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A Guide To New York City's COVID-19 Testing Options
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Elizabeth Kim
Published Oct 28, 2020
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By
Elizabeth Kim
Published Oct 28, 2020
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By now, getting a coronavirus test has become old hat for some New Yorkers, part of the uneasy regimen that comes with living in a pandemic. Every day, between 30,000 to 40,000 New York City residents get tested for COVID-19. The process has arguably never been easier or faster. There are now hundreds of free testing sites across the five boroughs, including mobile units in hotspot areas.
Easy access to testing has never been more critical. More indoor activity brought on by colder weather, along with the reopening of schools and restaurants, has made people more likely to be exposed to the virus. New York City is now recommending monthly coronavirus testing for essential workers, including those who work in congregate settings, and most individuals who work outside their home. Those who are in one of the hotspot zones are also urged to get tested frequently.
The COVID testing landscape is still relatively new as well as complicated. There are now a myriad of tests, many of them boasting fast result times. Experts say it's important to keep in mind that information on the reliability of these tests is still evolving.
"We are still learning how well all of these tests perform," Dr. Jen Rakeman, the head of the New York City Public Health Laboratory, told Gothamist.
Nonetheless, she encouraged New Yorkers to become "informed consumers" by learning the basics of testing and asking providers smart questions like what type of test they are giving and where the tests will be processed. Tests processed on site should ensure a faster turnaround, she explained.
Here is a primer on testing, including a breakdown on some of the COVID-19 tests currently available in New York City.
Know the difference between diagnostic and antibody tests—and which one you should take.
A diagnostic test, also known as a viral test, indicates whether a person has an active coronavirus infection. The process involves submitting to a nasal or throat swab, or in some cases, a saliva specimen spit into a cup.
An antibody test, which requires a blood sample, detects whether the body has antibodies produced by the immune system in response to the virus. But because antibodies can stay in the blood for several weeks after a person has recovered from COVID-19, an antibody test will not indicate whether an individual has an active coronavirus infection.
From a public health standpoint, antibody tests provide important data, showing how extensively the virus has penetrated a community. In August, the New York City Department of Health revealed that a little over a quarter of more than 1.8 million tests taken in the city were positive for antibodies. While antibody tests may satisfy people's curiosity about whether they have been infected, they are not considered very accurate, warned Wafaa El- Sadr, an epidemiology professor at Columbia University.
"We also don’t know if the antibodies detected are protective," she said. "So much remains to be learned about those tests."
Bottom line: People who want to know if they've been recently infected should get a diagnostic test.
There are many types of diagnostic tests, but only one is considered the gold standard for detecting COVID-19.
Diagnostic tests are broken down into two types: molecular tests, which identify the virus's genetic material, and antigen tests, which detect certain proteins on the surface of the virus.
Among molecular tests, the most common is the RT-PCR test, or more simply PCR test. The initials stand for "real-time reverse transcription polymerase chain reaction," a very long and scientific way of describing a process that can detect and amplify minute amounts of a virus’s genetic material.
The most important thing to know about PCR tests is that are considered the most sensitive and accurate ones now on the market. The very first COVID-19 test was a PCR test developed by the Centers for Disease Control and Prevention. Others, including the New York state Department of Health, have since created their own, making PCR tests the most popular and widely available.
And in a critically important distinction from some other tests, PCR tests are designed to detect the virus regardless of whether a person is feeling symptoms.
Still, it is important to remember that no test is foolproof. Even PCR tests have been known to have gotten it wrong sometimes. The Centers for Disease Control and Prevention recommends that even people who test negative quarantine for 14 days if they have been exposed to the virus.
Bottom line: A PCR test is the most accurate diagnostic test available.
How are antigen tests used? Who should get those?
Antigen tests are the other type of coronavirus diagnostic test, which are distinguished by their speed and low cost. The first antigen test for COVID-19 was approved by the Federal Drug Administration in May. The tests can produce results within minutes. They are often compared to pregnancy tests in the way they work: colored bars on a test strip will show whether a person is positive or negative. Unlike PCR tests, they are low-tech. No lab or special equipment required.
But they have one important caveat: they can miss detecting the virus in some people, specifically those who are in the early infection stage harboring only small amounts of the pathogen. While PCR tests amplify genetic fragments, antigen tests do not amplify the protein in viruses, making them less sensitive and prone to false negative results. They can also sometimes give a false positive result. This is more likely to happen in people without symptoms or exposure history that are less likely to actually have the disease. In August, Ohio Governor Mike DeWine received a false positive on antigen test. A PCR test later showed he was negative.
Because of these issues, antigen tests are not recommended for those who are not feeling coronavirus symptoms. Instead, they should be used only within the first seven days of symptoms.
Dr. Rakeman of the city's public health lab likened the proper use of coronavirus antigen tests to the way rapid flu tests are typically administered to sick-feeling patients. "If you have a positive result, then that is consistent with your symptoms and exposure history," she said.
Antigen tests are good for screening lots of people on a regular basis as very frequent testing (multiple times per week) can overcome some of the limitations of the test.
Some experts, including Dr. Denis Nash, an epidemiology professor at CUNY, have envisioned at-home antigen tests as potential "game changers" for the pandemic, prior to the approval of a successful vaccine.
"If they work well, are affordable and can be deployed in the right population frequently enough, they could really do a good job of removing people from the population who are infectious," he said.
Two companies, E25Bio and OraSure, are reportedly planning to seek FDA approval to sell at-home antigen tests using nose swabs.
Bottom line: Consider an antigen test if you are feeling symptoms and cannot get an appointment at one of the city's COVID Express sites (see below).
I'm hearing a lot about "rapid tests." What are these and are they reliable?
Rapid tests are simply tests that provide results quickly, typically within a few hours. They can be either antigen or molecular tests.
