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What is an antigen test?

At Nobraa we sell different types of COVID-19 self-tests that you can use to test if you are infected with the coronavirus. Most of these self-tests are suitable to be carried out at home. A few of these are called antigen test. These tests must be carried out by a professional.

An antigen test determines whether your body contains coronavirus antigens. Antigens are minute fragments of virus protein present in your throat and/or nasal mucus that provoke an immunological reaction in your body. You may check whether you have the coronavirus by obtaining a sample of mucus from your nose or throat and putting it through the test gadget.

An antigen test determines whether a person is or isn’t infected with a disease, such as the SARS-CoV-2 virus. The antigen remains stable for at least months once the infection is gone. Antigen assays detect proteins or glycans, unlike nucleic acid-based tests like PCR, which detect the presence of genetic material, such as the spike proteins found on the surface of the SARS-CoV-2 virus. Though, these tests often have a lesser sensitivity than PCR, which might make a high accuracy challenging.

Because suitable antibodies for use in the assays must first be found and generated, which can be a difficult and time-consuming procedure, they can take longer to develop than molecular and antibody testing. However, they usually produce test results quickly, are relatively inexpensive, and may be used at the point of care, making them more ideal for the community and remote testing.

Is an antigen test the same as an RT-PCR test?

What is a PCR COVID test?

Currently, the Reverse Transcription Polymerase Chain Reaction (RT-PCR) test is the most widely used for tracing the infection in those who have flu-like symptoms. This lab test has a specificity rate of nearly 100 percent, which means it can identify people without the disease, and a sensitivity rating of 67 percent, which means it can identify people with COVID-19. The result can be falsely negative if the sample is not collected properly by a professionally trained lab technician.

The RT-PCR test detects the presence of viral RNA using Real-Time Reverse Transcriptase (RT)-PCR Diagnostic Panels and is very accurate. The presence of the virus is determined by analyzing the swab samples for reagents. This test can detect the virus even before symptoms appear and aid in isolation, preventing infection from spreading further.

If the test is positive, the patient must adhere to all COVID-19 procedures, which include self-isolation, taking prescribed medications, eating a nutritious diet, and monitoring vital signs such as oxygen saturation.

What is a rapid antigen test?

Only when recognizing people who are highly symptomatic does the quick antigen test come in handy. A swab is also used to gather samples from the nose or throat. Despite the fact that the findings are available in 30 minutes, this test is not considered accurate since it may not read into essential proteins that are part of Coronavirus in its early stages.

Even if your quick antigen test comes out negative, your doctor may advise you to wait a few days before confirming the illness. If you observe COVID-19 symptoms, do an RT-PCR test to get more accurate results.

Doctors believe that in some circumstances, the quick antigen test should be accompanied with RT-PCR to totally rule out infection. 

What does the COVID antigen result mean?

Positive result

If you carry out a validated antigen self-test and get a positive result, you can be confident that the result is accurate. If the test comes back positive, you're almost confident you've been infected with the coronavirus. If the antigen test is performed by a professional, the reliability is much better because this individual understands how to properly perform the test, lowering the margin of error.

If the antigen test comes back positive, it's critical that you stay indoors and avoid contact with your surroundings. It's critical to have the results of a self-test confirmed by a validated antigen test or PCR test performed by a specialist. A second test for confirmation is not required if the result comes from an antigen test performed by a professional. In that situation, you can put your faith in the test's outcome.

Negative result

A PCR test is more sensitive than an antigen test. While that's generally speaking a plus, the test may not be able to detect enough antigens during the beginning or final stages of infection. Therefore, it's possible that the test will come back 'negative' while you’re actually sick with the virus. For a PCR test to be effective, it’s best to wait at least five days after the possible moment of infection.

On the other hand, the antigen self-test has a higher margin of error as well. This is due to the fact that you will be performing the test yourself and be careful in doing it appropriately. Aside from that, there is a small chance that other environmental conditions are causing the testing instrument to malfunction.

