Everyone should be able to take a rapid home COVID test for an affordable price (IMHO, that would be $5 or less in the USA) as often as needed at this point in a pandemic. In reality, the cheapest tests available to Americans cost at least $10 per swab, and supplies are so limited that even those who can afford tests don’t have access to them.

For those of us fortunate enough to have a little more disposable income, however, there is an option available and in stock for shipping as of January 5, 2021, though at a higher price: the Cue Health Monitoring System.

Cue’s Health Monitoring system is composed of a device called the Reader, COVID-19 test cartridges sold separately, and the Cue Health App which runs on your smartphone.

The company is located in San Diego, California. Cue manufactures its test cartridges and produces its biochemistry components domestically, in house, to avoid supply chain disruptions such as we’ve all suffered this year.

Cue Reader at home molecular COVID-19 test

My family bought a Cue Reader home molecular test device ($249) at the end of 2021. Test cartridges are sold separately direct from Cue. They’re currently available in packs of three ($225) or ten ($712.50) or bundled with membership services in even more expensive packages.

We used a Cue COVID-19 test for the first time on January 1, 2022 to test our vaccinated but un-boosted teen after a cross-country flight. This was before he spent an hour—still masked, just in case!—visiting his vaccinated, boosted, but vulnerable grandfather.

A Cue COVID-19 test is a molecular test. This is more like a laboratory-based PCR test in quality than the typical home antigen test purchased at a drugstore, but the technical process isn’t identical to the hospital version.

The COVID-19 test is an FDA approved test under Emergency Use Authorization EUA210180, the same level of approval as most other COVID-19 tests and treatments.

Cue’s COVID-19 detection cartridge is a test you perform yourself, at home, with the Reader automatically processing your swab right in your living room or kitchen, bathroom, etc.

There are no samples to ship; no run to the post office or a FedEx drop box is required.

To use the Cue Reader, you swab your nostrils, stick the swab into the otherwise sealed test cartridge you’ve placed in your machine, and initiate processing via your cell phone. You’ll have a result displayed on your phone in about 20 minutes without leaving your house for about $75 per test.

Cue COVID-19 tests are accurate enough to be used for international travel, but to do so requires an expensive, upgraded subscription option that covers medical supervision via video for a certified result. I’ll talk about access to certified tests via “Cue+” membership later in this post, but it’s not required for personal virus screening.

Molecular (e.g., PCR) vs. antigen COVID-19 tests

A Mayo Clinic study found 97.8% agreement between Cue’s COVID-19 test results and those of a central lab PCR test. This is significantly more accurate than drugstore antigen tests but with the same degree of at-home convenience and with results available in a similar amount of time.

The Cue Cartridge Reader device performs a molecular test in search of bits of RNA from the SARS-CoV-2 virus. An antigen test, on the other hand, looks for proteins from the surface of the same virus.

Cleveland Clinic describes molecular vs. antigen tests here.

I’m not the best person to further explain the difference between molecular and antigen tests, though I’ll run any questions that show up in the comments by my husband, the biologist, but a pair of links† in the comments may offer enough explanation for the mildly curious reader.

For those who prefer the endorsement of the rich and powerful over checking data, Google supplies Cue tests to its US employees as a work from home perk, and the NBA is relying on this product to protect its players during the 2021-22 season.

I learned about the Cue Reader and its COVID-19 tests from this Washington Post article by Steven Zeitchik. The Detect system mentioned in the article was already out of stock, but the Cue was ready for shipping.

Had both Detect and Cue systems been available, I probably would have agonized over the details of which to pick.

After I shared Zeitchik’s article, my husband immediately ordered a Cue Cartridge Reader for household use since I was still out of town, visiting my father. We anticipated a round of testing after airline travel and holiday gatherings beyond our bubble. We’ve since conducted two Cue COVID-19 tests with the Reader.

For an up front cost of $249 for a gadget, plus the annoyance of installing an app and creating yet another online account, then an additional $75 per test, anyone can administer a molecular COVID-19 test at home and have results within half an hour.

Availability made the decision for my family

Pharmacies are sold out of antigen tests everywhere I’ve looked in my area (New England) as well as near my father’s home (Pacific Northwest), making mere availability of the Cue system a tremendous selling point.

