BY MOLLY TAFT, PHOEBE PINDER and JEANNE PINDER
(Updated) Many of us are tired of sitting at home, thinking about how we may have already been exposed to the novel coronavirus – and wondering if we can get tested. News all over has heralded the arrival of tests for antibodies – new ways to tell if you may have been infected and if you may be immune to a new infection.
Can you get an antibody test? How much does it cost? Where should you go to get tested? We break down what you need to know.
TWO KINDS OF TESTS
There are two kinds of tests for the novel coronavirus. One is currently the most common — the one that tells whether you actually have an active coronavirus infection. That’s usually done with a swab stuck into your nose or elsewhere in the respiratory tract, and the resulting sample is tested at a lab.
Another kind of testing is now being done, serological (blood) testing for the presence of antibodies to the virus. We’ll discuss those here.
SEROLOGICAL OR ANTIBODY TESTING: CHECKING TO SEE IF YOU WERE EXPOSED
Serological tests measure the amount of antibodies present in the blood in response to a particular virus – in this case, SARS-CoV-2, the virus that causes COVID-19. The presence of antibodies in the blood indicates a prior infection. These antibodies for SARS-CoV-2 seem to typically appear within the second week after onset of symptoms, making this type of testing ideal for detecting prior infection, according to the World Health Organization. Nasal swab tests, by contrast, seek to detect active infections.
Researchers hope that antibody tests will be more accurate than the nasal-swab tests, and also that they could help provide a clearer sense of the number of asymptomatic coronavirus cases in the country.
The situation is complicated by the fact that the nation – and the world – is in a panic. Public health officials, businesses, and ordinary people are looking for answers in an uncertain situation, hoping for a test that has a definitive answer. But experts disagree on how accurate the tests actually are, and caution on relying too heavily on serological testing at this stage in the pandemic.
WHAT TO KNOW ABOUT TESTS AND LABS
There are three important components of any serology test that are important to know. First, there’s the provider – where you visit a physician who will order the test for you. This can be a private practice, a chain like CityMD, or a state- or city-run testing center.
Next, there’s the lab where the test itself is performed. This is the purpose that big national lab chains, like Quest or Labcorp, serve. Some hospitals and medical facilities also run labs in-house.
Finally, there’s the brand of the test that you take, which can be offered through multiple testing locations and labs. A number of independent manufacturers have received Emergency Use Authorization from the FDA for their branded tests – you can see a full readout at the FDA’s page here.
As an example of how this works, if you visit a CityMD and your doctor orders you a test, they will order an Abbott test, which will be processed at a Quest or Labcorp facility. However, if you visit a Medrite Urgent Care facility, they will use the Diazyme test, which is processed by Lenco Diagnostic Laboratory.
Not all tests are created equal – some may be more accurate than others. That’s why we’re giving the name of the manufacturer or processor of the test where we know it. For more information on how to read the efficacy of tests on the FDA site, see our post about sensitivity and specificity. Our “What you can do” section at the bottom lists out some important questions you should have in mind when going in for an antibody test.
Most of these tests also have language about how the results are not clear – it’s important to understand that these tests do not convey immunity. See our post on immunity for more.
A GUIDE TO GETTING TESTED IN NEW YORK
We will be updating this guide with new information regularly.
Here’s our data from our reported and crowdsourced “where to find a test site” collection for the serological or antibody test. To add your data, go to this link. We have not included here the Quest lab locations nationwide, because we understand that you need to go to your primary care provider first to get a prescription. Story continues below spreadsheet. (Pro tip: If data is not visible, you may need to scroll to the top of the spreadsheet, or left to right; we are adding data daily, and welcome your contributions.)
New York Gov. Andrew Cuomo ran a series of pop-up tests at grocery stores and big-box stores around the state, with testing via the Wadsworth Laboratory, a state-run agency. Those tests were unannounced. The program seems no longer to be active, although our understanding from the state is that they did not want to announce their plans and locations for fear they’d be overrun. The purpose was to do random testing of people at the store or people in the shopping center, and announcing it would make it non-random. This is what the testing looked like (jeanne’s two stories).
Gov. Cuomo said in early May that the state would partner with Northwell Health-GO Health to provide more than two dozen antibody testing sites in low-income and minority communities, including testing sites in churches, in New York and Long Island. According to Northwell Health-GO Health’s FAQ page on their testing, they use the Abbott test.
Mayor Bill de Blasio said in early May that the city would launch free antibody tests, with five initial locations in Morrisania, East New York, Upper Manhattan, Long Island City, and Concord, with the goal of testing 70,000 people over the first 2 weeks, and rolling out another effort in June. The tests will be supplied by New Jersey lab BioReference. To schedule a test, New Yorkers must call 888-279-0967 or visit the BioReference appointment page.
Bioreference said on its site that its test “has been registered with the FDA, but not reviewed.” Bioreference did not respond to an email asking for clarification.
Medrite Urgent Care reportedly uses the Diazyme kit, processed by Lenco Diagnostic Laboratory to analyze the presence of IgG and IgM antibodies. The IgG sensitivity is 95.6% and shows no cross-reactivity to 24 pathogens, including the common flu virus and coronaviruses HKU1, NL63, OC43, or 229E, which means that this antibody test will not be positive if the sample is infected with prior strains of coronaviruses that affected humans or the common flu virus.