One of the better known rapid tests on the market is the ID NOW, a molecular test which was developed by the pharmaceutical giant Abbott and adopted early on by the White House. Authorized by the Federal Drug Administration for emergency use in March, the test can show a positive COVID-19 result in five minutes and negative result in 13 minutes. The samples do not need to be processed in a lab. Instead, clinics use an instrument that has been described as the size of a toaster.
But all that convenience and speed comes at a cost. Similar to antigen tests, the ID NOW can produce false negatives. Which is why Abbott advises that the test be used only within the first seven days of symptoms. As the New York Times recently pointed out, the White House plainly ignored this guidance by relying on the ID NOW test, and later another Abbott rapid test, to screen visitors who came in contact with President Donald Trump. The strategy apparently failed. Earlier this month, a COVID outbreak at the White House infected the president, the first lady, their son, and more than a dozen staffers and Republican lawmakers.
Even among those with symptoms, some tests on the ID NOW have shown that it misses 25% or more of infections.
A lab technician dips a sample into the Abbott Laboratories ID Now testing machine.
Carlos Osorio/AP/Shutterstock
The other Abbott test used and touted by the White House has been the BinaxNOW, a rapid antigen test. The company claims that the product is accurate 97% of the time. The verdict is still out; one recent non-peer-reviewed study in San Francisco found that the BinaxNOW is good but not as effective as a PCR test: out of 878 people tested, 26 tested positive on PCR tests. BinaxNOW, meanwhile, detected 15 positive cases.
Like the ID Now, the BinaxNow is also only recommended for use within the first seven days of symptoms.
Both the ID NOW and BinaxNOW have been distributed by the federal government to governors across the country and have been deployed for rapid testing by the New York City health department.
City health officials first introduced ID NOW as part of a test and trace pilot program in the Bronx. Rakeman described the use of that rapid test as strategic. Because positive tests results under the ID NOW have been shown to be mostly accurate, the machine was used in hotspots. That allowed the city to test a large number of residents and quickly detect and inform those who were infected. Afterwards, family members and other close contacts could also be contacted and asked to come in for a test, she said.
To ensure accuracy, all New Yorkers tested with the ID NOW also received a PCR test. Had the city not deployed the ID NOW, health officials and patients would have had to wait at least 24 hours for the results, Rakeman said.
Bottom line: "Rapid test" is a broad category that can include new and relatively untested products. People should find out what exact type of test is being administered.
Does NYC have a test that is both fast and accurate?
In August, the city launched a trial rapid test clinic in Chelsea. The concept for a "quickie test site" actually predated the pandemic. In the summer of 2019, health officials had opened the Chelsea clinic to test for sexually transmitted diseases on-site. The goal was to deliver quick and accurate results.
"We already had that infrastructure and capacity at the Chelsea lab so we were able to pivot from that," Dr. Rakeman said.
Now, the rapid or COVID Express site employs a PCR test that can be processed within 45 minutes on site using technology developed by a company called Cepheid. Test results under the so-called Cepheid Xpert Xpress platform are promised within 24 hours but patients can receive them as quickly as within a few hours of their visit at the clinic.
Those who download the healthcare app called Mychart can get results directly on their phone.
The city last month announced a total of nine rapid test clinics across Manhattan, the Bronx, Brooklyn and Queens. Testing is free at all locations.
Visits at Express sites are by appointment only, a process that helps the city manage wait times and enforce social distancing.
Depending on location and times, demand may be high.
What are my other options? How long do they take?
For the full universe of testing sites, New York City refers users to a search website run by the health data firm Castlight. Note that some of the clinics on the list may charge for testing.
For a full list of free and walk-in testing sites, New Yorkers should visit the city's Health and Hospitals system website to find a convenient location or call 212-COVID19. The urgent care clinic CityMD gives free tests to all uninsured New Yorkers under an agreement with the city.
Public school families and staff are urged to visit one of 22 priority testing sites run by the city’s Health and Hospitals system. No appointment is needed.
Wait times for test results have improved. During the summer, a surge in testing demand in other parts of the country led to weeks-long delays in some cases. Earlier this month, Mayor Bill de Blasio announced that the citywide average turnaround, including at urgent care facilities, was two days, the shortest it has ever been. At city-run clinics, the average turnaround is one day, he said.
New Yorkers getting tested should ask providers where the tests are processed. Keep in mind that many urgent care clinics, like CityMD, contract with national labs like Quest Diagnostics, which was responsible for many of the previous delays.
Quest now claims they have a two-day average turnaround time.
Lastly, I hate doctors visits. Will this test hurt or feel uncomfortable?
Early coronavirus testing involved a nasopharyngeal swab, which is a long swab inserted deep into the nose. In May, Governor Andrew Cuomo received a COVID test using a nasopharyngeal swab on live television during one of his press conferences.
"I’m not in pain, I’m not in discomfort," said the governor, who is known for projecting a tough and fearless persona. "Closing my eyes was a moment of relaxation."
But others have described the long swab, which is meant to reach area where the nasal cavity meets the throat, as an unpleasant sensation. Some may cough or gag.
The good news is that New York City health officials have increasingly moved to anterior nasal samples, involving shorter less invasive swabs that can be self-administered.
Bottom line: A pandemic is no time to be a wimp. Get a test if you need one, and while you're at it, consider getting a flu shot too.
Tagged
COVID-19
testing
coronavirus
explainer
Elizabeth Kim
Elizabeth Kim is a reporter on the People and Power desk who covers mayoral power. She previously covered the pandemic, housing, redevelopment and public spaces. A native of Queens, she speaks fluent Mandarin. Got a tip? Email [email protected]
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Gothamist is funded by sponsors and member donations
Gothamist is funded by sponsors and member donations
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