Corona test: important questions and answers

The coronavirus test is carried out daily on many people in Germany. For example, if they have respiratory symptoms, they may contact an infected person in community facilities for “free testing” after an infection or voluntarily. How does a coronavirus test work? Who bears the costs, and where can I get tested? When is a PCR test recommended, and when is a rapid antigen test recommended? How long does it take for the result to be available, and what happens if the test is positive or inconclusive? Here, you will find the most frequently asked questions and answers about the test for the coronavirus.

When is a coronavirus test carried out?

To combat the coronavirus, the federal government has developed the so-called national test strategy in addition to hygiene and protective measures. It has adapted several times to the current situation. It defines a targeted procedure for the coronavirus tests. This document shows when who receives which type of corona test. The assessment of the treating doctor or the responsible health authority is also essential.

Unless the test is carried out on doctor’s orders, a positive rapid antigen test is a prerequisite for a PCR test. A positive self-test also entitles you to a PCR test. However, a red warning message on the Corona-Warn-App is no longer sufficient.

Due to the limited test capacities, the evaluation of PCR tests can be prioritized so that members of risk groups and employees in the medical field and vulnerable areas (e.g. home care) are tested preferentially or receive the result of their PCR test.

The following people should carry out a rapid antigen test themselves or have it carried out at a test centre:

• People with typical symptoms of the coronavirus (e.g. severe respiratory symptoms) – regardless of whether they are vaccinated or have recovered
• People who have had contact with a person infected with SARS-CoV-2 (members of a household, contact persons of infected people, people identified as contact persons by the Corona-Warn-App)
• People in community facilities (e.g. medical practices, schools, daycare centres) and community accommodation (e.g. asylum seekers’ homes, emergency accommodation) and their visitors if an outbreak has occurred there
• People who are admitted to hospitals and care facilities as patients or residents, for example, and who are about to undergo outpatient surgery or dialysis

In addition, rapid antigen tests are used for preventive testing in hospitals, practices or care facilities – individual test concepts can be used here, including series tests. The hygiene and test concepts can also provide rapid antigen tests in the operational context and educational institutions.

Who bears the cost of the coronavirus test?

Health insurance companies cover the costs for a PCR test for a coronavirus infection if the treating doctor or the notified health authority considers it medically helpful and if a previous antigen test has been positive. In some cases, contact persons of infected people or people in community facilities are also entitled, provided a doctor or the health department confirms the need.

In the case of preventive tests (usually with rapid antigen tests), the federal states or employers also bear the costs. The groups listed above are currently being tested and serve as a benchmark.

Since June 2022, only certain groups of people have been entitled to the free citizen test. These include, for example, children under the age of five, pregnant women in the first trimester, carers, infected people who want to “test themselves”, and other particularly vulnerable groups. Otherwise, a personal contribution of three euros is due for the citizen test. The costs for self-tests must be borne by yourself.

How does the standard test for the coronavirus work?

A swab is usually taken from the nose and throat using a special swab to test for the coronavirus. Since the coronavirus affects the lower, deep respiratory tract, especially in the later course of COVID-19, sending coughed-up secretion to the laboratory for diagnosis makes sense.

 

Corona test: how is the sample examined?

After the swab, the samples are sent to the laboratory. The standard method, PCR (polymerase chain reaction), is used to detect the virus’s genetic material in the secretion. The genetic material is greatly amplified, so even small amounts of virus can be seen. If there is an infection with the coronavirus, this is indicated by coloured markings.

In the meantime, rapid tests have also been developed that are also based on the PCR method. While the PCR usually takes place in several steps in the laboratory, cartridges for analyzing the sample are already integrated into the rapid tests. This means that the test can be carried out directly on-site, transport to the laboratory is no longer necessary, and the result is available within a few hours. On the other hand, the tests are significantly more expensive than the classic PCR tests, consume more material, and yield less reliable results. For this reason, they have only been carried out in some instances, for example, in the emergency room, outpatient clinics, or nursing homes.

Gurgel-Tests

So-called throat tests can also be used as an alternative to the nose and throat swab. The procedure involves gargling thoroughly with some liquid and then spitting it out. The liquid is also examined using the PCR method.

An advantage of this method is that it is more comfortable for the tested person than a swab. Also, no medical staff is required to take the sample material.

However, it is still unclear how reliably the method indicates an existing coronavirus infection and whether there may be dilution effects. Due to different study designs, the current study situation still needs to allow a definitive assessment. In addition, a change in the test procedure also brings new hurdles in terms of sampling (due to possible aerosol formation) and evaluation in the laboratory (space requirement for the comparatively large throat wash water samples). The suitability of the process is currently being investigated.

In addition, gargle tests are also available as antigen tests.

Antigen-Tests

The antigen test has been part of the national test strategy since October 15, 2020—the antigen test tests for antigens, i.e. protein fragments of the coronavirus. The structure of this test is simple: the sample is applied to a test strip, and you get an immediate reaction comparable to a pregnancy test. The results are available within 15 minutes at the latest.

The addition “colloidal gold” or “colloidal gold”, which can be found on many antigen rapid tests, refers to the way the tests work: tiny gold particles are referred to as colloidal gold, which in combination with antibodies against SARS-CoV- 2 are on the test strip. If protein fragments of the virus are contained in the sample from the throat or nose used, the antibodies turn red in connection with the colloidal gold.

