That is Amazon’s at-home COVID-19 check equipment: We tried it and talked to a testing professional about it

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The Amazon COVID-19 test components are simple. (GeekWire Photo)

Amazon launched an at-home COVID-19 test kit for U.S. consumers last month, broadening the options for people to get tested for the disease.

The self-administered test builds on Amazon’s in-house COVID-19 testing program, which has processed millions of tests from more than 750,000 employees, according to the company. And though Amazon is slowing down testing of its warehouse employees, anyone can now order up an Amazon COVID-19 test from Amazon’s website.

The $39.99 price tag (plus $4.10 tax in Washington state) includes delivery via Amazon Prime for all customers, and overnight return of the sample to Amazon’s lab in Kentucky.

At GeekWire, we decided to try out the test. I did not have any symptoms and had been vaccinated but was willing to serve as the guinea pig. My conclusion: the whole process was Amazon-easy. Delivery of the test was rapid, and I had my result within 24 hours of mailing it back on a weekday.

For this episode of GeekWire’s Health Tech Podcast, we also talked to an expert in COVID-19 testing, Jerry Cangelosi, a University of Washington professor of environmental and occupational health sciences.

“I thoroughly applaud it,” he said of Amazon’s COVID-19 test, citing the public health benefits of making testing more widely available.

But how accurate is this type of self-administered COVID-19 test?

Cangelosi and his colleagues published a study last year that helped set the stage for at-home COVID-19 testing. That study showed that collecting a non-invasive sample from lower in the nose area detected almost as many COVID-19 cases as the gold-standard collection method, a nasopharyngeal swab: “Basically a Roto-Rooting that goes right back to the base of your brain,” said Cangelosi. That’s the kind that makes you sneeze and also puts health care workers at greater risk.

You can’t collect a nasopharyngeal sample yourself, so home testing involves that lighter touch in the nose. The Amazon test has emergency use authorization from the U.S. Food and Drug Administration for people ages 18 and over.

The COVID-19 testing service adds to Amazon’s health care offerings, including its Halo health band and service, cloud services for healthcare and life sciences, and its prescription delivery service Amazon Pharmacy. According to Business Insider, plans are under discussion at Amazon for a larger foray into health diagnostics.

“Healthcare is going to become a bigger and bigger component of what their strategy is going to be, from every angle,” said John Rossman, a former Amazon business leader and the author of The Amazon Way, in a recent episode of another GeekWire podcast, Day 2

Taking the test: Amazon-easy

How to take the test. (Amazon Photo)

Ordering the test, taking it, and receiving the results was simple and easy.

I ordered my test by early afternoon and the test arrived at my home in Seattle the next day before 11 a.m. Before taking the test, I registered it online at Amazondx.com, which sets the clock ticking to get it in the mail within 24 hours.

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Amazon uses a PCR test, the type of test used at free testing sites in Seattle and other municipalities and generally requires analysis in a lab. PCR tests are more accurate than the often-cheaper antigen tests, which provide results within minutes but can miss some infections, particularly at the early stages. An Amazon spokesperson provided us a link that describes the test types, which unfortunately was not easily accessible on the website by searching for COVID-19 tests.

The kit has an almost Ikea-like quality with simple diagrams to accompany the short instructive video. There’s even a handy cardboard circle cutout to place the collection tube so it doesn’t spill. I swabbed each nostril for 15 seconds (not too far up, no need to sneeze).

Handy tube holder. (GeekWire Photo)

Some at-home tests come with video observation to make sure you take the test correctly, such as a kit available from Costco for over $100. That kit is approved as part of the travel program to Hawaii, unlike Amazon’s test (which works for most other travel locations).

In Cangelosi’s study, patients were observed by a health professional as they self-administered a nasal swab. The Amazon test does not involve such observation, which may put a dent in accuracy. Still, the instructions were clear, so it seemed hard to get it wrong.

In the absence video observation, I pulled in some neighborhood kids who may or may not be related to me, as witnesses to my test. “You’re not doing it right!” one said. I’m not sure exactly what she thought I was doing wrong, but either way fixing it was not getting me to Hawaii. I popped the swab into the collection tube and taped up the return box.

Clear instructions. (GeekWire Photo)

As with some other test kits, this one needed to be dropped off at a UPS drop box or store.

“I don’t have COVID-19 symptoms!!” I assured the clerk, “I’m doing this for work!”

She looked at me like I had lost my mind. Amazon did not remind me to wear a mask (which I did) or to wrap myself in an impermeable plastic coating (which I did not).

