For Some Breast Cancer Survivors, October Is the Cruelest Month

Regular home testing for coronavirus can lower risk, ease worry and allow you to live a more normal life.

For many people, the hardest part of pandemic life after vaccination is the uncertainty about risk. Is it safe to gather unmasked with my vaccinated friends? Can I travel for the holidays? Can my children safely see their grandparents?

But rapid home testing can lower risk, ease the worry and help you get back to life.

Testing isn’t a substitute for getting the vaccine. But as long as large numbers of people remain unvaccinated and continue to spread the coronavirus, vaccinated people are at risk for so-called breakthrough infections, which often come with mild symptoms or none at all.

For the vaccinated, a negative test is like a one-day anxiety-free pass. At-home rapid tests can tell people within minutes whether they are contagious with Covid-19. It gives added assurance that no one at a child’s birthday party, a wedding or family gathering is spreading the virus. If you’ve been traveling through airports or you’ve recently spent time at a crowded outdoor concert, a few rapid tests, taken days apart, can show that you’re unlikely to be spreading the coronavirus after attending those higher-risk events.

One big problem is that the tests can be hard to find, but that should improve soon with the authorization of a new test and an investment of $1 billion in home testing^[1] from the Biden administration. Many stores do still have tests in stock, but it may require some effort to find them. If you find some, don’t hoard. Tens of millions more tests are expected to arrive on the market in the coming weeks, and by December, 200 million rapid tests will be available to Americans each month.

No test is a 100 percent guarantee, but given that your vaccine already protects you, a home test is another layer of precaution to lower risk. Unvaccinated people can benefit from using home tests as well, but they should not rely on testing as a substitute for a vaccine. Home tests are particularly useful for families with young children who aren’t yet eligible for vaccination and for anyone with an at-risk family member. When my vaccinated daughter wanted to visit her 80-year-old vaccinated grandmother in New Mexico, she was tested in New York before leaving, and she carried several rapid home tests to use when she landed and every day of the short visit.

“Testing is an information business, and that information is liberating,” said Mara Aspinall^[2], an expert in biomedical diagnostics at Arizona State University who is also on the board of OraSure, which makes rapid Covid tests. “For some, it’s going to be to not wear a mask at an event. For some, it’s going to be to go visit great grandma or interact with the public. If your test is positive, it means you’ve got the power to protect yourself and other people.”

In the United States, the tests can range from $7 to $12 each, making them too expensive for most people to use frequently. But with the cold weather approaching and the winter holidays ahead, home tests still can be a helpful way to lower the risk of indoor gatherings and spending time with extended family members.

“I think people should embrace home testing more,” said Neeraj Sood^[3], a professor and vice dean for research at the University of Southern California and director of the Covid Initiative at the U.S.C. Schaeffer Center.^[4] “I’m planning to go to India. I’ll do the home test the moment I land to make sure I’m not infectious before I give a hug to my father.”

How do they work?

The rapid home tests work much like a pregnancy test with a pink line indicating you’re positive for the coronavirus. The tests all require you to swizzle a long swab in both nostrils. Depending on the test, you may insert the swab into a special card reader or dip the swab in a solution and use a test strip, then wait 10 to 15 minutes for the result.

Currently, the rapid home antigen tests available in the United States include Abbott’s BinaxNOW^[5], Quidel’s QuickVue^[6], Australia’s Ellume^[7] and the recently authorized test by Acon Labs, Flowflex^[8]. The tests typically are packaged two per box.

A rapid home molecular test, Lucira, uses a different technology and is similar to the test you might get at the doctor’s office. But it’s hard to find, and at a cost of about $50, it isn’t a practical option for most people.

Are home tests reliable?

Although no test is 100 percent accurate, the new rapid home tests are highly reliable for telling you whether you’re contagious on a given day. Rapid tests identify about 98 percent of cases in which a person is infectious.

But it’s also possible to test negative on one day, and then test positive a few days later. That doesn’t mean the first test was wrong — it just means on the day you tested, you weren’t infectious yet, even though you later tested positive for the virus. (The test you get at the doctor’s office can also return a false negative, depending on the timing of the test.)

“If the test is negative and you later test positive, it’s not wrong,” said Gigi Gronvall^[9], an associate professor at the Johns Hopkins Bloomberg School of Public Health. “The question the rapid antigen test is asking is, Do you have a lot of virus in your nose at this moment, yes or no?”

So how should I use the tests?

Most home tests advise testing twice over a three-day period, with at least 36 hours between tests. The timing of the test matters. Using one test is a useful precaution right before seeing friends or family members who want to gather indoors and unmasked. A quick test can also help a parent make sure a child’s cough or sniffle isn’t spreading Covid.

If you’re worried that you’ve been exposed to Covid, you should take two tests over a three to four day period. The Centers for Disease Control and Prevention says the best testing window after a potential exposure is to test three to five days after the high-risk event or contact with an infected person.

The bottom line is that the more often you use the tests, the better, said Dr. Michael Mina^[10], an epidemiologist at Harvard and a proponent of rapid testing^[11]. (Dr. Mina advises Detect, Inc., a diagnostics company working on a rapid molecular test.) If you want to spend time with a medically vulnerable person, you should take a test a few days before seeing them, and then take another test on the day of the visit. “Think about, How do I test as close as possible to the thing that I’m doing?” Dr. Mina said. “When I go visit my parents, I always bring rapid tests with me. Right before I walk in the door, I use the test in my car.”