Even if the test comes back negative, it's critical that you remain vigilant and cautious. Particularly if you are experiencing symptoms, working with vulnerable individuals, or being a member of a high-risk group. Finally, in some cases, it may be prudent to conduct a second PCR test just to be sure.

What are the advantages of the COVID-19 antigen test?

The antigen test has a number of advantages. First and foremost, this test is faster than the PCR test, which is advantageous if you need the results quickly. An antigen test can yield a response in as little as thirty minutes, and in some cases as little as ten minutes.

Furthermore, if you want it done by a commercial provider, the antigen test is generally less expensive than the PCR test. So, if you don't require a PCR test because of symptoms but just want to perform it as a check-up or for prevention, this could be a cheaper choice.

Finally, one of the best aspects of the antigen self-test is how simple it is to use. You are free to take it whenever and wherever you wish. You also don't need to make an appointment or fly somewhere. Of course, if you want the test to be administered by a professional, you will have to travel to a specified testing place.

The antigen test is available in some (XL) GGD test lanes. Other organizations have taken the initiative to test their staff for COVID-19 using a rapid antigen test. Outside of the GGD test lanes, principles for COVID-19 testing have been formulated to ensure clarity regarding necessary testing criteria.

A small percentage of positive and negative results from this test may be incorrect. Positive results from patients without symptoms should be treated as presumptively positive unless they are confirmed by another test as soon as possible. This is especially true if a community has fewer illnesses, as false-positive results are more common in populations with low COVID-19 levels when antigen testing is used (low prevalence).

The COVID-19 pandemic has put a lot of strain on healthcare institutions and populations all around the world. Accurate and timely diagnosis of COVID-19 cases is one of the cornerstones of successful sickness management, both at the individual patient level and, more importantly, at disease control and prevention level. Currently, real-time PCR (RT-PCR) is used for the majority of testing, but other countries, such as Germany, France, and the United Kingdom, have already implemented antigen testing into their strategies.

How to do a rapid antigen test?

Antigen testing is used to establish whether or not a person has COVID-19. They're generally used to test for COVID and, in some situations, to diagnose it:

Diagnosis is the process of determining whether or not a person has shown symptoms of a disease or has been exposed to one. When other tests are not available, an antigen test can be performed to diagnose persons with COVID-19 like symptoms. Antigen tests, on the other hand, have a higher possibility of reporting a negative result in someone who has been infected with the virus, which is known as a false-negative result.

Screening is the process of detecting disease in people who have no indications or symptoms. Antigen tests may be employed in mass screening programs that include repeatedly testing people to help prevent the spread of SARS-CoV-2 since they may be performed quickly and at a cheap cost. Because of the danger of false-positive results, this form of screening must be done with caution. The potential of false positives is greatest in areas where viral transmission is minimal.

Antigen tests look for viral proteins to determine the presence of the pathogen, whereas PCR testing hunts for the virus's genetic material.

A PCR test isolates genetic material from the sample, including virus-specific genetic material. The material goes through a thermal process that divides the DNA into two single-stranded bits. The DNA strands are then duplicated by an enzyme called Taq polymerase. Each of these strands can be used to make two more copies of itself, and so on. The cycle is repeated several times, resulting in millions of perfect clones of the original DNA segment, allowing the infection to be identified.

When there is a virus in the sample, this process can take hours and involves complex lab equipment and specialist staff, but the results are nearly 100 percent accurate in recognizing infected persons.

Antigen tests, on the other hand, use a solution that splits the virus open and releases specific viral proteins. This mixture is then put to a paper strip containing an antibody designed to bind to these proteins in the solution if they're present. The result appears as a band on the paper strip, similar to a home pregnancy test.

In 15 to 30 minutes, samples can be processed on the spot. These tests are generally inexpensive and are most effective in the early stages of infection when the viral load is at its maximum. However, this quickness comes at the expense of sensitivity.

What are the most accurate corona tests?

