PCR test after positive rapid?

[Natitude61]

Just because I’m rather anxious about this whole testing bit, does anyone know if RCI will accept a negative PCR after a positive rapid test? I know the rapids can have a 4% or so false positive rate, and as an RN, I’ve seen a fair share of patients who had a positive rapid followed by a negative PCR (which is considered more accurate). Thinking about having a PCR scheduled just in case my rapid comes back positive, but wondering if ROyal Caribbean will accept if we’ve already been “branded” as positive with the rapid.

 

We do have a testing site that will result PCRs by midnight if taken by 2 pm. And I do realize that I could just do the PCR, but the testing site is a bit far away so just want to have it in my back pocket if necessary. 
 

And to make it clear, we have no intent or desire to cruise if we really are positive…just want to ensure that we’re not prevented from cruising due to a false negative. 
 

Thank you!

[joepeka]

This idea occurred to us recently - get a PCR test (which can take 48-72 hours to return results in our area) AND a rapid test (results in an hour or so). False positives with the rapid test are a concern for us and were hoping we could use the PCR test (assuming it was negative) in place of the rapid regardless of it's results, if the PCR results were returned within the 2 day window. Cannot answer your question really but I'm not sure what "branded" could be applied if you showed a negative PCR test result taken in the 2 day window.

[Rysyonok]

I would not chance cruising after a positive test, false or not. In the day of everything being digital, this could be a lifetime ban in the brewing.

[Lou33]

From what I have read, the rapid antigen tests are extremely accurate if they show a positive result.  But they have a much greater chance of showing a false negative.   This article shows that 99.6% of positive results are accurate.  That's not 4% false positive.  It's 0.4% false positive.

 

https://www.healthline.com/health/how-accurate-are-rapid-covid-tests#advantages-of-rapid-testing

[Lou33]

25 minutes ago, joepeka said:

Cannot answer your question really but I'm not sure what "branded" could be applied if you showed a negative PCR test result taken in the 2 day window.

If you do a proctored rapid antigen test, the results will go into a database.  Also, I'm assuming that RCI will ask you at check-in if you've had "any" positive test results in the last few days.  I don't know if they will allow a second PCR test as a backup, but I'm not going to lie to them.  

[joepeka]

12 minutes ago, Lou33 said:

If you do a proctored rapid antigen test, the results will go into a database.  Also, I'm assuming that RCI will ask you at check-in if you've had "any" positive test results in the last few days.  I don't know if they will allow a second PCR test as a backup, but I'm not going to lie to them.  

Then what happens if a person gets a positive rapid test 48 hours ahead of sailing and a negative rapid test 24 hours ahead of sailing? Or a negative rapid test on the day of embarkation? 

[Lou33]

4 minutes ago, joepeka said:

Then what happens if a person gets a positive rapid test 48 hours ahead of sailing and a negative rapid test 24 hours ahead of sailing? Or a negative rapid test on the day of embarkation? 

You would have to ask RCI, but I would think that they would not let you sail.  How do you know that the negative result (whether anitigen or PCR) was not a false negative?  

 

If you think about this statistically, there is almost zero chance that you could be impacted by a false positive.  Somebody has no symptoms and they take a test for travel.  You would hope that less than 1/1,000 people would have "any" kind of positive result.  And if they do test positive, there is less than a 1/200 chance that it was a false positive.  So that means that only 1 out of 200,000 people would be wrongly impacted by a false positive.  It is a non-issue.  

[joepeka]

2 minutes ago, Lou33 said:

You would have to ask RCI, but I would think that they would not let you sail.  How do you know that the negative result (whether anitigen or PCR) was not a false negative?  

 

If you think about this statistically, there is almost zero chance that you could be impacted by a false positive.  Somebody has no symptoms and they take a test for travel.  You would hope that less than 1/1,000 people would have "any" kind of positive result.  And if they do test positive, there is less than a 1/200 chance that it was a false positive.  So that means that only 1 out of 200,000 people would be wrongly impacted by a false positive.  It is a non-issue.  

I realize it's a cruise line (RCI in this case) call but as you note, statistically the odds of someone being impacted by a false positive are remote so why would it be an issue for RCI? I know, it's their call and they will err on the extreme side of caution. 😉

[Lou33]

@joepeka It would not be an issue for RCI.  Maybe an issue for the extremely rare person who got the false positive, but not for RCI.  There would be a much greater chance that somebody is positive, and they got on the ship from their test being a false negative.  

[brillohead]

1 hour ago, kardut said:

Just because I’m rather anxious about this whole testing bit, does anyone know if RCI will accept a negative PCR after a positive rapid test? I know the rapids can have a 4% or so false positive rate, and as an RN, I’ve seen a fair share of patients who had a positive rapid followed by a negative PCR (which is considered more accurate). Thinking about having a PCR scheduled just in case my rapid comes back positive, but wondering if ROyal Caribbean will accept if we’ve already been “branded” as positive with the rapid.