Having missed an entire holiday season in late 2020, I would have paid almost anything I could afford to see 2021 end in a more traditional manner.

Paying $75 per test instead of $12 a swab for the Abbot BinaxNOW doesn’t delight me, but it becomes more reasonable when I recognize that Cue’s is a superior, more accurate test.

For my family, using one $75 molecular Cue test—alongside a package of two BinaxNOW tests for the other family members who travelled—seemed like the best blend of caution and frugality. Performing serial testing on two separate occasions, a different family member took the molecular test in each session.

We foresaw the need for serial testing since we wanted to greet a relative shortly after our flight yet before the end of the average incubation period for Omicrom or any other strain of the virus.

Added value derived from a higher quality test

Users of a home test should know the “specificity” and “sensitivity” of the test they are taking. Cue’s COVID-19 test has 96% Sensitivity and 98% Specificity. Sensitivity tells us how well a test can identify a person who has the disease (positive cases) whereas specificity measures how well it identifies individuals who aren’t sick (negative cases.)

When one of these measures is less accurate, you can get false positives (a test says you are sick when you are actually healthy) or false negatives (a test says you are healthy when you actually carry the illness in question.) False positives just cost you time away from other activities, but false negatives can lead you to unwittingly harm other people.

Antigen tests can result in as many as 20% false negatives.

To be clear, access to an antigen test with “only” an 80% chance of identifying an active infection is still very, very helpful. I strongly encourage anyone who can get ahold of an affordable home antigen test to use it to protect vulnerable loves ones!

The more often at-risk individuals use antigen tests, the healthier we can stay as a society. That said, a test that is even more accurate does seem worth its higher price.

I will gladly pay $75 for a test with fewer false negatives before visiting my grandmother in her 90s or even my father or father-in-law both past age 75.

According to the FDA, the Omicrom variant may also evade testing more readily than previous strains of SARS-CoV-2, especially when an antigen test is what’s looking for signs of infection. I think that’s because most of Omicrom’s mutations are on the surface, from which the antigen test is searching for signs of infection… That’s yet another selling point for Cue’s molecular test right now.

Paying for Cue COVID-19 tests

Further details haven’t been released as far as I know, but it was announced in December 2021 that home COVID-19 tests would become reimbursable by one’s private health insurance provider starting in January 2022.

Contact your health insurance provider to learn whether—and how—you can get your purchase price back from them as a reimbursement if you require a COVID-19 test from now on.

I imagine insurance reimbursement will involve filling out forms for most of us, and it may only apply to tests taken due to exposure to the virus or symptoms, not for work- or travel-related elective testing. I’m not an insurance expert, however.

What I do know from personal experience is that home tests, including the Cue COVID-19 test, can be paid for with Flexible Spending Account funds.

Flexible Spending Accounts are an employment perk allowing Americans to set aside part of their income pre-tax for use exclusively toward qualified health care costs. You should know if you have an FSA; ask your Human Resources department if you aren’t sure.

My FSA debit card worked for a purchase made direct from Cue via their website, though I did have to upload a receipt for this transaction. We used up the last few dollars from our 2021 funds with our first order of three tests.

The benefits provider that manages our Flexible Spending Account links to the “FSA Store” online commerce site where all items are guaranteed eligible FSA expenses. A mail-in molecular COVID-19 test offered by the FSA Store cost $199, offering another perspective on the value proposition of Cue’s system.

I’ve never made a purchase from FSA Store, but wanted to offer another price and availability comparison for the home COVID-19 test category.

Unboxing the Cue Reader home molecular test device

When I opened the Cue Reader device packaging, I was reminded of unboxing a new iPhone, but not in the best way. I pulled out a plastic bit I couldn’t identify, then a paper-wrapped mini manual. There was a cord which seemed pretty self explanatory tidied with a pair of paper wraps, but then another flat plastic tray, and was that round thing packaging or part of the device?…

To get to the instructions, I had to wrestle the three-inch-square booklet and an accordion-folded flier out of snug paper wrappings. Admittedly, I’m not the most dexterous, but finding the parts list and releasing it from its bonds was the most difficult part about using a Cue test!