Antigen tests successfully identified COVID-19 infection in 72 percent of persons with symptoms, compared to 58 percent of those without symptoms, in people with proven COVID-19 infection. When tests were used in the first week after symptoms appeared, they were the most accurate (an average of 78 percent of confirmed cases had positive antigen tests). This is most likely due to the fact that people have the most virus in their system in the days following infection.

Antigen tests properly ruled out infection in 99.5 percent of patients with symptoms and 98.9 percent of people without symptoms who did not have COVID-19.

The inaccuracy of different brands of testing varies. The results of one test (SD Biosensor STANDARD Q) were deemed "acceptable" by the World Health Organization (WHO) for verifying and ruling out COVID-19 in patients who had COVID-19 signs and symptoms. At least one study found that two other tests (Abbott Panbio and BIO NOTE NowCheck) matched WHO-approved requirements.

If 1000 patients with symptoms had the antigen test and 50 (5%) of them had COVID-19, 53 people would test positive for COVID-19, according to summary data from SD Biosensor STANDARD Q. COVID-19 would not be present in 9 of these patients (17%). (false-positive result).

  • 947 people would be COVID-19 negative. Six people (0.6 percent) would be infected with COVID-19 (false-negative result). The number of confirmed cases of COVID-19 among persons who have no symptoms is likely to be significantly lower than in people who have symptoms. Using SD Biosensor STANDARD Q summary results in a larger sample of 10,000 patients with no symptoms, where 50 (0.5%) of them had COVID-19:
  • COVID-19 would be found in 125 persons. COVID-19 would be absent in 90 (72%) of these persons (false-positive result).
  • COVID-19 testing would be negative in 9,875 persons. COVID-19 is present in 15 of these people (0.2 percent) (false-negative result).

However, using computational models, a team of researchers from Ashoka University in Sonipat and the National Centre for Biological Sciences (NCBS) in Bengaluru has shown that the judicious use of rapid antigen tests (RAT) alone can yield good results from an epidemiological standpoint if the testing is done on a large scale.

The scientists, on the other hand, were adamant about a few requirements. To begin with, RAT should have a reasonable sensitivity, a much higher proportion of people should be tested (around 0.5 percent of the population per day), those who have been tested should be isolated until the results are available, and testing should be accompanied by other non-pharmaceutical interventions such as wearing a mask and maintaining physical distance, among other things.

Questions About Accuracy of COVID-19

There have been some questions about the accuracy of COVID-19 fast antigen tests, which are clinical diagnostic tests that look for the presence of the virus's antigens. This was heightened by Tesla CEO Elon Musk's tweet, in which he claimed to have been tested positive twice and negative twice on the same day.

Musk tweeted, “Something highly fake is going on.” “Today, I was tested for covid four times. Two of the tests were negative, while the other two were positive. The same equipment, the same test, and the same nurse. BD has a rapid antigen test.”

The BD could relate to Becton Dickinson and Co's fast antigen test, albeit this hasn't been confirmed.

Confirming positive tests would be a regular operating procedure in any case. Otherwise, he said he had a "normal cold" in response to a Twitter question regarding his symptoms.

The US Food and Drug Administration (FDA) warned clinical laboratories and health care providers earlier this month that antigen tests can provide false-positive findings, “including when users do not follow the guidelines for using antigen tests for the fast detection of SARS-CoV-2.”

Rapid antigen tests are normally indicated for persons who are suspected of COVID-19 by their healthcare professional within a certain number of days after symptom onset, according to the researchers. The FDA also stated that all laboratory tests, especially rapid tests, have the risk of producing false-positive results, and that “Laboratories should expect some false-positive results to occur even when very accurate tests are used for screening large populations with a low prevalence of infection.”

They advised health care professionals and clinical laboratory staff to follow authorized instructions and use the testing procedures recommended by the Centers for Disease Control and Prevention in the United States (CDC). When required, follow-up (reflex) testing using a molecular assay—like the one Musk is getting—is performed, as well as reviewing the expected occurrence of false-positive results when interpreting test results in respective patient populations.