The advantage is that the antigen test can be produced in large quantities and delivers a result quickly – even faster than the rapid PCR test. However, the results still need to be more reliable than the standard PCR test, so this method may only be used in some instances. It is primarily suitable for identifying people with a high risk of infection, but it often needs to be corrected when infected people tend to show a mild course. A negative result is, therefore, only sometimes meaningful. Conversely, however, a positive result must also be confirmed by a PCR test.

How long do you have to wait for the result of the corona test?

The pure analysis of the sample takes about four to five hours with a PCR test. Overall, it usually takes about one to two days from the time the sample is collected until you know your test result – depending on how quickly the sample arrives at the laboratory and can be examined. You will receive feedback as soon as the test result is available. Please understand that the laboratories will be in heavy demand if it takes longer due to the many coronavirus tests.

You must remain calm until the test for the coronavirus has been evaluated and, to be safe, avoid direct personal contact with other people. If you are infected with the coronavirus, you could infect other people.

Where can you get tested for the coronavirus?

If you suspect COVID-19, please do not visit your doctor’s office unannounced. First, call and explain what symptoms you have. If your family doctor’s practice is unavailable, contact the medical on-call service on 116 117.

The local health department is also a possible contact point if an infection with the coronavirus is suspected. There, you will receive information about where to have a smear test, and if necessary, you will be given an appointment. The smear for the test for the coronavirus is usually taken in test centres or hospitals specially set up for this purpose, occasionally also at home or dental practices.

It is also possible for people to be tested and visited at home by medical staff for a swab. This is especially true if they belong to a risk group.

If the coronavirus test is only to be carried out preventively, rapid antigen tests can be used at home. Medical practices, pharmacies, and special test centres offer the opportunity for a test to be carried out by medically trained staff.

What happens if the test for the coronavirus is positive?

If the test for the coronavirus is positive, it is repeated to rule out an incorrect test result. If the rapid antigen test is positive, you should go into quarantine at home and make an appointment for a PCR test.

Depending on the severity of the symptoms and the general state of health of the person affected, the following options are possible after a positive result:

1. If the person has no or only mild symptoms, they can recover at home. You should go into isolation – the health department decides on the duration; the quarantine is usually about five days. During this time, personal contact should be reduced to an absolute minimum. This also applies to people who live in the same household: infected people should stay in separate rooms and eat and sleep separately from the others.
2. In severe cases and if there is sufficient capacity in hospitals, infected people are treated under strictly controlled quarantine measures.

 

Corona test is negative: repeat the test.

If a PCR test for the coronavirus is negative, this does not yet clearly rule out a possible infection with SARS-CoV-2. It is possible that viruses were overlooked in the test because the viral load and virus concentrations in different body secretions vary depending on the stage of the disease. Suppose the coronavirus is initially more likely to be found in the pharynx as the disease progresses. In that case, it increasingly settles in the lower airways and is only detectable in pulmonary secretion.

Suppose there is still reasonable suspicion that there may be an infection with the coronavirus after a negative test result. In that case, the test can be repeated in consultation with the doctor treating you.

Corona test needs to be clarified: what to do?

In some cases, the coronavirus test result needs to be clarified. This can happen, for example, if the sample taken was too small or contaminated. What to do if the PCR test does not give a clear result? Usually, a new sample is then taken, and the test is repeated. If there are symptoms or if there has been close contact with a person who has been proven to be infected, to be on the safe side and if the result is not clear, you should go into domestic isolation until the suspicion can be refuted.

Coronavirus antibody test

Some tests do not detect the coronavirus, but antibodies are against it. Unlike the standard PCR test, these rapid tests do not examine a sample from the respiratory tract but rather blood serum.

However, such antibody tests only sometimes provide meaningful results since antibodies are only gradually formed by the body after infection. It takes a few days, sometimes up to three weeks, for these to be detected in the blood in sufficient quantities. The test can, therefore, be harmful, especially in the initial phase of the disease, although an infection with SARS-CoV-2 is present.

According to the RKI, it is not advisable to make a diagnosis from the result of an antibody test alone. Even if the antibody tests are not meaningful for acute diagnostics, they can make a decisive contribution to researching the spatial and temporal spread of the coronavirus.

 

Behaviour in case of suspected coronavirus

If you suspect you may be infected with the coronavirus, remaining calm is essential. The flu, cold or other respiratory illness can also cause symptoms.

In this article, you can find out what to do if you suspect a coronavirus infection.

Anyone suspecting a SARS-CoV-2 infection should first perform a rapid antigen test. If this is positive, you should contact your family doctor’s practice by telephone, outside of office hours, with the medical on-call service or the responsible health authority. Under no circumstances should you go to a doctor’s office or emergency room if you suspect you have the coronavirus without prior notification. Inform the person you are talking to about your assumption and explain the background. In urgent cases, dial the free hotline 116 117.

Even if the rapid antigen test was negative, you should exercise caution and reduce contacts if you have symptoms or are in close contact with a person who has been proven to be infected. Carry out a daily rapid antigen test to rule out an infection with certainty.