ℹ️ Skipped - page is already crawled
| Filter | Status | Condition | Details |
|---|---|---|---|
| HTTP status | PASS | download_http_code = 200 | HTTP 200 |
| Age cutoff | PASS | download_stamp > now() - 6 MONTH | 0.3 months ago |
| History drop | PASS | isNull(history_drop_reason) | No drop reason |
| Spam/ban | PASS | fh_dont_index != 1 AND ml_spam_score = 0 | ml_spam_score=0 |
| Canonical | PASS | meta_canonical IS NULL OR = '' OR = src_unparsed | Not set |
| Property | Value |
|---|---|
| URL | https://www.caltech.edu/about/news/study-at-home-rapid-covid-tests-may-miss-many-infections |
| Last Crawled | 2026-04-07 11:01:04 (10 days ago) |
| First Indexed | 2023-06-14 22:51:43 (2 years ago) |
| HTTP Status Code | 200 |
| Meta Title | Study: At-Home Rapid COVID Tests May Miss Many Infections - www.caltech.edu |
| Meta Description | Researchers in the lab of Rustem Ismagilov have found that COVID tests that rely on rapid nasal swabs can be prone to false negatives during early infection. |
| Meta Canonical | null |
| Boilerpipe Text | For the last couple of years, the rapid at-home COVID tests that can identify an infection with a simple swab of the nose have been a mainstay of efforts to diagnose infection with the SARS-CoV-2 virus and prevent its spread.
But what if these tests are often wrong?
New research conducted at Caltech suggests that in many cases, rapid tests that use a nasal swab provide false negatives—suggesting that a person is infection-free even though other parts of their respiratory tract are teeming with the virus. The findings, from the lab of
Rustem Ismagilov
, Ethel Wilson Bowles and Robert Bowles Professor of Chemistry and Chemical Engineering, appear in a paper published in the journal
Microbiology Spectrum
on June 15 .
Researchers in Ismagilov's lab tracked viral loads in three places in the human body during the course of a COVID-19 infection: the nose, the throat, and the mouth. Because the nose, throat, and mouth are so closely connected, one might expect to see similar virus levels in those locations. That turns out not to be the case.
"Generally, we saw that most people have virus first appear in their throat and in saliva, and then, sometimes days later, in their nose," says Alexander Viloria Winnett, biology graduate student and study co-author. "Actually, each sample type from a single person follows its own distinct rise and fall of viral load, so it makes a big difference which sample type is used for testing."
At the beginning of the pandemic, the gold standard for testing was the deep nasal swab (PCR test) administered by a medical professional, which is highly sensitive and accurate but uncomfortable for many people and slower to provide results. As the pandemic progressed, people more and more relied on at-home nasal rapid antigen tests, which can be performed without the assistance of a medical professional and provide results in as little as 15 minutes.
However, in their study, the Caltech researchers found that most people showed a delay of several days between when the virus first appeared in the throat or saliva and when it appeared in the nose. Importantly, 15 of the 17 study participants had high and presumably infectious levels of virus for at least a day prior to getting a positive antigen test.
"In one individual, levels of virus in throat swabs were extremely high and presumably infectious for almost two weeks while nasal-swab viral loads were undetectable or remained so low they would have been detected only by a highly sensitive PCR test," says Natasha Shelby, the Caltech COVID-19 study's administrator and a co-author on the paper. "This individual never tested positive on her daily rapid antigen tests."
Shelby says antigen tests have two major limitations: "First, they only test for virus in the nose, even though the SARS-CoV-2 virus is known to be in the mouth, and, in fact, numerous studies show it often shows up in the mouth days before the nose. Second, these rapid tests have low sensitivity, which means they require a lot of virus to indicate a positive result. People assume that these tests will be positive when people are infectious, but we now know from numerous studies that this is not always true."
That means at-home tests can indicate that a person is negative for the virus even though they are actually infected—and even currently infectious.
"Rapid tests have some benefits. You can get results in about 20 minutes, they tend to be less expensive, and they can be more portable than other testing methods," Viloria Winnett says. "But because they are only approved for nasal swabs and have low sensitivity, correct detection of infection by those tests is often delayed by several days."