When I open an expensive, novel gadget, I’d like to know immediately which bits are  valuable stuff, and what is just packaging fluff. Cue failed at that, and I worried I would accidentally throw away an important component out of ignorance.

Package designers, please keep all packaging trays made of folded paper instead of plastic, or color code the trash and ditch the modern minimalist design for clarity and ease of use. Unlike a phone, I’ve never unboxed a home medical testing device before. I wish Cue had labeled every part, or put a simple diagram right on top.

I do appreciate that more paper than plastic appears to have been used in wrapping the device. This is all the trash generated by the unboxing.

As it happens, the cord, the wall plug, and one large plastic chunk that turned out to be the Reader were the only valuable bits. That should have been immediately clear.

Flipping through the manual, I thought perhaps a bit of flat plastic was a charging base… until a note further along told me the wireless charging base was an optional accessory which is not yet available for sale on the manufacturer’s website as of January 2022.

I suspect this product was packaged for people who will never crack the paper manual, preferring to watch a video on their phones. Well, that isn’t me. I still like at least an initial overview of every high-value device, printed and in my hand. I’d rather RTFM than view it on YouTube.

The Cue Reader testing device came in a box slightly larger than a Rubik’s cube. Sports fans, think of the box as a softball while the test mechanism itself is smaller than a baseball. Also, far less aerodynamic. Don’t fling it.

Cue Reader device specifications

The Cue Reader is a little less than 3″ square and sits just under 1.5″ high off the firm surface upon which you should set it to run a test.

Together with its power brick and cord, the entire device weighs only 228 grams.

The interesting part—where the action happens—is fairly obviously the open cavity on Cue Reader’s front. Here’s the best photo I could get of the interior. You can see a row of contacts and at least one other port or connection inside, but the user doesn’t need to interact with these elements beyond inserting a closed, sealed test cartridge. It seems like it would be difficult to accidentally damage these internal parts.

On top, there are five LED indicator lights. They illuminate in a pattern when power is turned on or off by plugging it in (there are no switches); I’m not quick enough to get a photo of that lighting effect, but it looks nifty.

Both sides are featureless so one photo should suffice.

The back has the power input port and a manual reset “button” of the jam-in-a-paperclip-when-needed variety.

The only branding or other labeling is printed on the bottom of the Cue Reader. The QR code there is required to initialize the process of pairing a smartphone with the device.

I’ve blurred my QR code and serial number in this photo for privacy. No idea why the retouching made it look like a whale’s tail.

There is no way to use any Cue test without a smartphone and a user account in the Cue Health App. Without its Bluetooth connection to another device and a network, the Cue Reader is a brick. I don’t prefer this aspect of the system, but I recognize that this is the sad world in which we currently live.

Were COVID-19 tests readily available to anyone needing one, I would have thought much harder before joining this closed health ecosystem for reasons of data privacy principle. I do not trust Big Tech with my privacy. Cue does adhere to HIPAA security standards with its data, for what that’s worth.

The cord is longer than it needs to be at almost 5′, but excess length is more convenient than too little.

The flat cord coils easily, though it’s too fiddly for me to fit it back into the original box. The carton might otherwise be a great place to store‡ the device. You’ll have to wrap the cord just so to make it curve neatly around the ring of plastic packaging inside to pack it all back as it was for shipping.

The cord seems to have USB-C connectors. They fit into my Anker brick, but I have no intention of trying to run a test with random wires. I will instead stick with the OEM cord to power or recharge the Cue Reader.

The manual (page 35) does say to use only the included power cord and adapter.

The Cue power adapter provides 7.5 W and has folding prongs making it well suited for travel and tidy storage.

The two tests we’ve processed have been run with the power cord plugged in to the wall outlet. The Cue Reader contains a rechargeable battery for those who might want to test themselves away from home.

Cue claims an eight hour battery life.

Tests can only run when the machine is on a flat, level surface, however, so power isn’t Cue Reader’s primary limitation. I imagine there is a narrow range of appropriate temperatures at which the process can work as designed, though I haven’t explored that question extensively.

