Given the current pandemic, questions around the effectiveness of masks, vaccines and if it is safe yet to travel, there is so much information floating around and it can cause confusion.

We thought we would take a moment here to discuss the different types of COVID tests and when to get each one.

Not all tests are created equal

There are primarily 2 types of COVID-19 tests to check for active infection – Molecular Test and Rapid Antigen Testing. These would identify if a patient is currently actively infected with the Coronavirus or if they are a carrier of the infection.

The COVID-19 Antibody test identifies whether or not a person has had a recent infection or has received the COVID-19 vaccine
So what are the different types of COVID-19 tests that are available and which one should you get?

• Molecular Test/RNA Test/PCR Test

The molecular test is widely known as RNA or PCR test and is considered as Gold standard (according to FDA, US Food and Drug Administration) in detecting the coronavirus. It is considered one of the most sensitive as well as accurate tests to detect the coronavirus infection. The test is highly recommended to detect any infections, and also to show the lack thereof.
The PCR test is the standard for screening before travel, return to work or school.

The molecular test is very often called as PCR test, Polymerase Chain Reaction. The test detects the genetic material of the coronavirus in a lab via the nasopharyngeal swab of the patient. The swab is taken from the nose or the back of your throat. The test detects the viral RNA (the genetic information of coronavirus). If the viral RNA of coronavirus gets detected then it is confirmed that the patient is infected with the coronavirus.

The test report comes within minutes to a week; it depends on various factors –from onsite lab analysis to outside lab analysis and the number of patients testing for the same on the same day.

• Antigen Test/Rapid-RNA Test

The Antigen test, also known as the Rapid RNA test, can provide results within 15 minutes. Since it provides a rapid result, the Antigen Test can be used for quick screening purposes to help reduce spread of infection. However, it is not as accurate or reliable, therefore most airports and employers will not accept the results for screening purposes.

The test is best utilized in an acute care, urgent care setting to help evaluate the risk that the patient has COVID-19. Most clinics will do a default PCR COVID-19 test if you have a negative Rapid Test, for confirmation.

• Antibody Test/Serology Test

The antibody test is also known as serology or blood test to screen coronavirus in a patient. This test detects antibodies (proteins produced by our immune system to invade the virus in our bodies) to the COVID-19 virus. The test does not detect active coronavirus infection but does detect whether the patient was infected by coronavirus at some point in the past. Thus, it is recommended to get an antibody test to screen a patient after 14 days from the starting of symptoms.

COVID 19 antibody test is done via a blood test. The blood can be taken by pricking a person’s fingertip or drawing blood from an arm’s vein. Though, FDA approves only the fingertip antibody test between two processes of COVID-19 antibody tests. It takes 1 to 3 days to show a result.

The IGM antibody test detects if you have had the Coronavirus infection and formed antibodies against the infection within the past 10-14 days.

The IGG antibody test detects if you have had the Coronavirus infection and formed antibodies against the infection greater than 14 days ago.

How to use the antibody test:

The COVID-19 antibody test cannot be used to detect a positive and active Coronavirus infection. The antibody tests will not typically test positive at the onset of the infection, But they will stay positive long after it has ended. It can serve as a last ditch, diagnostic aid. For patients that have been symptomatic for several days or weeks, but continue to test COVID-19 on PCR tests, the COVID antibody might be used to confirm past diagnosis.

If you are looking to get an antibody test after having an infection, you would check for antibodies that recognize a protein called nucleocapsid, which is found in the coronavirus but not in the vaccine. If you are looking to test for antibodies after receiving your vaccine, you would test for antibodies against spike proteins. However, the presence or absence of these antibodies does not always indicate efficacy of the vaccine. Thus, the utilization of these antibodies is limited and should be used sparingly.

You tested positive, now what?

So, you were symptomatic, went to a clinic or testing facility and tested COVID positive by Rapid Antigen or PCR testing, now what do you do? The current CDC guidelines recommend quarantine and isolation for 10 days as long as you are symptom free for the last 24 hours of quarantine and are fever free without medication. Repeat testing is not required or recommended at this time.

Per the CDC guidelines, recovered patients can continue to have SARS-CoV-2 RNA detected in their upper respiratory specimens for up to 12 weeks after symptom onset. (31,33,34) Investigation of 285 “persistently positive” adults, which included 126 adults who had developed recurrent symptoms, found no secondary infections among 790 contacts to these case patients. Efforts to isolate replication-competent virus from 108 of these 285 case patients were unsuccessful. (31)

Ending quarantine and isolation

After 10 days of isolation, as long as your symptoms have improved and you are fever free without medication for 24 hours, you can come out of isolation. Repeat testing is not recommended. However, several companies and schools continue to require repeat testing. If that is the case, you can retest in 14 day intervals, however, this is not recommended as you are no longer considered contagious as long as you have completed 14 days of quarantine and are symptom free.

Post COVID Syndrome

Now that we are a year removed from the start of the COVID-19 pandemic, we have been finding that after the infection period, patients continue with symptoms or after a short interval of relief, their symptoms recur. Patients may have lingering symptoms of headache, congestion, cough, weakness, bodyaches, sleep disturbances, or loss of sense of smell or taste. These symptoms can linger for weeks to months.

For those experiencing severe Post COVID Syndrome symptoms, you should follow up with your Primary Care Provider. Usually, we will implement symptomatic interventions and determine the severity of your symptoms and refer you out as needed.

Since the symptoms of post-COVID syndrome are diverse, because COVID-19 is new and symptoms are diverse, your PCP and your healthcare team will need to decide which specialists, tests and treatments are appropriate for you.
“Post-COVID syndrome is a new, unique phenomenon, and we’re still learning about it. But we know its symptoms, particularly the extreme fatigue, can have huge downstream effects on a person’s quality of life — impacting family life and work productivity,” explains Dr. Sandeep Lahoti, gastroenterologist at Houston Methodist who is leading the COVID-19 Recovery Clinic.

“Lastly, given what we’re seeing with the long-term impacts COVID-19 can have on some people, even those who had only mild symptoms, it’s all the more reason to continue to take steps to reduce your risk of getting sick,” adds Dr. Lahoti.

Remember that prevention is key when it comes to COVID-19 infections. Preventative measures include:

• Wearing a mask over your nose and mouth
• Social distancing, atleast 6 feet apart from others
• Avoid large crowds or gatherings
• Practice good hygiene with handwashing, using hand sanitizer and avoid touching your face.

Asma Bhaidani, PA-C
Complete Family Wellness

Asma Bhaidani