Viloria Winnett says he hopes the Caltech COVID-19 study findings will spur development of home testing kits that sample both the nose and throat. Such tests are common in other parts of the world, such as the United Kingdom, but are not authorized for use in the United States.
"This has implications," Viloria Winnett says. "People are still becoming infected with COVID. We're still seeing waves, and we're still seeing the development of new variants. I don't want to be alarmist, but we still need to be aware and reactive to the pandemic. And hopefully this work can inform our initial response to other upper respiratory viruses that may emerge so testing strategies can be more effective."
Exactly why such different viral trajectories are seen in these parts of the body remains an open question that will have to be the subject of future research.
"Why is there virus in a certain sample type and not in another? It could be the route of initial infection or susceptibility of different anatomical sites to the virus. This is what I'll be trying to figure out in follow-up investigations," Viloria Winnett says.
The work in the study, titled "
Daily SARS-CoV-2 Nasal Antigen Tests Miss Infected and Presumably Infectious People Due to Viral-Load Differences Among Specimen Types
," was primarily funded by Caltech's Ronald and Maxine Linde Center for New Initiatives and Caltech's Jacobs Institute for Molecular Engineering for Medicine. |
| Markdown | [skip to main content](https://www.caltech.edu/about/news/study-at-home-rapid-covid-tests-may-miss-many-infections#content)
- [Visit](https://www.caltech.edu/about/visit/plan-your-visit)
- [Careers](https://hr.caltech.edu/careers)
- [Access](https://access.caltech.edu/)
- Quick Links  
- [for Faculty](https://www.caltech.edu/quick-links-faculty)
- [for Students](https://www.caltech.edu/quick-links-students)
- [for Staff](https://www.caltech.edu/quick-links-staff)
- [for Alumni](https://www.caltech.edu/quick-links-alumni)
- [Directory](https://directory.caltech.edu/)
- [Ion Caltech Today](https://ion.caltech.edu/)
- [Alumni](https://www.alumni.caltech.edu/)
- [Give](https://giving.caltech.edu/)
[](https://www.caltech.edu/)
- [About](https://www.caltech.edu/about)
Open About submenu
- [At a Glance](https://www.caltech.edu/about/at-a-glance)
Open At a Glance submenu
- [University and College Rankings](https://www.caltech.edu/about/university-and-college-rankings)
- Leadership
Open Leadership submenu
- [President](http://president.caltech.edu/)
- [Provost](http://provost.caltech.edu/)
- [Board of Trustees](http://bot.caltech.edu/)
- [Academic and Administrative Leadership](https://www.caltech.edu/about/leadership/academic-and-administrative-leadership)
- Values
Open Values submenu
- [Diversity, Equity, and Inclusion](https://inclusive.caltech.edu/)
- [Sustainability](https://sustainability.caltech.edu/)
- [Freedom of Expression](https://www.caltech.edu/about/values/freedom-expression)
- [Honor Code](https://www.deans.caltech.edu/HonorCode)
- Legacy
Open Legacy submenu
- [History & Milestones](https://www.caltech.edu/about/legacy/history-milestones)
- [Awards & Honors](https://www.caltech.edu/about/legacy/awards-and-honors)
- [Caltech Archives](http://archives.caltech.edu/)
- [Interactive History Map](https://www.caltech.edu/map/history)
- [News](https://www.caltech.edu/about/news)
- Publications
Open Publications submenu
- [Caltech Science Exchange](https://scienceexchange.caltech.edu/)
- [This is Caltech](https://thisis.caltech.edu/)
- [Caltech Magazine](https://magazine.caltech.edu/)
- [Periodic Table of Caltech](https://www.caltech.edu/documents/10/Periodic_Table_of_Caltech.pdf)
- Visit
Open Visit submenu
- [Directions](https://www.caltech.edu/about/visit/directions)
- [Campus Maps](https://www.caltech.edu/about/visit/campus-maps)