The COVID-19 test cartridge packet indicates it is for use only in a temperature range between 59 – 86 °F. I would test carefully if away from wall power and controlled indoor conditions.The Cue Reader will warm up a little bit while a COVID-19 test is processing inside, but it never felt even remotely hot to the touch when I checked it throughout my test.

Administering Cue COVID-19 home molecular test

We opted for a three pack of COVID-19 tests with our device. That was the minimum possible package in December 2021. Tests bought then came with a June 2022 expiration date, so a six month shelf life.

Update January 6, 2022: An additional box of 10 test cartridges ordered on January 4th—using Cue’s least expensive, regular shipping option—arrived the next day (2022-01-05) at our home. Expiration date for this batch of ten tests is 2022-09-14 for an eight month shelf life.Within the outer carton, each of the three COVID-19 molecular test cartridges came wrapped in its own sealed foil pouch. I feel confident that this format will keep a test fresh for at least its stated shelf life.

For the cartridges, packaging seems adequate, appropriate, but not excessive.

If the carton gets misplaced or destroyed—or if I choose to travel with just a single test cartridge instead of the whole box—I won’t worry about the integrity of a test cartridge tossed loose into a carry on or suitcase. They feel sturdy.

Having conducted quite a few Abbott BinaxNOW antigen tests on my family by this point, it felt uncomfortable to old-school me to begin without an unfolded paper instruction sheet on the table in front of me.

The Cue Reader’s manual provides only minimal starting instructions. The rest will be viewed upon your own device. You don’t have to like it, but, if you aren’t willing to play along, this isn’t the COVID-19 test for you.

I’ll offer a brief description of the testing experience from memory, but mainly to point out ways in which taking/administering a Cue test varies from the BinaxNOW home antigen test process.

Begin by unpacking your Cue Reader and plugging the device into wall power (or charge the battery.)

The LED lights will flash in a pattern to show you’ve powered the device on, then they go dark again while waiting for a test to commence.

Battery status is visible within the Cue Health App, under Manage Readers, but not on the device itself which is mostly featureless.

You must download and install the Cue Health App on your smartphone. We used an iPhone, but the Google Play Store should offer an Android version.

Don’t bother to open your test cartridge pouch until you are logged in to the app with a User Profile created for the person being tested. You should use a test cartridge within 30 minutes of taking it out of its wrapper.

Definitely don’t gather any young child waiting to be tested until after you’ve set things up for the first test. This step can take a few minutes, especially because you create the adult account holder’s User Profile before any child User Profile.

Per Cue’s manual:

If you purchased your device direct from Cue, as we did, the person who placed the order may already have a Cue account and should use that to log in to the Cue Health App. The account holder can make multiple user profiles, for example, for a parent and multiple children. Nothing prevents an adult account holder from creating a User Profile for a different adult.

Another useful point to know in advance for use cases with multiple adult users is that a single Cue Cartridge Reader device can pair with multiple smartphones. Similarly, the same iPhone should be able to pair with multiple Cue Cartridge Readers, though I haven’t personally confirmed that functionality.

Both of our iPhones paired readily to the same family Cue Reader; so could that of my father-in-law, my neighbor, or my teen.

Cue’s website does specify that children should have adult assistance with testing, probably just for liability reasons.

If your office has a Cue Reader, you can pair your phone both at home and at work, presumably using the same Cue Account to access all of your results. Again, I can’t check that detail without access to a second Reader. Sorry!

We’ve only got access to the one Reader. Both parents in our household created separate Cue accounts to monitor test results or purchase future supplies of tests and paired each of our own iPhones with that same Cue Reader.

We then created User Profiles for one of our two kids each under our own User Profile to see how the system works. This way, we are ready to test either child as needed.

I’ve got a tech support question in to Cue Health Customer Support asking if child User Profiles can be shared by both parents, but haven’t received an answer from them. We don’t always know in advance which parent will take a child to a given medical appointment, so it would be nice to have a complete record available to either.

Entering information into the app on my iPhone 12 Mini was mildly annoying.

The Cue Health App has one of those interfaces that decides before you are finished entering data—a date of birth, in this case—that your partial answer is an invalid one. The app then slides half the data entry form off the screen in a misguided attempt to be helpful.

