COVID-19 Testing

As the world grapples with the spread of the Omicron variant of COVID-19, regular testing continues to serve as a crucial tool in the public health fight against this pandemic. In addition to vaccination, testing is a safe and effective way to help prevent the spread of the virus.

Many people with COVID-19 are asymptomatic but can still spread the virus, so regular testing helps identify those who have the virus before it can spread to others. Testing is especially important for those who are unvaccinated or otherwise at risk of getting seriously sick from COVID-19. Regular testing also enables individuals to plan for treatment and take steps to protect their family, friends, coworkers, and communities from COVID-19.

The Purpose of COVID Tests

 COVID-19 testing is done for one of two reasons:  to diagnose or screen.

Diagnostic testing is intended to identify current infection and should be done on:

  • People who have signs or symptoms consistent with COVID-19
  • Traced contacts of an infected individual
  • Asymptomatic persons who have had recent known or suspected exposure to COVID-19

Screening is intended to provide early identification of unknown cases in people who might be unknowingly spreading the virus. Some examples include testing:

  • Asymptomatic persons without recent known or suspected exposure to COVID-19
  • A person before or after travel
  • Students, faculty, and staff in a K-12 school or institute of higher education
  • Workers in high-density worksites
  • Government workers with public interaction duties
  • First responders and healthcare personnel
  • Residents and staff in congregate settings
  • Patients in healthcare settings

Where to Get a COVID Test

COVID-19 testing  can be done in different locations.

In contrast to laboratory tests that can take days for results, point-of-care (POC) tests can provide quick results at or near the testing site without sending your sample to the lab. Rapid tests are a type of POC test that can be performed in minutes rather than hours. POC tests are available in a variety of settings, such as:

  • Physician offices
  • Urgent care facilities
  • Pharmacies
  • School health clinics
  • Long-term care facilities
  • Drive-through testing sites

Self-Tests, also called a “home test” or “at-home test,” are available by prescription or over-the-counter. These tests can be taken at home or anywhere, are easy to use, and produce rapid results. People can purchase them online, in pharmacies and retail stores, or get them for free through some local health departments or Federally Qualified Health Centers. Most self-tests require the collection of a nasal specimen, with only a few requiring a saliva specimen.

If not self-testing, ensure you’re visiting a CLIA-certified setting or that the site is operating under a CLIA Certificate of Waiver, which is necessary to perform temporary, off-site testing, such as at a nursing home or drive-through location.

Different Types of COVID Tests

COVID-19 testing is available in different platforms.

COVID-19 tests can detect either SARS-CoV-2, the virus that causes COVID-19, or antibodies, proteins in your blood that your immune system makes after exposure.

Viral tests check specimens from your nose or your mouth and come in two different platforms:

  • Antigen Tests, most of which are available as rapid POCs and popular for use in screening programs. In areas where community risk or transmission levels are high, serial screening (repeatedly testing at different points in time) using POC antigen tests can rapidly detect infection among close contacts of a COVID-19 case.
  • NAATs (Nucleic Acid Amplification Tests), also called “molecular tests,” which include the RT-PCR tests you may have heard about (stands for “real-time reverse transcription-polymerase chain reaction”). Most NAATs need to be processed in a laboratory, with results generally taking 1-3 days; a few are available as POCs with results available in 15–45 minutes. Laboratory-based NAATs are considered the most sensitive and specific for diagnosing SARS-CoV-2 infection.

Antibody Tests, also called “serology tests,” are used to tell you if you have had a past infection but should not be used to diagnose a current infection or to determine if an individual is immune against reinfection. These tests are currently used for public health surveillance and epidemiologic purposes.

How to Dispose of COVID Tests

Managing COVID-19 testing waste depends on where you are.

For at-home users, after you have the results, discard the specimen collection swab or tube and test in the trash, clean all surfaces that the specimen may have touched, and wash your hands.

For testing sites, the CDC recommends the following practices:

  • Personnel collecting specimens or working within six feet of patients suspected to be infected with SARS-CoV-2 should use an N95 or higher-level respirator (or face mask if a respirator is not available), eye protection, gloves, and a lab coat or gown. To avoid cross-contamination, gloves should be changed each time a specimen is collected from a different person and/or before placing new specimens into a device for batched testing.
  • Personnel handling specimens, but not directly involved in the collection (e.g., self-collection) and not working within six feet of the patient, should follow Standard Precautions, which include hand hygiene and using well-fitting cloth masks, facemasks, or respirators.
  • Special Considerations:
    • Precautions should be taken when handling specimens suspected or confirmed to be positive for SARS-CoV-2 (remember, all specimens may contain potentially infectious materials).
    • Do not reuse used test devices, reagent tubes, solutions, swabs, lancets, or fingerstick collection devices.
    • Discard tests and test components that have exceeded the expiration date or show signs of damage or discoloration, such as reagents showing any signs of alteration.
    • Refer to the manufacturer’s instructions to see how long a reagent, test device, or cassette can be used after opening.
    • Discuss used and unused test kit waste with your facility waste management contractor, your State Department of Public Health, and the test manufacturer’s technical support.

Most test manufacturers advise users to dispose of testing materials in accordance with local, state and/or federal regulations (regulations often vary from state to state). These links to Instructions for Use and Safety Data Sheets for some popular FDA-approved POC and rapid tests provide more information – with special recommendations for professional use included where applicable:

  • Advaite RapCov Rapid COVID-19 Test
  • Cepheid Xpert® Xpress SARS-CoV-2
    • Biological specimens, transfer devices, and used cartridges should be considered capable of transmitting infectious agents requiring standard precautions.
    • Used cartridges and unused reagents may exhibit characteristics of chemical hazardous waste requiring specific national or regional disposal procedures.
    • If national or regional regulations do not provide clear direction on proper disposal, biological specimens and used cartridges should be disposed of per World Health Organization medical waste handling and disposal guidelines.
  • Abbott ID NOW™ COVID-19 test (fast and portable molecular test; 13 minutes)
    • Base and Buffer: Dispose of materials or solid residues at an authorized site according to licensed collector’s sorting instructions.
  • Abbott BinaxNOW™ COVID-19 Ag Card (antigen test, generally used after symptoms begin; 15 minutes and is available for home use)
    • Patient samples, controls, and test cards should be handled as though they could transmit disease.
    • Observe established precautions against microbial hazards during use and disposal.
  • CueTM COVID-19 Test
    • Dispose of the used cartridge with the sample wand still inside according to the appropriate regulations and your institution’s environmental waste procedures.
  • BD Veritor™ System for Rapid Detection of SAR-CoV-2
    • Dispose of used materials in an approved biohazard waste container.
    • Do not flush reagents down the drain.
  • Quidel QuickVue SARS Antigen Test (no instrument required) and Quidel Sofia SARS Antigen FIA (requires instrument)
    • Dispose of the used swab in your biohazard waste
    • Dispose of other materials or solid residues at an authorized site in accordance with licensed collector’s sorting instructions.
    • Avoid release to the environment.

Additional disposal considerations may apply for multiplex tests that test for flu, RSV, or other infections in conjunction with COVID-19. Contact Sharps Compliance if you have questions about properly disposing of COVID test waste.

Kathryn earned her Masters in Public Health with a concentration in Epidemiology from Texas A&M University and her Bachelor of Science from the University of Texas. She is certified in high-complexity testing by the ASCP and has been published in the journal Cancer Cytopathology. Her experience ranges from the clinical laboratory to compliance expertise in biohazardous waste management.

published in NewsTagged