- [Parking](http://parking.caltech.edu/)
- [Tours](https://www.caltech.edu/about/visit/tours)
- [Administrative Offices & Departments](https://www.caltech.edu/about/offices-departments)
- [Media Relations](https://www.caltech.edu/about/media-relations)
Open Media Relations submenu
- [Earthquake Information for the Media](https://www.caltech.edu/about/media-relations/earthquake-information)
- [Caltech Experts Guide](https://experts.caltech.edu/)
- [Media Assets](https://mediaassets.caltech.edu/)
- [Filming](https://filming.caltech.edu/)
- [News Crew Information](https://www.caltech.edu/about/media-relations/crew-information)
- [Research Impact](https://researchimpact.caltech.edu/)
- [Research](https://www.caltech.edu/research)
Open Research submenu
- [Research Impact](https://researchimpact.caltech.edu/)
- Academic Divisions
Open Academic Divisions submenu
- [Biology and Biological Engineering](http://www.bbe.caltech.edu/)
- [Chemistry and Chemical Engineering](http://www.cce.caltech.edu/)
- [Engineering & Applied Science](http://eas.caltech.edu/)
- [Geological & Planetary Sciences](http://www.gps.caltech.edu/)
- [Humanities and Social Sciences](http://www.hss.caltech.edu/)
- [Physics, Mathematics and Astronomy](http://pma.caltech.edu/)
- [Jet Propulsion Laboratory](https://www.caltech.edu/research/jpl)
- [Student Research](https://sfp.caltech.edu/)
- [Centers & Institutes](https://www.caltech.edu/research/centers-institutes)
- [Technology Transfer & Corporate Partnerships](http://innovation.caltech.edu/)
- [Sponsored Research](http://researchadministration.caltech.edu/)
- [Research Facilities](https://www.caltech.edu/research/research-facilities)
- [Faculty Listing](https://www.caltech.edu/research/faculty-listing)
- [Academics](https://www.caltech.edu/academics)
Open Academics submenu
- [Undergraduate Studies](https://www.deans.caltech.edu/)
- [Graduate Studies](http://www.gradoffice.caltech.edu/)
- [Online Education](http://online.caltech.edu/courses)
- [Executive Education](https://ctme.caltech.edu/)
- [Teaching, Learning, & Outreach](http://ctlo.caltech.edu/)
- Resources
Open Resources submenu
- [Registrar](http://www.registrar.caltech.edu/)
- [Catalog](http://www.catalog.caltech.edu/)
- [Academic Calendar](https://www.caltech.edu/academics/resources/academic-calendar)
- [Library](https://www.library.caltech.edu/)
- [International Offices](http://international.caltech.edu/)
- [Career Development](http://career.caltech.edu/)
- [Admissions & Aid](https://www.caltech.edu/admissions-aid)
Open Admissions & Aid submenu
- Undergraduate Admissions
Open Undergraduate Admissions submenu
- [Apply](http://www.admissions.caltech.edu/)
- [Cost & Aid](https://www.admissions.caltech.edu/afford)
- Graduate Admissions
Open Graduate Admissions submenu
- [Apply](http://www.gradoffice.caltech.edu/admissions)
- [Funding & Aid](http://www.gradoffice.caltech.edu/financialsupport)
- [Campus Life & Events](https://www.caltech.edu/campus-life-events)
Open Campus Life & Events submenu
- [Institute Calendar](https://www.caltech.edu/campus-life-events/calendar)
- [Ion Caltech Today](https://ion.caltech.edu/)
- [Athletics & Recreation](http://gocaltech.com/landing/index)
- [Public Events](http://events.caltech.edu/)
- [Performing & Visual Arts](http://pva.caltech.edu/)
- [Housing](http://housing.caltech.edu/)
- [Dining](http://dining.caltech.edu/)
- [Caltech Y](https://www.caltechy.org/)
- [Wellness Services](http://wellness.caltech.edu/)
- [Diversity Center](http://diversity.caltech.edu/)
- [Security](http://security.caltech.edu/)
- [Emergency Information](https://www.caltech.edu/campus-life-events/emergency-information)
- 
Menu 
Close
- [About](https://www.caltech.edu/about)
Open About submenu
- [Research](https://www.caltech.edu/research)
Open Research submenu
- [Academics](https://www.caltech.edu/academics)
Open Academics submenu
