COVID-19 Testing

By: Amy Brown, Vice President of Product, and Janet Young, MD

Springbuk’s ultimate goal is to prevent disease with data. With that in mind, we aim to share actionable and useful information regarding COVID-19 testing to help our clients avoid spreading and contracting the disease wherever possible.

We built our curated search tool, Answers™, to empower employers with the right information at the right time, to decrease costs and avoid future risk. Our team recently released a new category of search queries into Answers to equip clients with crucial information regarding COVID-19 test utilization and payments for their populations.

Are you interested in determining the rate of testing for active COVID-19 infection or COVID-19 antibodies? Do you want to determine rates of testing by age, sex, location, member type, clinical conditions, or other characteristics? Springbuk Answers is ready to help.

Search for COVID-19 within Answers, and you will instantly find relevant business questions.

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Search for COVID-19 within Answers, and you will instantly find relevant business questions.

Once you select the desired question, toggle between utilization and payment metrics to learn more, or use the filter bar to determine testing rates for the desired cohort compared to the benchmark. Additionally, you can create a focus population or download a list of members who received tests using the new Answers drill-down capabilities (for those with PHI access).

More questions related to COVID-19 will be coming soon, focusing on utilization and spend for treatment once a member is diagnosed.

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To better understand the relevance of the questions available today, and dispel potential confusion regarding the various types of tests, exposure, and safety practices, our clinical and analytics team has prepared answers to frequently asked questions.

Please note: Each individual situation may vary, so please consult with your healthcare provider for any specific questions or needs.

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What are the various types of tests available?

The number of different types of COVID-19 tests has caused more than a little confusion about the appropriate type of test to perform under various circumstances. Tests fall into two categories – those used to diagnose active infection, and those used to identify prior infection.

There are two types of tests currently available to diagnose active infection - molecular tests and antigen tests. Tests used to identify prior infection are generally referred to as antibody tests.

Someone I know had a serology test. Why isn’t that listed among the types of tests?

You may encounter other names for molecular tests, antigen tests, or antibody tests. Molecular tests may be referred to as PCR (polymerase chain reaction) tests, RT-PCR (reverse-transcription polymerase chain reaction) tests, viral RNA tests, or nucleic acid tests. Antigen tests are sometimes referred to as rapid diagnostic tests. Antibody tests may be referred to as blood tests or serological tests because they are performed on blood.

When is the right time to get a test?

The optimal time to be tested to reduce false negatives would be the day an individual has the highest amount of virus in their body, known as the viral load. While the day when an infected individual has the highest viral load varies from person to person, five days following exposure is often recommended for testing asymptomatic individuals. Individuals who are symptomatic should be tested once the symptoms are consistent with those of COVID-19.

Antibodies typically develop one to three weeks after active infection with the virus, so the test may be negative if performed too soon after an individual becomes infected. The test is most likely to detect antibodies three to four weeks after onset of symptoms.

If I aim to test for active infection, which test is best, molecular tests or antigen tests?

Molecular tests are generally preferable because they are more accurate. Both molecular and antigen tests return few false positives, meaning there is high certainty of infection when either type of test returns a positive result. While both molecular and antigen tests may return false negative results when amounts of virus in the specimen are below the threshold of detection, molecular tests tend to have fewer false negative tests due to their greater sensitivity.

Due to the greater likelihood of false negatives with antigen tests, there are differences of opinion as to the appropriate uses for this test. Circumstances where an antigen test might be preferable include situations where individuals are symptomatic and a positive result will change management, particularly if molecular tests require a longer turnaround time.

While the point of care products for molecular tests exist, the vast majority of these tests are performed in laboratories with typical turnaround times of one day to one week. But, turnaround times may be even longer, particularly when lab testing capacity is strained by increased demand during outbreaks. Antigen tests can be performed at the point of care, providing results in under an hour, and are generally less expensive than molecular tests, making them more economical for large scale or serial testing. For instance, antigen tests have been used in serial testing of individuals in congregate living situations for early detection of COVID-19 to prevent widespread outbreaks.

What does it mean if my test result is negative?

While a positive test based on either a molecular or antigen test provides high certainty of infection, a negative result from either test is not definitive. In addition to true negatives, tests may be negative due to issues with specimen collection or low amounts of the virus in the specimen that fall below the threshold of detection. Because antigen tests generally require higher levels of the virus in the specimen, they are more likely to return false negative tests. In some instances, a second test may be recommended by your healthcare provider. Additionally, antigen tests have been reported to have a high rate of false negatives in asymptomatic individuals.

The CDC currently recommends that individuals with significant exposure, such as being within six feet of someone with COVID-19 for 15 minutes or more, should quarantine for 14 days from exposure regardless of the test result.

If I test positive, how long should I self-isolate?

Symptomatic individuals who have a positive test need to self-isolate for a minimum of 10 days from the day of testing. Other criteria that must be met before ending self-isolation include being fever-free for 24 hours without taking fever-reducing medications and improvement in symptoms. Individuals requiring hospitalization or oxygen may need to self-isolate for a longer period.

Asymptomatic individuals who have a positive test need to self-isolate for 10 days after the test date.

If I test positive for the COVID-19 antibody, am I immune from getting COVID-19 again?

Based on the best information we have now, someone who has had COVID-19 should NOT assume that they are immune from getting COVID-19 again. Because COVID-19 is caused by a new strain of virus that has not been previously identified in humans, information related to how long someone may be immune to reinfection is limited. Much of what we know is based on individuals who have been infected and have subsequently had tests for antibody levels prior to donating convalescent plasma, which is plasma that is used to treat currently infected patients. These tests have shown that antibody levels diminish over time, but how quickly they decrease is quite variable. Based on these findings, some experts believe that immunity, which may be reflected by antibody levels, dwindles over a variable amount of time, eventually leaving individuals susceptible to reinfection. Other hypotheses about the typical time individuals will remain immune have been made based on the typical length of immunity to coronaviruses that are similar to the virus that causes COVID-19, including ones that cause the common cold. Individuals are usually immune to other coronaviruses for several years.