OneMedical, which has locations in several major cities and in all five boroughs of New York City, says it has “started accepting patient requests for COVID-19 antibody testing.” A OneMedical patient representative told us that they are processing all tests through LabCorp and Quest, which uses the Abbott test.
Locations of the chain CityMD are doing both swab and antibody testing. For the antibody test, they told us they are using the Abbott test and that they process both at Quest and at Labcorp, although there was some confusion about whether all the tests are Abbott tests. When we went to the Mamaroneck, N.Y. location, they told us (confusingly) that there would be no charge, and also that we would be responsible for anything not covered by insurance. Other reports from people in New York City have said they are free. We were told to walk in without an appointment, and we did not wait on a Sunday morning in May, while people in the city have said that there were lines and staff members were managing the flow of patients with social distancing rules in mind. Some CityMD locations have closed, so check before you go.
Northwell-GO Health said on its website that “antibody testing will be limited until at least the first or second week of May 2020.” It has specifically labeled two of its locations in Lynnbrook, NY and New Hyde Park, NY as “COVID-19 Antibody Testing” facilities. According to Northwell Health-GO Health’s FAQ page on their testing, they use the Abbott test.
At Madison Medical in Manhattan, they draw a vial of blood and send for processing to Quest. The test itself is $75; Madison Medical will send the test to insurance, and if they don’t cover it, you would receive a bill from the lab itself. You would also have an office visit copay.
At one Westchester, N.Y., medical practice, a patient seeking an antibody test said the nurse told him not to do it — that the tests are generally regarded as unreliable. He did it, and got a negative result.
Quest gives patients the option of ordering a test online, where it says that “independent physicians will provide oversight and, if appropriate, order your testing.” The test provided is Abbott. Labcorp, another major lab chain, also provides tests that can be ordered online. The company has told press it uses tests from Abbott and Euroimmune.
There are a number of scientific studies enrolling those who can confirm they have had a positive test, either the nasal swab (polymerase chain reaction, or PCR) test or antibody test. These plasma donation studies, genetic studies, and so on may offer a different kind of testing. One thing seems certain: They won’t take you as a donor or subject if your status is iffy, so this should be more reliable testing than any commercial test.
Our plasma donation trial data is primarily from the New York area so far; if you’re interested in finding out in your area, seek academic medical centers or the local blood center. Details here.
Also health care workers may have access to tests that are different from the tests civilians can access.
Users on social media have also posted a variety of prices for testing: A Reddit user in Chicago says the cost for the test without insurance would have been $250. Another Chicago user paid $250 for the test and the doctors’ fee combined. Another user in Illinois paid $130 after fees.
ARCpoint is charging $195 in Creve Coeur, Mo., according to local television reporting.
Who will pay?
Federal and state laws passed earlier in the crisis mandated testing with no co-pay for diagnostic purposes. But in some cases, we heard that the provider construed antibody testing not to be diagnostic, and sought to charge for it.
This is the description of the state of play from the respected journal Health Affairs: “The Families First Coronavirus Response Act (FFCRA) was passed by Congress on March 18 and mandated that Medicare, Medicaid, and private insurance plans cover COVID-19 testing and administration costs without cost-sharing. A frequently asked questions document published April 11 by the Departments of Health and Human Services (HHS), Treasury, and Labor specifies that FFCRA also requires health plans and health insurance issuers to cover COVID-19 serology testing. Under the Act, states have the option of providing limited Medicaid coverage to the uninsured for COVID-19 diagnostic testing, including serology testing. However, the law does not require COVID-19 serology testing to be provided free of charge to all uninsured individuals. ”
CityMD in New York City was reportedly testing everybody free, though we’re not sure that is a continuing program. Uninsured individuals certainly should ask in advance.
What you can do
if you’re thinking of getting a coronavirus test, we recommend doing a little homework first:
- Ask who made the test. What is the test’s methodology, and what are the results? Ask to see a package insert or written material about the test, and see if it’s approved by the FDA. (Check on this list of approved tests before you order. ) But remember what we told you above: Even if it’s approved by the FDA, that does not mean it’s been widely tested or is infallible.
- Ask how much it will cost. If they’re charging you, how much are they charging, and does this smell like a moneymaking scheme? Jeanne Pinder, one of the authors of this piece, got an antibody test free under the New York State testing program, using a test developed by the Wadsworth Center, at the New York State Department of Health. It has an “emergency use authorization.” She wrote about it here.
- Ask about fees associated with the tests – how much are lab fees? Doctor’s fees? Make sure you’re getting all the associated costs for your test, and know that your insurance may or may not cover it.
- Think critically. Jeanne Pinder’s first one was administered by the New York State Department of Health; her second came from Stony Brook Medical Center, which is conducting a plasma donation study. Another provider might not be using an authorized test. Did you find the site on Google search or through your county or state health department? This post of ours lists a number of testing sites.
- Remember that in any of these tests, errors exist. So if you get a “you’re all clear” result from a nasal swab, remember that there are a lot of false negatives, and doctors say that if you have symptoms, whether you have a negative or a positive result, you should think that you’ve got it. Also, if you have a positive result in an antibody test, remember that there could easily be false positives, and doctors don’t know if positive results for presence of the antibodies means you’re immune. So don’t act as if you’re in the clear.