- [Admissions & Aid](https://www.caltech.edu/admissions-aid)
Open Admissions & Aid submenu
- [Campus Life & Events](https://www.caltech.edu/campus-life-events)
Open Campus Life & Events submenu
- [Visit](https://www.caltech.edu/about/visit/plan-your-visit)
- [Careers](https://hr.caltech.edu/careers)
- [Access](https://access.caltech.edu/)
- Quick Links
- [for Faculty](https://www.caltech.edu/quick-links-faculty)
- [for Students](https://www.caltech.edu/quick-links-students)
- [for Staff](https://www.caltech.edu/quick-links-staff)
- [for Alumni](https://www.caltech.edu/quick-links-alumni)
- [Directory](https://directory.caltech.edu/)
- [Ion Caltech Today](https://ion.caltech.edu/)
- [Alumni](https://www.alumni.caltech.edu/)
- [Give](https://giving.caltech.edu/)
About Caltech
Back
- [At a Glance](https://www.caltech.edu/about/at-a-glance)
- [University and College Rankings](https://www.caltech.edu/about/university-and-college-rankings)
- Leadership
- [President](http://president.caltech.edu/)
- [Provost](http://provost.caltech.edu/)
- [Board of Trustees](http://bot.caltech.edu/)
- [Academic and Administrative Leadership](https://www.caltech.edu/about/leadership/academic-and-administrative-leadership)
- Values
- [Diversity, Equity, and Inclusion](https://inclusive.caltech.edu/)
- [Sustainability](https://sustainability.caltech.edu/)
- [Freedom of Expression](https://www.caltech.edu/about/values/freedom-expression)
- [Honor Code](https://www.deans.caltech.edu/HonorCode)
- Legacy
- [History & Milestones](https://www.caltech.edu/about/legacy/history-milestones)
- [Awards & Honors](https://www.caltech.edu/about/legacy/awards-and-honors)
- [Caltech Archives](http://archives.caltech.edu/)
- [Interactive History Map](https://www.caltech.edu/map/history)
- [News](https://www.caltech.edu/about/news)
- Publications
- [Caltech Science Exchange](https://scienceexchange.caltech.edu/)
- [This is Caltech](https://thisis.caltech.edu/)
- [Caltech Magazine](https://magazine.caltech.edu/)
- [Periodic Table of Caltech](https://www.caltech.edu/documents/10/Periodic_Table_of_Caltech.pdf)
- Visit
- [Directions](https://www.caltech.edu/about/visit/directions)
- [Campus Maps](https://www.caltech.edu/about/visit/campus-maps)
- [Parking](http://parking.caltech.edu/)
- [Tours](https://www.caltech.edu/about/visit/tours)
- [Administrative Offices & Departments](https://www.caltech.edu/about/offices-departments)
- [Media Relations](https://www.caltech.edu/about/media-relations)
- [Earthquake Information for the Media](https://www.caltech.edu/about/media-relations/earthquake-information)
- [Caltech Experts Guide](https://experts.caltech.edu/)
- [Media Assets](https://mediaassets.caltech.edu/)
- [Filming](https://filming.caltech.edu/)
- [News Crew Information](https://www.caltech.edu/about/media-relations/crew-information)
- [Research Impact](https://researchimpact.caltech.edu/)
Research
Back
- [Research Impact](https://researchimpact.caltech.edu/)
- Academic Divisions
- [Biology and Biological Engineering](http://www.bbe.caltech.edu/)
- [Chemistry and Chemical Engineering](http://www.cce.caltech.edu/)
- [Engineering & Applied Science](http://eas.caltech.edu/)
- [Geological & Planetary Sciences](http://www.gps.caltech.edu/)
- [Humanities and Social Sciences](http://www.hss.caltech.edu/)
- [Physics, Mathematics and Astronomy](http://pma.caltech.edu/)
- [Jet Propulsion Laboratory](https://www.caltech.edu/research/jpl)
- [Student Research](https://sfp.caltech.edu/)
- [Centers & Institutes](https://www.caltech.edu/research/centers-institutes)
- [Technology Transfer & Corporate Partnerships](http://innovation.caltech.edu/)
- [Sponsored Research](http://researchadministration.caltech.edu/)
- [Research Facilities](https://www.caltech.edu/research/research-facilities)
- [Faculty Listing](https://www.caltech.edu/research/faculty-listing)
