Crystal Howell, PharmD, BCIDP, BCPS

Along with other health care professionals, pharmacists have been called to aid in the fight against the coronavirus disease 2019 (COVID-19) pandemic. One of our primary roles as health care professionals is to clarify health information and provide reliable, accessible advice to patients.

Recently, our roles have further expanded due to the 

approval by the Department of Health and Human Services (DHS) to allow pharmacists

 to administer severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing.

Furthermore, following the issuance of several emergency use authorizations (EUAs) by the FDA that allow at-home sample collection,

 it is imperative for the pharmacy team to stay abreast of current testing recommendations and limitations when recommending SARS-CoV-2 home tests to patients.

All current COVID-19 guidelines recommend testing based on a priority stratification algorithm. Symptomatic hospitalized patients, long-term care facility residents, and health care workers are classified as high priority for testing.

 Persons exposed to a confirmed or suspected COVID-19 case, whether or not they are symptomatic, are classified as priority.

Asymptomatic persons with no known exposure are not considered a priority.

However, it is reasonable to recommend testing in such persons if they are employed in workplaces located in communities with a moderate-to-high rate of viral transmission.

 Additionally, these workplaces should consist of the following: be composed of essential workers, provide housing to employees, be located in remote settings with limited access to medical care, or be in a setting where physical distancing between coworkers and the public is difficult.

If cost is an issue, the DHS website includes an online locator listing free testing sites in all 50 states.

 For patients concerned about potential exposure from a testing facility and who have a reliable internet connection, it may be beneficial to recommend an at-home sampling test.

At-home tests may only be obtained via prescription.

 Most can be purchased online and require a completed symptom questionnaire reviewed by health care professionals.

Additionally, testing kits are overnighted to patients who are considered at-risk. All testing kits require samples to be mailed to the corresponding laboratory on the same day of specimen collection.

Proper sample collection is imperative for testing accuracy and is an important counseling point for pharmacists.

Patient samples for SARS-CoV-2 tests are typically collected via saliva samples or nasopharyngeal, nasal, or oropharyngeal swabs. In general, nasopharyngeal and nasal swabs are considered more accurate and are the preferred sampling method by many guidelines.

Given the potential difficulty, awkwardness, and discomfort of self-administered specimen collection, some home test kits also require video conferencing with a health care professional for directly observed collection,

which may alleviate apprehensions a consumer may have about potentially inappropriate collection.

Diagnostic tests for SARS-CoV-2 are 1 of 2 types: molecular or antigen-based.

 Although antigen tests typically have a rapid turnaround time, false negatives are more likely and require follow-up testing to confirm a negative result.

molecular testing is preferred by all current guidelines and is the only currently available method for home test kits.

Many EUA marketed tests fail to disclose information regarding the test’s sensitivity and specificity either on their website or on package labeling. For this reason, it is beneficial to refer patients to those tests which have disclosed sensitivity and specificity above 90% in order to decrease the incidence of false negatives.

There are many tests, including some that promote fraudulent and/or misleading information, advertised to patients, which can make safe and effective product selection more difficult. As one of the most accessible and trusted health care professions, pharmacists are aptly positioned to help patients navigate the many options available for at home testing.

The table below contains a review of the currently available EUA issued home sampling kits that can be prescribed to patients.

Pixel by LabCorp COVID-19 test home collection kit

			Diagnostics Self-Collection Kit for COVID-19

Articles

Following the issuance of several emergency use authorizations by the FDA that allow at-home sample collection, it is imperative for the pharmacy team to stay abreast of current testing recommendations and limitations.