Unlike some apps, the Cue Health App didn’t permanently shove the required boxes off my admittedly small screen, but it still left me feeling like some software improvements could be made. Overall, everything runs smoothly, though, and the interface seems thoughtfully designed.

I appreciate the fact that DH and I could each keep our medical records to ourselves if we preferred to do so. This functionality makes the Reader more appropriate for offices or roommate situations than it might otherwise be.

Having made an account and described the user you’re about to test, scanning the QR code on the bottom of the Reader will “Set Up your Cue Cartridge Reader.” There are some troubleshooting steps in the booklet, but our Reader was ready within moments with no trouble to be shot.

Now the manual tells you to carefully follow Chapter 4: Running a Test on the Cue Cartridge Reader, but this photo gives you almost the entire contents of that oh-so-illuminating chapter.

Travel with the Cue Reader

Packing the Cue test system

Taking the Cue Reader along on a trip shouldn’t cause a typical traveler too much trouble. It is both compact and light in weight.

Due to my annoyance with re-inserting the cord into the Reader’s original box, I tried tucking the three parts of the device into the open carton with two remaining COVID-19 test cartridges instead. It’s a snug fit, but forms a package about the size of—while much lighter than—a hardback book.

Packed together in this way, the combination of Cue Reader and two COVID-19 test cartridges weighs in at 326 grams. Straight from the pharmacy, an Abbott BinaxNOW package of two tests is even lighter, weighing only 102 grams.

Side by side, a BinaxNOW package of two tests is longer than—yet similar in width to—a Cue COVID-19 Cartridge carton, but Abbott’s antigen offering is much thinner. My rough estimates for both are 5″ x 7″ x 2.5″ (87.5 cubic inches) for the Cue box vs. 9″ x 5″ x 1.5″ (67.5 cubic inches) for a BinaxNOW package.

I’ll remind you that this is just the test cartridge box that I repurposed to also hold the Reader itself.

While the Abbott test is clearly smaller and lighter in weight, the important thing to note is that travel with the more sensitive and specific Cue testing system isn’t likely to be the straw that breaks any camel’s back. Either would be easy pack.

I carried a BinaxNOW box of tests on my last flight because I was afraid I wouldn’t be able to buy one when I needed it. I was right, I couldn’t. Any test in hand beats the test that’s out of stock.

The lack of moving parts in the Cue Reader makes me feel confident that my usual degree of caution with my personal baggage should provide it with sufficient protection within a carry on bag while in transit. No aspect of the system feels particularly delicate or prone to damage from rough handling, though I wouldn’t press this point myself.

A hard-sided case might be nice for the pricey Cue system, but I don’t think one is necessary.

Certified COVID-19 test results with Cue+ Complete membership

But what if you need proof of a recent negative COVID-19 test in order to travel, for example, internationally? Cue can help you with that, but you’ll need more than what I’ve described thus far.

If you want an officially supervised COVID-19 test that will be accepted for travel, you must pay extra—a lot extra, currently $89/month on a one year subscription—for a Cue+ Complete membership to upgrade the Reader’s functionality. That’s $1068 per year.

It was obvious within the Cue Health App how one could upgrade with the click of an on screen button.

Membership doesn’t change the device in any way. Your test results won’t be any more reliable or accurate. What you get, however, is a telemedicine consultation that offers certified results in exchange for a medical provider supervising your self-swabbing and the subsequent test run.

Presumably, if one tests positive, that health care practitioner will also provide care, prescriptions, and advice on what to do next, which is not a valueless proposition.

Cue+ Complete does—according to the website, because I don’t have it!—include a discounted Cue Reader, 20 COVID-19 tests, and some other telemedicine access for its fee, but it is not a package my family considered. We were merely looking to protect our local community and make domestic travel safer, so we didn’t need the membership.

I note, however, that the Cue+ Complete FAQ’s include this one:

“Cue+ Members can share virtual care and other benefits with family members.”

I read that to mean all the members of my household could use a Cue+ membership if I paid for just one. I haven’t delved into the fine print for Cue’s lawyers’ definition of “family members.”

