Every American traveling abroad needs to take an antigen test to return to the United States. But the start of the trip is often even more cumbersome, as many other countries (nearly every one I have traveled to since the pandemic) require the more difficult and expensive molecular (PCR) test. In most cases this must be taken within 72 hours of departure, but the test results can often take three days and most test sites do not guarantee faster turnaround. Those that do often charge an arm and a leg - I know a traveler who just paid $250 for a same day PCR test so she could go the Caribbean.
But what if you could get similar results in 20 minutes - without leaving your house?
Three days ago, a new solution went on sale that is faster than anything on the market and competitively priced. Publicly traded healthcare technology company Cue Health (Nasdaq: HLTH) launched its direct-to-consumer virtual health platform on November 15th. The flagship product is Cue’s first-of-its-kind home molecular Covid-19 test and claims to be the first molecular self-test to receive FDA authorization for at-home use without a prescription (For clarification, there are two types of testing, molecular and antigen. Molecular COVID tests are also called nucleic acid amplification test, or NAAT, and PCR is the best known form of molecular testing, but most of the time the requirement is actually for molecular testing, which has become synonymous with PCR even though not all molecular testing is PCR. However requirements vary by country and some places will not accept NAAT tests other than PCR). The company says its testing is already used by the Mayo Clinic, NBA, and Major League Baseball.
The required hardware is the Cue Reader ($249), a reusable compact device half the size of a smartphone that processes each sample and connects wirelessly to your mobile device via the Cue Health App (for both iOS and Android). The tests use nasal swabs and self-contained, single-use cartridges that go into a slot on the reader (I have had a lot of PCR and antigen tests, but I have not yet tried Cue myself).
For those who simply want to test themselves regularly at home, that’s about it. But for travel you need the results so be official, which means doing the testing live via video with a medical proctor who can certify the testing. This is the same way that BinaxNOW works, and this product from Abbott Labs is currently the most popular self-test option for travelers. But the big difference is that BinaxNOW (which I’ve bought for travel) is an antigen test accepted for those returning to the U.S., but it doesn’t work for traveling to the many countries requiring a molecular test. However, the Cue test may also not work for some countries requiring PCR tests. In addition, the landscape is fast changing and what may be acceptable today may not be weeks or months from now, or vice versa. Another catch is that to get the supervised certification requires a monthly subscription to Cue+ Complete™.
For frequent self-testers, the main selling points are speed and convenience, and the more recognized detection of molecular testing, as you can already do at home antigen testing for less, as the non-travel version of BinaxNOW is around $24 per test, and Cue is $54-$75 depending on quantity. But for frequent international travelers, this is likely to be the least expensive alternative (unless you get free PCR testing), the most convenient, and almost certainly the fastest - and for many the only way to ensure you get results in the needed time frame (availability and price of testing and time frame varies greatly from state to state). In comparison, the widely available Everywell home PCR test requires shipping your sample to a lab, and you get results 24-48 hours after receipt, which adds at least a day in shipping, and that test costs $109. Frequent travel website The Points Guy just did a roundup of rapid (same day) PCR testing sites around the country and prices varied from $199 (San Diego, LA, Denver) to $299 (Las Vegas) with most around $250, plus another vacation detour before the airport.
But, and this is a big but, if you are buying this for travel, before committing to the subscription you should make sure that the Cue NAAT molecular test will be accepted in the places you are likely to visit. It may be nearly equivalent to the PCR test in terms of results but not in terms of various international requirements.
At the minimum you need to buy the reader which comes with three tests cartridges, then buy additional test cartridges for $75 each (in 3-packs for $225). But for more frequent testing, there’s the monthly Cue+ Essential™ plan ($50 a month) which includes 10 Covid-19 tests per year, 20% off additional tests, $100 off the Cue Reader and 24/7 telehealth primary care visits. This brings the cost down to $60 per test. The Cue+ Essential plan ($90 a month) adds the all-important CDC-compliant, supervised and certified Covid-19 testing for travel, work, or school and includes 20 Covid-19 tests per year (effectively $54 each). The beauty of both subscriptions is that they cover your entire household. If you have a family of four and are paying $250 for fast PCR tests for a trip, the entire year can essentially be paid in one vacation (you still need to thoroughly check requirements where you are traveling to as some destinations specify PCR rather than molecular testing, require tests from specific providers or test results signed by the administering professional).
And even though you don’t need a molecular test to come back home, it can still save you money. I just returned from St. Barts where the antigen test at a pharmacy costs nearly $65 bucks. In addition, you can pay for the Cue with HSA/FSA dollars, which some people are trying to use up right about now.
Cue basically combines the speed of rapid antigen tests with the lab-quality accuracy of PCR tests and does it at home, or in your hotel or wherever you are. Cue says its portable Covid-19 test showed 97.8% concordance with central lab PCR tests in independent studies and is authorized by the FDA to test both symptomatic and asymptomatic adults and children ages two and up using a lower nasal swab.
For now, this is big thing, but the company looks at the Cue Reader as the mainframe of an integrated home health testing platform and plans to augment it with future care offerings across the categories of respiratory health (such as for influenza, RSV, and strep throat), sexual health (such as for chlamydia and gonorrhea), cardiac and metabolic health (such as for cholesterol and HbA1c), women's and men's health, and chronic disease management.
But right now, people are traveling again, and I get more questions and see more stress around testing than any other travel-related issue, so it is good news whenever testing gets easier.