Academics
Back
- [Undergraduate Studies](https://www.deans.caltech.edu/)
- [Graduate Studies](http://www.gradoffice.caltech.edu/)
- [Online Education](http://online.caltech.edu/courses)
- [Executive Education](https://ctme.caltech.edu/)
- [Teaching, Learning, & Outreach](http://ctlo.caltech.edu/)
- Resources
- [Registrar](http://www.registrar.caltech.edu/)
- [Catalog](http://www.catalog.caltech.edu/)
- [Academic Calendar](https://www.caltech.edu/academics/resources/academic-calendar)
- [Library](https://www.library.caltech.edu/)
- [International Offices](http://international.caltech.edu/)
- [Career Development](http://career.caltech.edu/)
Admissions & Aid
Back
- Undergraduate Admissions
- [Apply](http://www.admissions.caltech.edu/)
- [Cost & Aid](https://www.admissions.caltech.edu/afford)
- Graduate Admissions
- [Apply](http://www.gradoffice.caltech.edu/admissions)
- [Funding & Aid](http://www.gradoffice.caltech.edu/financialsupport)
Campus Life & Events
Back
- [Institute Calendar](https://www.caltech.edu/campus-life-events/calendar)
- [Ion Caltech Today](https://ion.caltech.edu/)
- [Athletics & Recreation](http://gocaltech.com/landing/index)
- [Public Events](http://events.caltech.edu/)
- [Performing & Visual Arts](http://pva.caltech.edu/)
- [Housing](http://housing.caltech.edu/)
- [Dining](http://dining.caltech.edu/)
- [Caltech Y](https://www.caltechy.org/)
- [Wellness Services](http://wellness.caltech.edu/)
- [Diversity Center](http://diversity.caltech.edu/)
- [Security](http://security.caltech.edu/)
- [Emergency Information](https://www.caltech.edu/campus-life-events/emergency-information)

[Home](https://www.caltech.edu/) / [About](https://www.caltech.edu/about) / [News](https://www.caltech.edu/about/news) / Study: At-Home Rapid COVID Tests May Miss Many Infections

# Study: At-Home Rapid COVID Tests May Miss Many Infections
June 14, 2023
For the last couple of years, the rapid at-home COVID tests that can identify an infection with a simple swab of the nose have been a mainstay of efforts to diagnose infection with the SARS-CoV-2 virus and prevent its spread.
But what if these tests are often wrong?
New research conducted at Caltech suggests that in many cases, rapid tests that use a nasal swab provide false negatives—suggesting that a person is infection-free even though other parts of their respiratory tract are teeming with the virus. The findings, from the lab of [Rustem Ismagilov](https://www.cce.caltech.edu/people/rustem-f-ismagilov), Ethel Wilson Bowles and Robert Bowles Professor of Chemistry and Chemical Engineering, appear in a paper published in the journal *Microbiology Spectrum* on June 15 .
Researchers in Ismagilov's lab tracked viral loads in three places in the human body during the course of a COVID-19 infection: the nose, the throat, and the mouth. Because the nose, throat, and mouth are so closely connected, one might expect to see similar virus levels in those locations. That turns out not to be the case.
"Generally, we saw that most people have virus first appear in their throat and in saliva, and then, sometimes days later, in their nose," says Alexander Viloria Winnett, biology graduate student and study co-author. "Actually, each sample type from a single person follows its own distinct rise and fall of viral load, so it makes a big difference which sample type is used for testing."
At the beginning of the pandemic, the gold standard for testing was the deep nasal swab (PCR test) administered by a medical professional, which is highly sensitive and accurate but uncomfortable for many people and slower to provide results. As the pandemic progressed, people more and more relied on at-home nasal rapid antigen tests, which can be performed without the assistance of a medical professional and provide results in as little as 15 minutes.
