COVID- 19 tests – What do you need to know?

Many people think it is not their job to learn about COVID-19 tests and this should be left for the experts and governments to decide about these tests.

COVID- 19 tests – What do you need to know?

Author: Dr. Rakesh Choudhary MBBS, MS, FRCS UK, FRCS Orth UK, MChOrth UK.

 Dr. Choudhary is a practicing consultant surgeon in the UK.

So many of us think it is not their job to learn about COVID-19 tests and this should be left for the experts and governments to decide about these tests. But I strongly suggest the public must have a basic understanding of these tests which they may have to have themselves.

Basically there are two types of tests, one which can detect the virus in the body and the other one which tells if the person had the previous infection.

Virus test

The virus test detects an active infection. It detects the genetic material (RNA) of the virus during an active infection. It is also called a PCR (polymerase chain reaction) test or nucleic acid test and is sometimes inaccurately called an antigen test.

 A swab is taken from deep in the back of your throat and deep in the nose. The swab should go deep up to 7-8 cm and is generally uncomfortable for the patient. Swabbing patients using the correct technique is paramount in ensuring an accurate result. By simply swabbing the inside of the nasal passage is not deep enough to verify that the virus is present.

What does virus testing tell you?

This test tells us if a patient is actively infected with the COVID-19 virus. Virus testing is used mainly for the diagnosis of COVID-19.

When should it be done?

The virus test works best during the first seven days of symptoms.

The coronavirus can be detected in swabs even before symptoms of illness first appear. This is why people can be infectious for a few days before the onset of symptoms, which usually appear about 5 days after the virus infects. Some people have no symptoms throughout their infection but are positive on the virus test and infectious to others. After a few days of illness, the concentration of the virus falls (as seen in swab samples) and the symptoms of the illness usually recede. 

Accuracy of the test

In a person with COVID-19, the test is less likely to give a positive result late in the course of infection once the virus has been cleared by the immune system, or if an inadequate sample is taken from the nose or throat. There are concerns that the rate of ‘false negative’ test results could be as high as 30% and a significant number of people are wrongly being told they do not have the virus.

Antibody test

Antibody tests check your blood by looking for antibodies, which may tell you if you had a past infection with the virus that causes COVID-19. Antibodies are protein structures that are produced by the immune system in response to certain infections. The antibody can help fight off infections and can provide protection against getting that disease again (immunity). Antibodies are disease-specific. For example, measles antibodies will protect you from getting measles if you are exposed to it.

The antibody test detects the presence of antibodies as a marker of past infection. The antibody test (blood test) will only detect infections after the immune system has produced antibodies that recognize the virus. This happens approximately 7–10 days after symptoms develop.

Tests carried out a week after a patient develops symptoms will detect only 30% of people who had COVID-19 infection. Accuracy increases to 72% at two weeks and to 94% in the third week. Some people may take even longer to develop antibodies, and some people who are infected may not ever develop antibodies.

Interpretation of the antibody test is complex for non-medical people. Basically having antibodies to the virus that causes COVID-19 may provide protection from getting infected with the virus again. If it does, we do not know how much protection the antibodies may provide or how long this protection may last.