears to be strong,” Carmen Balber, executive director of Consumer Watchdog, told TODAY.com. “From all indications that I’ve seen … our system is much better prepared to fulfill the kind of demand that you might anticipate if there is another spike in COVID."
That said, Balber still encouraged stocking up now: “It’s always better to have those tests than to have to wait for them to be delivered or, if you’re feeling sick, being forced to go to the store to buy them and potentially expose other people.”
When should you take a rapid test before gatherings?
Anytime a person is feeling sick or has COVID-19 symptoms, they should test immediately, according to the experts.
If you have symptoms and your first rapid antigen test is negative, then you should take another test 24 and 48 hours later "to get a more definitive answer," said Murray.
People who have been exposed to a person who was sick or had COVID-19 should take a rapid test five days after the exposure, Maldonado added, and another one 24 to 48 hours later.
If you have no symptoms or exposure and are testing ahead out of precaution ahead of a gathering with vulnerable individuals, the experts recommend doing so within 24 hours of the event.
“The sooner you are to the actual event, the better …. so if you’re going to (Christmas) dinner, then doing it that morning would be the best,” said Murray.
The further away from the event you test, the less likely those results can be trusted, said Maldonado. “If you test yourself three days before, for example, and you’re negative, that may not really predict whether you’re going to be positive the day of.”
If you get a negative test and have no symptoms, it's unlikely that you have COVID-19, said Benjamin. “It's not 100% by any means, but you are doing your due diligence,” he added.
But if you're sick, a negative COVID-19 test isn’t a free pass to socialize. “If you’re symptomatic, you probably should not go to (any gathering) because it still could be COVID or a number of respiratory viruses,” said Murray.
“I do think a rule of thumb is … if you’re sick, you probably don’t want to be around a large number of people,” said Maldonado.
If you’re not getting better and still testing negative for COVID-19, Benjamin recommends going to your doctor to get a flu test.
Are rapid tests still accurate with the new variants?
“Whenever there is a new variant, there’s always a question of whether the antigen test will detect the variants or whether there will be some mutation such that it doesn’t work as well,” said Murray.
“All the evidence I’ve seen so far is that the antigen tests will continue to detect new variants,” Murray added, but research is ongoing. Whether there’s any change in sensitivity in the tests with the new variants, for better or worse, won’t be clear until the variants are circulating in large enough numbers, he said.
“I’ve seen data that suggests people have to get two or three tests before they actually test positive if they’re symptomatic. … We don’t know why,” Maldonado said. Possible reasons could be that the omicron variants are not as easily picked up on rapid tests or people have lower viral loads if they are infected with the omicron variants, said Maldonado, but it’s still unclear.
“Part of the challenge with all these home tests is they’re not perfect, and they work best when you do them exactly as instructed by the manufacturer, which not everybody does,” said Murray.
Another factor that can affect a rapid COVID-19 test’s accuracy is its age, so always check the expiration date. The U.S. Food and Drug Administration doesn't recommend using rapid COVID-19 tests after their expiration dates, but the shelf life (typically four to six months) for some kits has been extended, so check the FDA site before throwing it out based on the date on the box, Benjamin advised.
How to get free at-home COVID-19 tests
The government program that was mailing out free at-home tests to households through the postal service is now defunct, said Balber.
Instead, the federal government has shifted the responsibility for paying for at-home COVID-19 tests to insurance carriers, said Benjamin. (COVID-19 vaccines are still 100% free to everyone, per the U.S. Department of Health and Human Services).
“Anyone in the country who has insurance, whether they purchased it on their own through the marketplace or they get it from their employer or Medicare, is eligible for eight free tests every month,” said Balber. These can be purchased all at once or separately. This means a family of four can get 32 free at-home tests a month, according to the Centers for Medicare & Medicaid Services.
Insurers will reimburse consumers up to $12 per individual test, according to CMS. Although there are a variety of brands, most COVID-19 rapid tests available for purchase at major retailers are capped at $12 or $24 for a two-pack, said Balber.
How you get reimbursed depends on your insurance plan, Balber explained. Some insurers will cover the cost upfront, meaning you pay nothing because the pharmacy bills your insurance directly. Other insurance providers require you to pay for the tests and submit a claim with the receipt then they'll reimburse you. You can find out which applies to you by contacting your insurance provider and the pharmacy, said Balber.
If you don’t have coverage, free COVID tests are available for uninsured individuals at over 10,000 locations at community clinics or other distribution sites, said Balber. “There’s no one place to direct people, but anyone can go to the HHS website and navigate to find where free COVID tests would be available to them."
There are still a number of COVID-19 test scams out there, but “as long as consumers go to a reputable source, they’re going to be getting legitimate information,” said Balber. These include state or local public health departments, the CDC, HHS and Medicare.gov.
In addition to having a supply of rapid tests, you can also prepare for this winter by getting your annual flu shot and the updated bivalent COVID-19 booster, said Benjamin. Wearing masks in crowded indoor spaces, frequently washing your hands, and staying home when sick can also help reduce spread of respiratory viruses.