What do I do if the test is positive?

Most of the time, a positive result means you have the coronavirus, particularly if you have symptoms. But false positives do happen. Recently, Ellume, an Australian company, recalled nearly 200,000 test kits^[12] because of concerns about a higher-than-expected rate of false positives.

If there’s reason to doubt a positive result, take another test, preferably from a different manufacturer or at a testing center. People hosting large events, like weddings, and using the tests to screen guests should have a few extra tests on hand from a different brand for those guests who test positive. You can be confident in the result if the second test is negative, Dr. Mina said.

“It would be really rare for someone to have a true positive and then have a second test show a false negative result,” he said. “If you’re having a dinner, you may as well just cancel dinner if someone tests positive. But if it’s a high consequence event, like you’re having a wedding and flying somewhere, and you’re going to screen a few hundred people, you may get a false positive and want to test again.”

How do I find a home test?

Although supplies are expected to improve in the coming weeks, the tests can be difficult to find right now. Try the websites of stores like CVS, Walgreens, Costco or Walmart or check with a local drugstore. I recently searched the CVS website for a friend in New Jersey and found BinaxNow tests at a store about 30 minutes away. When he arrived, he found the shelves stacked with tests.

A word of warning: Make sure you search by brand name. If a store is sold out of a rapid test, the website may direct you to a different type of test, called a home collection test, that requires you to mail the sample to get the result. But hold out until you find a rapid test. “The fact that they are rapid,” Dr. Gronvall, of Johns Hopkins, said, is what “makes them a really great test to make sure somebody is not infectious at that moment.”

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The cost of growing old

Many people, myself included, worry about whether we’ll have enough money to pay for the costs of aging, whether it’s money for prescription drugs, a home health aid or assisted living. Paula Span looks at new research that calculated how many older Americans would need help as they age. Here’s what she found:

• About one-fifth of retirees will need no support at all.

• About one-quarter will have severe needs.

• Most older people will fall between those poles, with 22 percent having only minimal needs. The largest group, 38 percent, can expect moderate needs — like support while they recover from a heart attack, after which they can again function independently.

• People who attended college for some period are expected to fare far better than those without high school diplomas.

• Black and Hispanic seniors, reflecting entrenched economic and health inequities, are more apt than older white people to develop moderate or severe needs.

• Married people are less likely to need extensive care than those who are single. They have higher incomes and spouses to take care of them.

Read more:
Tallying the Cost of Growing Older^[13]

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Try a bear meditation

I’ve been following Fat Bear Week, a fun annual event during which people vote on the Alaskan bear that’s done the best job fattening up for hibernation. The Guardian has a fun post^[14] with before and after pictures of the bears. But I’ve been enjoying the live bear cams on Explore.org. Watching the bears search for salmon and listening to the sounds of the river is a meditative experience that I recommend! You can also find live cams for puppies, bees, birds and oceans. And while you’re there, check out the “Zen” cams.

Watch the Explore.org bear cams:
The Brown Bears of Katmai, Alaska^[15]

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The Week in Well

Here are some stories you don’t want to miss:

• Jane Brody explains the link between mind and body.^[16]

• Gretchen Reynolds reports that exercise may ease “chemo brain^[17].”

• Pam Belluck has a fascinating story on depression and a “pacemaker” for the brain.^[18]

• And of course, we’ve got the Weekly Health Quiz.^[19]

Let’s keep the conversation going. Follow me on Facebook^[20] or Twitter^[21] for daily check-ins, or write to me at well_newsletter@nytimes.com^[22].

Stay well!

References

1. ^{^} $1 billion in home testing (www.nytimes.com)
2. ^{^} Mara Aspinall (chs.asu.edu)
3. ^{^} Neeraj Sood (priceschool.usc.edu)
4. ^{^} director of the Covid Initiative at the U.S.C. Schaeffer Center. (healthpolicy.usc.edu)
5. ^{^} BinaxNOW (https://ift.tt/2U8RjZZ)
6. ^{^} QuickVue (quickvueathome.com)
7. ^{^} Ellume (www.ellumehealth.com)
8. ^{^} Flowflex (www.aconlabs.com)
9. ^{^} Gigi Gronvall (twitter.com)
10. ^{^} Dr. Michael Mina (twitter.com)
11. ^{^} proponent of rapid testing (www.nytimes.com)
12. ^{^} recalled nearly 200,000 test kits (www.nytimes.com)
13. ^{^} Tallying the Cost of Growing Older (www.nytimes.com)
14. ^{^} has a fun post (www.theguardian.com)
15. ^{^} The Brown Bears of Katmai, Alaska (explore.org)
16. ^{^} mind and body. (www.nytimes.com)
17. ^{^} ease “chemo brain (www.nytimes.com)
18. ^{^} a “pacemaker” for the brain. (www.nytimes.com)
19. ^{^} Weekly Health Quiz. (www.nytimes.com)
20. ^{^} Facebook (www.facebook.com)
21. ^{^} Twitter (twitter.com)
22. ^{^} well_newsletter@nytimes.com (www.nytimes.com)

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