If I were making an international trip with my family of four, and all were covered by a Cue+ Complete Membership, the combined cost—$1068 + $149 (for a discounted Reader device with membership)=$1217—of $1217 would become far more attractive.

Assuming a need for a negative test both before leaving the country and before returning to the USA, and with the 20 tests included in the package more than covering the eight required for parents and two kids, the total for just the mandatory travel tests works out to $152.13 per certified result ($1217 ÷ 8 mandatory tests.) After that, our hypothetical family of four would still have a dozen COVID-19 tests to use for other purposes, further increasing the overall value of membership.

$150 per test is well within numbers I’ve seen travelers quoting in recent horror stories. Travel site ThePointsGuy gives a range from $90-349 per travel COVID-19 test in the post linked here. Many would-be international travelers are missing flights due to late results, too, which would be virtually impossible when bringing along one’s own Cue system since a doctor would on call via cell phone.

Bottom line: Nice to have, but not vital, Cue Reader’s value will increase if new tests are added in the future

If I couldn’t afford my rent or heating bill, I would not splurge on the Cue system. I see it as a great thing to add to my already comfortable life, but not as essential as heat or even broadband internet.

Theoretically, the makers of the Cue device will someday offer more kinds of tests. Sexual health, cardiac, and metabolic testing are amongst the categories of home diagnostics mentioned on their website as potential developments. I love the idea of having ready access to home testing for common conditions.

If I could plug in a flu test cartridge or one for strep throat, send the results to my primary care physician, and get medication prescribed via telemedicine appointment without the hassle of dragging a sick kid or, worse!, a sick me through traffic to his office, I would happily spend $30-50 a pop on that convenience.

Realistically, having splurged on the Reader already, I’ll probably keep spending $75 per test if that’s really what home testing needs to cost. I’m very willing to pay extra for a USA-made product that keeps essential goods and services grown/manufactured domestically.

At the moment, where a septuagenarian lives in my household and no over-the-counter antigen tests are available locally at any price, $75 per test feels like a bargain, and I’m only a little irked by the $250 up front for the Cue Reader device.

I recognize that this position is a result of the great good fortune of my life, and I’m grateful that I don’t have to think twice about paying to protect my loved ones. I hope that early adopters like me can help bring down the cost of similar products, putting this technology within reach of more organizations and households as time goes on.

I have already reached out to a neighborhood friend about this purchase. “If you can’t get a test and need one for your family,” I told her, “I’m happy to share my device if you just want to buy your own Cue test cartridges.”

In reality, it may not be every household that needs a home molecular testing device, but having one in every school seems like a no brainer. Every nursing home, maybe even every gym, and certainly all day care centers, could offer participants on-site, stress-free testing for common ailments for the common good.

What a relief to get clarity about one’s contagiousness without losing hours of personal time for an office visit that may result in nothing but advice to take rest and fluids.

What I love about the potential of the Cue system is its modularity and expandability. It’s got so much potential to improve a stressful part of modern life.

If we aren’t going to have universal healthcare like a developed nation, the least we can do is authorize widespread availability of useful technologies to allow for more advanced self- and community care.

Doing so might simultaneously limit the spread of disease in congregate settings full of vulnerable people. That’s what the Cue Health Monitoring system offers with its Reader device and COVID-19 test cartridges today.

Note: I composed this review of the Cue Reader in January 2022. In June 2022, I purchased shares of common stock in its manufacturer, Cue, and thereby acquired a financial interest in the reviewed product.

♦

†For a brief comparison, reporter Steven Zeitchik offered the analogy, “The antigen test is basically to the molecular test what a cloth mask is to the N95.”

Note this is the same link to the same article that I give in the main body of this post.

From a different NBC news article, another expert, Dr. Omai Garner, said, “It takes more virus for the antigen test to be positive than it does for the PCR to be positive,” explaining one reason antigen tests give more false negatives—which might trick a sick person into thinking she is healthy—than a lab test would.

‡Since the packaging is also about twice as large as necessary given the size of the components, I will be adapting a Tupperware or travel pouch I find lying about my cluttered home for Cue Reader and Cartridge storage purposes. If I find an ideal object for this purpose, I’ll update the post with a link if it’s something available for sale.