Getting tested for COVID-19? Here's what to ask at the doctor's office

When a new type of saliva test for COVID-19 received emergency use approval from the Food and Drug Administration earlier this week, experts began to wonder if it was truly as "groundbreaking" as FDA director Dr. Stephen Hahn said it was.

While Yale University's SalivaDirect has advantages over other tests — it requires fewer components and generates results faster — it won't necessarily ease the strain on labs, experts say. What's more, the current demand for testing is still "astronomical," Dr. Jake Deutsch, clinical director and co-founder of Cure Urgent Care in New York City, which has run more than 5,000 COVID-19 tests, told TODAY.

In the wake of surges in several states, and as clusters pop up at universities across the country, the testing infrastructure in the U.S. is shaky enough that there's much to consider before seeking one out.

Here's what to know about getting a coronavirus test right now. (This article does not address antibody tests; learn more about antibody testing.)

Most tests rely on a sample gathered one of four ways: nostril, saliva, back of the throat or deep inside the nose, Dr. Eric Cioe-Pena, an emergency medicine physician at Northwell Health in New York City, told TODAY.

Looking at the mechanics of the test itself, there are two kinds. The most common is the polymerase chain reaction (PCR) test. Depending on the facility, these are usually sent to a lab off-site.

"(A PCR test) detects viral genetic code that does not exist in the human body otherwise," Cioe-Pena explained. "They're sensitive to the point where it will even detect fragments," which can mean that someone who was sick but then recovered could still test positive, he said.

The other kind is the antigen test, which can be done on-site and provide a rapid result, per the FDA. The first one was authorized in mid-May. They usually rely on a nasal or throat swab and detect the coronavirus by looking for virus proteins in the body rather than genetic material. Because they're newer and the necessary tools are in short supply, these tests are not widely available, Cioe-Pena said.

The FDA has also authorized a few at-home tests. Most, if not all, use PCR technology and require a nasal or saliva sample. To get one, you typically need approval from your health care provider.

The resources of the facility where you're being tested typically determine which type of test you'll receive and what type of sample is collected. Therefore, it's unlikely you'll be able to choose what kind you want when you arrive.

For example, medical professionals must be trained on how to collect the best possible sample, so priority is usually given to one or two types. And the lab analyzing the samples may only have the ability to run certain types of tests.

For now, PCR tests are much more available, and rapid tests are "not the mainstay," Deutsch said.

Cioe-Pena said his facility reserves rapid tests for when providers "need to make a medical decision very quickly." Say you had a heart attack and need to be admitted to a part of the hospital that does not house COVID-19 patients; then you need to test negative — and fast — to enter.

Deutsch added, "Different standards of care exist in different environments."

The length of time to get a test result usually depends on where you're tested, both the facility itself and your part of the country.

Some places offer "point-of-care" tests (usually antigen-based), meaning the testing center can process it on the spot, and those results take minutes. For tests that need to be sent to a lab off site, results can take anywhere from a day to two weeks.

"It's not ideal when the virus incubation is two weeks, and the illness generally lasts at most for two weeks," Deutsch said.

The delay usually is caused by the lab processing the results, many of which take samples for an entire region. So, the timing of results may be "affected not only by your state but neighboring states," Cioe-Pena explained.

The "type of patient" can also affect turnaround time, he added. For example, at his hospital, "(intensive care unit) patients will get their tests faster than walk-ins."

Deutsch and Cioe-Pena both said the deep nasal, aka nasopharyngeal, swab is the most accurate. Deutsch ranked the accuracy of the four sample types as follows, from most to least accurate:

• Nasopharyngeal
• Throat
• Nostril
• Saliva

When looking at PCR versus rapid, antigen tests, Cioe-Pena said PCR is more accurate in part because it can detect the virus over a greater length of time. But PCR tests can also generate false positives for this reason. The FDA previously issued a letter warning that one of its authorized tests had a 3% false positive rate. (Yale researchers said their new saliva test, which uses PCR technology, is as accurate as nasal swabs, but the results haven't been peer reviewed.)

According to Cioe-Pena, false positives are preferable to false negatives, which he believes are more likely with antigen tests. He estimated that under ideal conditions, PCR tests are 99% accurate; Deutsch said that rapid, antigen tests are about 93% accurate.

Cioe-Pena and Deutsch both expressed reservations about the accuracy of at-home tests because the quality of the sample depends on how well it's collected, and it's hard to take a deep nasal swab yourself. One pro, however, is they reduce crowding at testing centers.

According to the Centers for Disease Control and Prevention, anyone experiencing coronavirus symptoms should get tested after first calling their health care provider. If you're not experiencing symptoms, the CDC suggests you consult your state's guidelines on current testing protocol.

Though Deutsch and Dr. Sten Vermund, dean of Yale School of Public Health in New Haven, Connecticut, explained several additional scenarios where it makes sense to get tested:

• If you've been within 6 feet of someone with COVID-19 (regardless of their symptoms) for more than 15 minutes.
• Periodic testing for health care workers and those working with vulnerable populations.
• Periodic testing for essential workers who come in contact with lots of people daily.
• People in hotbeds for COVID-19 should consider periodic testing.

They both discouraged testing as a way to justify a high-risk behaviors, such as large, indoor gatherings, and stressed the importance of practices that reduce spread of the coronavirus, like hand washing, social distancing and mask wearing.

"We're talking about ... making every effort to minimize one's risk and also minimize one's need for a test," Vermund said. "Our testing is not limitless. We don't want people who don't have a good reason to get a test."

If you believe you've been exposed to COVID-19, Vermund said to wait 24-48 hours before getting tested; otherwise you risk a false negative.

Traveling? Some international destinations require visitors have a negative test before arrival. Follow the protocol and get tested within the appropriate timeframe.

Deutsch also recommends his patients, especially those who have frequent in-person interactions at work, get tested once a month or so. He estimated that two-thirds to three-quarters of the positive tests at his facility are from asymptomatic patients, so the goal of regular testing, he said, is to "pick up otherwise undetected cases and continue to drive the infection rate down."

To start, determine how important the accuracy of the test is to you. For example, if you're wondering if you can safely spend time with a high-risk individual, then it's crucial.

Next, locate testing facilities in your area and learn whether they require symptoms or approval from a health care provider. You may also want to research how fast state-run facilities in your area are providing results versus private ones, as recent reports suggest they may be more efficient.

Last, call ahead and find out:

• What sample(s) does the facility take?
• Do they offer PCR or rapid, antigen tests?
• How long is the turnaround time for getting a result, and where is the test sent? Especially important if you're in a time crunch.
• How will they communicate the results?

If you want a rapid test, Deutsch advised finding out whether your insurance covers it, as many do not and they can be expensive. Cioe-Pena also suggested not seeking out a rapid test unless you "absolutely" need one.

Because we should still be staying home whenever possible at this stage in the outbreak, "my big question is where are you going that you need that test in an hour?" he said.

This story was updated on August 19, 2020 to include more up-to-date information on testing.