However, in their study, the Caltech researchers found that most people showed a delay of several days between when the virus first appeared in the throat or saliva and when it appeared in the nose. Importantly, 15 of the 17 study participants had high and presumably infectious levels of virus for at least a day prior to getting a positive antigen test.
"In one individual, levels of virus in throat swabs were extremely high and presumably infectious for almost two weeks while nasal-swab viral loads were undetectable or remained so low they would have been detected only by a highly sensitive PCR test," says Natasha Shelby, the Caltech COVID-19 study's administrator and a co-author on the paper. "This individual never tested positive on her daily rapid antigen tests."
Shelby says antigen tests have two major limitations: "First, they only test for virus in the nose, even though the SARS-CoV-2 virus is known to be in the mouth, and, in fact, numerous studies show it often shows up in the mouth days before the nose. Second, these rapid tests have low sensitivity, which means they require a lot of virus to indicate a positive result. People assume that these tests will be positive when people are infectious, but we now know from numerous studies that this is not always true."
That means at-home tests can indicate that a person is negative for the virus even though they are actually infected—and even currently infectious.
"Rapid tests have some benefits. You can get results in about 20 minutes, they tend to be less expensive, and they can be more portable than other testing methods," Viloria Winnett says. "But because they are only approved for nasal swabs and have low sensitivity, correct detection of infection by those tests is often delayed by several days."
Viloria Winnett says he hopes the Caltech COVID-19 study findings will spur development of home testing kits that sample both the nose and throat. Such tests are common in other parts of the world, such as the United Kingdom, but are not authorized for use in the United States.
"This has implications," Viloria Winnett says. "People are still becoming infected with COVID. We're still seeing waves, and we're still seeing the development of new variants. I don't want to be alarmist, but we still need to be aware and reactive to the pandemic. And hopefully this work can inform our initial response to other upper respiratory viruses that may emerge so testing strategies can be more effective."
Exactly why such different viral trajectories are seen in these parts of the body remains an open question that will have to be the subject of future research.
"Why is there virus in a certain sample type and not in another? It could be the route of initial infection or susceptibility of different anatomical sites to the virus. This is what I'll be trying to figure out in follow-up investigations," Viloria Winnett says.
The work in the study, titled "[Daily SARS-CoV-2 Nasal Antigen Tests Miss Infected and Presumably Infectious People Due to Viral-Load Differences Among Specimen Types](https://journals.asm.org/doi/10.1128/spectrum.01295-23)," was primarily funded by Caltech's Ronald and Maxine Linde Center for New Initiatives and Caltech's Jacobs Institute for Molecular Engineering for Medicine.
Written by
Emily Velasco
Contact
Emily Velasco
(626) 372‑0067
[\[email protected\]](https://www.caltech.edu/cdn-cgi/l/email-protection#f99c8f9c95988a9a96b99a98958d9c9a91d79c9d8c)
### Subscribe
[*The Caltech Weekly* ](https://www.caltech.edu/caltech-weekly)
### Share this
### Tags
[chemistry & chemical engineering](https://www.caltech.edu/about/news?tag=chemistry%20%26%20chemical%20engineering)
[See All News](https://www.caltech.edu/about/news)


California Institute of Technology

1200 East California Boulevard
Pasadena, California 91125
[Contact Us](https://www.caltech.edu/contact) \| [Claimed Copyright Infringement](https://www.caltech.edu/claimed-copyright-infringement) \| [Privacy Notice](https://www.caltech.edu/privacy-notice) \| [Digital Accessibility](https://digitalaccessibility.caltech.edu/) \|
Cookie Consent
\| Site Content Copyright © 2026 |
| Readable Markdown | For the last couple of years, the rapid at-home COVID tests that can identify an infection with a simple swab of the nose have been a mainstay of efforts to diagnose infection with the SARS-CoV-2 virus and prevent its spread.
But what if these tests are often wrong?