I delivered my sample to UPS at 4:15 pm on Tuesday and Amazon notified me by email and text at 7:03 a.m. on Wednesday that it had arrived at the lab. At 1:25 pm I received an email and text to check my results on AmazonDx.com. I signed in with the same Amazon username and password I use to buy products on their website.

Return box. (GeekWire Photo)

My test came back negative. I was not surprised by my result, but I must admit I still felt a little relief. Breakthrough infections in vaccinated people are rare, usually mild and can be asymptomatic, but I didn’t want to pass along anything unknowingly to vulnerable people I’d been close to. If I had tested positive, Amazon would be legally required to notify public health authorities, according to its website.

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Overall, the experience was simple. It would have been easier for me to stop by the free testing site only a mile away from my home, but not everyone has such close access to free testing in Washington state or nationally. Amazon’s test seems like a great public health tool.

Mixed messages on Amazon.com

While the test kit is a positive for public health, the array of anti-vaccination literature on Amazon may have the opposite effect and appears to be more popular, judging by the number of positive reviews.

My initial search for “at home covid testing kit” pulled up the Amazon test as well material such as a Kindle book warning about the COVID-19 vaccine and “ww3 tools for world depopulation and organ degeneration.”

Amazon has had an uneven and opaque approach to COVID-19 misinformation on its site, removing some material and keeping others. It’s not difficult to find similar publications on Amazon, such as material by Joseph Mercola, number one on a “Disinformation Dozen” list of people responsible for anti-vaccine messaging compiled by the nonprofit Center for Countering Digital Hate. Mercola’s “The Truth about COVID-19” has the added bonus of a forward by Robert F. Kennedy, Jr., number two on the list. It’s been reviewed more than 1,600 times and is the number one best seller in “Diseases & Physical Ailments Health.”

You can also buy supplements from Mercola’s supplements company on the Amazon site but not online from Walgreens, Bartell Drugs or Rite Aid.

Pair this with your COVID-19 test?

Listen above, subscribe in any podcast app, and continue reading for highlights from our interview with University of Washington’s Jerry Cangelosi, edited for brevity and clarity.

University of Washington Professor Jerry Cangelosi. (UW Photo)

Q: Your study enrolled about 500 patients in the Seattle, with about 10% testing positive. You compared the gold-standard nasopharyngeal swab to less invasive swabs, self-collected by patients under observation. What did you find?

Cangelosi: Each patient provided a nasopharyngeal swab, a non-invasive shallow nasal swab, and an oral swab. Basically, the shallow nasal swab detected 94% of the patients that you could with the gold standard nasopharyngeal swab. The oral swab was a little bit less at about 90%.

It turned out that the nasal swabs did the things that we wanted to do. They were easy for patients to collect on their own, but they worked almost as well as the invasive procedures.

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Q: How significant is the difference between the collection methods, and what does it mean for the viability of self-administered COVID tests?

Cangelosi: It’s very significant. So, you’re going to miss 6% of your patients, and in other evaluations it’s been more than that.

I’m a public health person. And my mission is to try to find ways to identify as many COVID patients as possible. Because when you identify a COVID patient, you can say, “You have COVID-19. Please isolate for two weeks.” And that’s going to stop the transmission of the disease.

And so, there are people that simply could not be reached by nasopharyngeal swabbing. That has to be done in a clinic. And there’s just not enough clinical facilities and not enough healthcare professionals to collect them all.

Q: What do self-administered tests the test mean for public health and COVID-19 transmission?

Cangelosi: We’re going to find more cases with self-administered non-invasive sampling. And of course, Amazon wants to take that to the next level. You’re going to need a non-invasive sample to do that.

And so, our dream, and it’s still just a dream, is to be able to approach people actively in a school or in a workplace or in an institution and test people more regularly so you can find people who are sick before they even know they’re sick. And then that way you can get them isolated or get them on treatment, and so they’re not spreading it around.

I think even though self-collected swabs are not going to be quite as good as provider collected swabs, they’re going to find more cases, and that’s good.

Q: What do you think of using UPS as a drop off location?

Cangelosi: That does seem a little bit problematic. Let’s just say it’s a work in progress. I think that Amazon is capable of bringing things along. I could conceive maybe if this catches on that there could be the establishment of drop boxes that provide for a little more isolation. I don’t encourage people who think they have COVID to go into a UPS Store.

Q: What would you leave us with in terms of where this is headed? In your ideal world, what would the testing landscape look like in a year or two?

Cangelosi: As much as I appreciate what Amazon is doing, and I thoroughly applaud it, in the ideal world, everyone has enough common sense to get vaccinated and so this whole topic becomes irrelevant, including my research in this area. And then I go back and start fighting tuberculosis in Africa again. There’s a vaccine against COVID-19. And if everybody used it, we’d be talking about something else.

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