BD, Quidel, and Abbott are the top manufacturers of fast antigen testing. 14,000 nursing homes have received kits from BD and Quidel. Abbott has agreed to offer 150 million of its fast card-based tests to the Trump administration. The Trump administration said it planned to distribute Abbott BinaxNOW diagnostic tests to nursing homes, schools, and other locations around the country, but warned that these antigen kits may be less sensitive than laboratory-based nucleic acid testing, posing a risk of false negatives. This is in direct contradiction to the FDA's findings on false positives.

Although the FDA advisory did not name a test provider, it appeared to make recommendations concerning Abbott's card-type kits as well as BD and Quidel's instrument-based tests. All of the test instructions emphasize that if the provider does not follow the timings correctly, incorrect results can ensue. They also mentioned issues with the “batch mode” processing of many specimens and the danger of cross-contamination.

They also pointed out that when screening populations where a pathogen has a low prevalence, any kit with less than 100 percent specificity, which is practically all of them, will generate a substantial number of false positives. With 98 percent specificity, ranges might run from 20% in a population with 10% prevalence to 96 percent in a population with 0.1 percent prevalence, according to the FDA. According to the CDC, 7.1 percent of tested samples in the United States were positive.

COVID-19-related limitations and lockdowns have enraged Musk, who has spoken out against them. Despite this, his company is collaborating with CureVac NV of Germany to build mobile RNA bioprinters for the production of CureVac's experimental COVID-19 vaccine. The printers are mobile, automated mRNA synthesis equipment that may be used in remote areas. CureVac is also constructing a more traditional manufacturing plant in order to raise vaccine production tenfold to billions of doses.

Reliability of COVID-19 diagnostic tests

The precision and reliability of COVID-19 diagnostic tests are critical for accurate diagnosis and ensuring people can make informed health decisions. If the results are accurate, people can take precautions to safeguard their loved ones and others if they test positive. If they get a "false positive" result (a positive result when you don't have the virus), they can prevent excessive self-isolation and distress.

Researchers from the Doherty Institute in Melbourne recently assessed the PanBio test, which is made by Abbott and is one of the fast antigen tests licensed for use in Australia. They screened 2,413 people without the virus and 22 people who had PCR-confirmed infections. They discovered that the PanBio test has a specificity of 99.96 percent, meaning that four out of every 10,000 tests may be false-positive.

COVID-19 prevalence rates remain extremely low, even in the midst of the current outbreaks. This level of specificity may result in more false positives than true positive cases in the community.

Antigen tests are ideal for screening people for certain activities or determining the prevalence of COVID-19 in a community. They are less precise than genetic testing, but they are less expensive, faster, and easier to use. This makes them more feasible for screening a large number of people and swiftly detecting epidemics.

When do I need a COVID-19 test?

If you see any of these symptoms, get emergency medical attention right away:

✔ Trouble breathing

✔ Persistent pain or pressure in the chest

✔ New confusion

✔ Inability to wake or stay awake

✔ Bluish lips or face

Dr. Ian Norton, a Respond Global expert emergency physician in charge of the trial at the Sydney aged-care facility, says fast antigen tests are most beneficial when there is a large community spread. The goal of testing in that situation, he explains, is to identify persons who have a high viral load and are most likely to spread the infection. “Rapid testing is excellent for detecting super spreaders. “This is when they come in handy,” he continues.

However, according to Norton, sensitivity is simply one indicator of a good test. During outbreaks, speed, accessibility, and cost are all important factors to consider because, according to him, the method is more about minimizing community transmission than tracing every single case.

In Sydney, critical personnel from three local government regions in the city's southwest have been required to undergo "surveillance testing" every three days. The strategy has resulted in kilometer-long lines at PCR testing sites, with results taking up to 90 hours to return, which is inconvenient. When trying to control an outbreak, a result that comes after "the horse has bolted" is useless, according to Norton.

However, researchers from the National Institutes of Health recently discovered that if performed at least every three days, fast antigen testing showed a sensitivity (>98%) comparable to PCR for identifying infected patients.

Daily screening utilizing self-swabbing antigen testing performed under the supervision of a qualified person or via telehealth, according to Norton, may keep critical workplaces open and secure.