New research conducted at Caltech suggests that in many cases, rapid tests that use a nasal swab provide false negatives—suggesting that a person is infection-free even though other parts of their respiratory tract are teeming with the virus. The findings, from the lab of [Rustem Ismagilov](https://www.cce.caltech.edu/people/rustem-f-ismagilov), Ethel Wilson Bowles and Robert Bowles Professor of Chemistry and Chemical Engineering, appear in a paper published in the journal *Microbiology Spectrum* on June 15 .
Researchers in Ismagilov's lab tracked viral loads in three places in the human body during the course of a COVID-19 infection: the nose, the throat, and the mouth. Because the nose, throat, and mouth are so closely connected, one might expect to see similar virus levels in those locations. That turns out not to be the case.
"Generally, we saw that most people have virus first appear in their throat and in saliva, and then, sometimes days later, in their nose," says Alexander Viloria Winnett, biology graduate student and study co-author. "Actually, each sample type from a single person follows its own distinct rise and fall of viral load, so it makes a big difference which sample type is used for testing."
At the beginning of the pandemic, the gold standard for testing was the deep nasal swab (PCR test) administered by a medical professional, which is highly sensitive and accurate but uncomfortable for many people and slower to provide results. As the pandemic progressed, people more and more relied on at-home nasal rapid antigen tests, which can be performed without the assistance of a medical professional and provide results in as little as 15 minutes.
However, in their study, the Caltech researchers found that most people showed a delay of several days between when the virus first appeared in the throat or saliva and when it appeared in the nose. Importantly, 15 of the 17 study participants had high and presumably infectious levels of virus for at least a day prior to getting a positive antigen test.
"In one individual, levels of virus in throat swabs were extremely high and presumably infectious for almost two weeks while nasal-swab viral loads were undetectable or remained so low they would have been detected only by a highly sensitive PCR test," says Natasha Shelby, the Caltech COVID-19 study's administrator and a co-author on the paper. "This individual never tested positive on her daily rapid antigen tests."
Shelby says antigen tests have two major limitations: "First, they only test for virus in the nose, even though the SARS-CoV-2 virus is known to be in the mouth, and, in fact, numerous studies show it often shows up in the mouth days before the nose. Second, these rapid tests have low sensitivity, which means they require a lot of virus to indicate a positive result. People assume that these tests will be positive when people are infectious, but we now know from numerous studies that this is not always true."
That means at-home tests can indicate that a person is negative for the virus even though they are actually infected—and even currently infectious.
"Rapid tests have some benefits. You can get results in about 20 minutes, they tend to be less expensive, and they can be more portable than other testing methods," Viloria Winnett says. "But because they are only approved for nasal swabs and have low sensitivity, correct detection of infection by those tests is often delayed by several days."
Viloria Winnett says he hopes the Caltech COVID-19 study findings will spur development of home testing kits that sample both the nose and throat. Such tests are common in other parts of the world, such as the United Kingdom, but are not authorized for use in the United States.
"This has implications," Viloria Winnett says. "People are still becoming infected with COVID. We're still seeing waves, and we're still seeing the development of new variants. I don't want to be alarmist, but we still need to be aware and reactive to the pandemic. And hopefully this work can inform our initial response to other upper respiratory viruses that may emerge so testing strategies can be more effective."
Exactly why such different viral trajectories are seen in these parts of the body remains an open question that will have to be the subject of future research.
"Why is there virus in a certain sample type and not in another? It could be the route of initial infection or susceptibility of different anatomical sites to the virus. This is what I'll be trying to figure out in follow-up investigations," Viloria Winnett says.
The work in the study, titled "[Daily SARS-CoV-2 Nasal Antigen Tests Miss Infected and Presumably Infectious People Due to Viral-Load Differences Among Specimen Types](https://journals.asm.org/doi/10.1128/spectrum.01295-23)," was primarily funded by Caltech's Ronald and Maxine Linde Center for New Initiatives and Caltech's Jacobs Institute for Molecular Engineering for Medicine. |
| Shard | 71 (laksa) |
| Root Hash | 9475656135030775671 |
| Unparsed URL | edu,caltech!www,/about/news/study-at-home-rapid-covid-tests-may-miss-many-infections s443 |