How long after exposure to COVID-19 should I get tested?

Your first impulse may be to rush out and get a test after knowing that you've been exposed to COVID-19. Instead of putting everything on hold to get a same-day test, experts advised waiting a few days because the virus may not be detectable in its early stages. This corresponds to the infection's incubation period, during which the virus begins to multiply but is undetected. The normal incubation period is 5 to 7 days, although it can go up to 14 days.

If you have COVID-19 and get tested too soon, your test results may come back negative, despite the fact that you are infected. A follow-up test a few days later would reveal the current infection, but many individuals don't think about it, particularly if they don't have COVID-19 symptoms.

COVID-19’s incubation period lasts up to 14 days. It takes time for the virus to develop up in your system if you have it. Testing too soon after exposure could result in samples lacking enough genetic material from the virus to register as positive. A COVID-19 test is limited in that it only captures a single moment in time. A negative PCR test does not suggest that an individual is clear of infection; rather, it means that the sample did not contain virus levels at a high enough concentration to be evaluated as a positive at that particular time.

Antigen tests, on the other hand, can provide immediate results. As a result, it's appropriate for periodic follow-up testing. It could be used in situations where a quick yes-or-no answer is required, such as in an overburdened hospital, a nursing home where patients are unable to go to a testing site, or to determine whether healthcare staff have been infected.

“We believe that the first step toward resuming normal life is to ensure that you and those around you are not infectious,” says Steve Tang, CEO of OraSure, which produces millions of HIV antigen tests each year and is currently developing a covid-19 test. “We need to get rid of these testing bottlenecks that are causing us problems right now. Antigen testing may be a useful new technique in achieving this goal.”

The COVID-19 assays were created using the same basic platform that was used to screen for Dengue and Zika. Those tests were 90 to 95 percent accurate, and he expects the COVID-19 versions to be the same. Each test, he claims, should cost no more than $10; a PCR test costs more than five times as much. When manufacturing is up and running, the company intends to be able to produce millions of these tests on a regular basis. E25Bio also plans to release an app that will securely collect test results from users and provide metadata, such as gender and age, as well as location, to epidemiologists and public health specialists looking to track the spread of covid-19.

Who should get an antigen test for COVID-19?

If you have symptoms of a lower respiratory tract infection, such as a persistent cough, shortness of breath, or fever, you should absolutely contact your local provider straight away, and they will make the decision. Do you fit the profile of someone who should be tested, or do you have another explanation for your symptoms? Because, as previously said, there are many other infections in the population that might cause the same symptoms as this virus.

What's to stop you? An antigen test for a bacterial infection, such as strep throat, works well. However, respiratory viruses such as coronavirus are a different story. A respiratory infection makes its home in the respiratory system, thus collecting samples deep in the nasal cavity with a nose swab is suitable. However, the virus's presence in this location differs from person to person. When done properly on a good nose swab, the antigen test for influenza, for example, has a fair sensitivity of around 70 to 80 percent—but only for children, because the quantity of virus in children is often considerably higher than in adults. When adults are tested using the same influenza antigen assays, the sensitivity declines to less than 50%. In the case of respiratory viruses, this is something that has been documented across the board. The viral genetic material is amplified in a PCR test to make it easier to detect indications of covid-19. In an antigen test, viral proteins are not amplified. Whether the test identifies them in the sample or not is a matter of opinion.

Companies like E25Bio and OraSure have created successful testing for other diseases, but not for respiratory viruses, and Wells is unconvinced that they've solved the biological and technological obstacles that are preventing these tests from being successful. He says, "I'd love to be proven wrong." “However, if I had to guess, the COVID-19 virus will be no different than the others. It isn't brand-new biology or chemistry.” Antigen testing companies that claim sensitivities of more than 90% rely on laboratory samples. They're still waiting for validation testing on real patient samples, which could be far less precise.

Gehrke, Tang, and others explicitly admit that even if these new antigen tests prove to be trustworthy, they will almost definitely not replace PCR testing. However, the tests could be used in conjunction with PCR and other forms of testing to help us get past the bottlenecks and closer to our goal of 20 million tests per day.

When should you get tested for COVID-19?

It's difficult to determine when you should get tested for COVID-19 and when you shouldn't, especially when limits and information are always changing. Milwaukee is currently well-prepared to put people to the test. Even if you are not a current patient, there are various locations throughout the city where you can get tested. So, when should you leave? We've had a lot of questions like, "I lost my mask at the grocery store; do I need to be tested?" Or, “Do I need to be tested because I went to a protest?” When determining whether or not to be tested, there are a few things to consider.

1. Symptoms

COVID-19 should be evaluated if you aren't feeling well. Fever, cough, shortness of breath, tiredness, muscular or body aches, the new loss of taste or smell, sore throat, congestion, runny nose, throwing up or feeling the need to throw up, and diarrhea are some of the symptoms.

Even if your symptoms are minor, you should get checked. COVID-19 does not cause everyone to become ill. It's critical to know if you have the virus so that you can avoid transmitting it to others. Even if you don't feel so horrible, you shouldn't go to work or send your kids to daycare. Self-isolation until you know your results is the correct thing to do for your family and community.

2. Exposure

You should be tested if you believe you came into contact with someone who tested positive for COVID-19 while neither of you was wearing a mask. Even if you don't have symptoms, there's a good chance they spread the virus to you. This exposure could be from your own family, friends, or coworkers.

When you're out in public or around other people, always wear your mask. If you develop symptoms after walking in a protest or being in big crowds of people without a mask, it is a good idea to be checked. Coronavirus is still circulating in our neighborhood, and it is likely to spread considerably more now that people are returning to work, shopping, and socializing.
If you always wear a mask in public and wash your hands frequently, it's fine to keep an eye out for symptoms and notify your doctor if they appear.

It's not a good idea to be tested simply because you're curious. Remember that even if you test negative for coronavirus, it doesn't mean you don't have it. The test is of excellent quality, however, it is not without flaws. Only a small percentage of persons who test negative for the virus are infected. A false-negative test is what this is known as. That's why it's recommended to keep your mask on at all times when you're not at home. It safeguards you and those around you.

3. Testing After Exposure

The virus must develop up enough in your system for the test to detect it after a few days. False-negative results are more frequent if you get checked too soon. You are contagious even at this early stage before you have any symptoms. As a result, you should begin isolating yourself as soon as possible and contact your doctor. Let them know when you believe you were exposed, and they'll set up an appointment for you at a convenient time. Stay at home and away from other people until you've received both your test and your results. Other family members should likewise stay at home during this period and avoid going to work. Also, request a work excuse from your doctor. If you share a home with others, keep your mask on at all times, try to keep your space clean, wash your hands frequently, and don't share household goods like food, cutlery, or the TV remote.

If you test positive, it's also polite to inform persons you've been in contact with for the past two weeks. There's a significant chance you've infected them with the virus. Because your friends or coworkers are aware that they should minimize their contact with individuals outside their houses, this helps to prevent the virus from spreading further.

4. Re-testing

After a positive test, just a small percentage of people need to be tested again. The reason for this is that a second test does not provide meaningful information to you or your doctor. You can't tell if you've recovered or are immune to the coronavirus with a second test. After your symptoms have subsided and you are no longer contagious, tests can remain positive for weeks. Your employer or your child's daycare provider should not require you to take a test to prove your recovery. If they persist, consult your doctor for advice on what to do next.

Medical wholesaler

Nobraa.com is a medical wholesaler that provides different parties with all the medical (corona) products they need. So are you a company, a health care institution, or a health care professional and would you like to order corona self-tests or professional antigen tests in large quantities? Then we, at Nobraa, are always here to help.

You can order self-tests, professional antigen tests, and antibody tests in large quantities. Whether you need this for yourself, your patients, or your employees. It also doesn't matter in what quantities you need them: dozens, hundreds, or thousands. At Nobraa nothing is too crazy for us!