You say that you are an RN.... if that's true, then you should know more than anyone cares to know about HIPAA.  

Lab results are PHI.  How on earth is Royal Caribbean going to know that you had a positive result if you're only showing them the negative test?

[brillohead]

41 minutes ago, Lou33 said:

If you do a proctored rapid antigen test, the results will go into a database. 

The database isn't shared with Royal Caribbean or anyone else.  

Lab test results are considered Protected Health Information and disclosing that information to anyone without a valid medical or insurance reason to have access to the information is a major federal offense subject to civil and criminal repercussions.  

[Lou33]

3 minutes ago, brillohead said:

How on earth is Royal Caribbean going to know that you had a positive result if you're only showing them the negative test?

 

Because when you check-in, you will complete a questionnaire.  I have not seen it, but I can't imagine that they would not ask you if you've had "any" positive result in the last few days?

 

Are there people here who would be so self-consumed that they would lie to them??

[Lou33]

17 minutes ago, Heymarco said:

Royal even recommends purchasing multiple tests per person in case of an “error”…

They're not talking about a false positive.  They're talking about an error when performing the test.  

[matt1]

4 minutes ago, Lou33 said:

They're not talking about a false positive.  They're talking about an error when performing the test.  

…that may lead to a false positive? 🤔

[Lou33]

21 hours ago, matt1 said:

…that may lead to a false positive? 🤔

No it can't.  If there is an "error" when performing the test, the proctor will declare the test "invalid".  There could be no false positive or false negative because there is no test result.  

[smokeybandit]

If you got a positive rapid test, then immediately followed that up with a negative PCR, then I'd present the PCR and not even mention the rapid test.

 

Why? Because that's how they'd do it on board ship, too. Give you a rapid test, then confirm the positive with a PCR test. And a negative PCR test would negate the positive rapid test.

Edited November 7, 2021 by smokeybandit

[matt1]

2 minutes ago, Lou33 said:

No it can't.  If there is an "error" when performing the test, the proctor will declare the test "invalid".  There could be no false positive or false negative because there is no test result.  

If anything, and since this is a self-administered test (albeit proctored), a false negative seems more likely, even saying so on the card itself if the test is not done correctly:

 

 

[Lou33]

6 minutes ago, smokeybandit said:

If you got a positive rapid test, then immediately followed that up with a negative PCR, then I'd present the PCR and not even mention the rapid test.

 

 

I have a question for you.  You will need to complete a heath questionnaire just before you board the ship.  I expect the that one of the  questions is something like:   Did you test positive for any COVID test in the last XX days?  Considering your scenario above, how would you answer that?

 

I don't know.  Maybe RCI would let you board with two different results.  I would think that they would want to at least administer a 3rd test themselves.  

[joepeka]

9 minutes ago, Lou33 said:

 

I have a question for you.  You will need to complete a heath questionnaire just before you board the ship.  I expect the that one of the  questions is something like:   Did you test positive for any COVID test in the last XX days?  Considering your scenario above, how would you answer that?

 

I don't know.  Maybe RCI would let you board with two different results.  I would think that they would want to at least administer a 3rd test themselves.  

Unless someone that has completed the health questionnaire recently can tell us for sure, the question you surmise about a positive test in the last xx days is just supposition - somewhat logical but still just supposition without evidence.

Edited November 7, 2021 by joepeka

[Lou33]

20 minutes ago, joepeka said:

.....somewhat logical but still just supposition without evidence.

That's true, and maybe somebody here can tell us exactly what is on the questionnaire.  But I'm just wondering if anybody here would lie to them?

 

From what I have read, false negatives are much more common than false positives, even on a PCR test.  So how do you know that the negative test was not the false one?  If a doctor and/or RCI knows that you have a positive result, and approves the negative PCR test, that seems the best approach to keep everybody safe.  But I can't see taking the health of all the other passengers into your own hands.  

Edited November 7, 2021 by Lou33

[smokeybandit]

You're much more likely to get a false negative with an antigen test than PCR.

 

I wouldn't hesitate to answer "no" to the positive test question since I'd have that negative PCR test in my hand.

[comfixit]

Well some thoughts:

• On the RCCL FAQ regarding testing it says: Without a negative pre-cruise test result, you will not be permitted to sail.
  
  Maybe this suggests you get a negative you are good to go.
   
• On the RCCL FAQ regarding positive test results prior to the cruise it says: 100% cruise fare refund for you, and your Travelling Party, if any of you tests positive for COVID-19 within 14 days prior to the cruise or at the boarding terminal.
  
  Perhaps this suggests that they won't let you on the cruise with a positive test and are providing you with a refund at least so you can experience the fun in the future.
   
• Do you really want to be on a cruise with Covid-19 even if you are not feeling the symptoms much? 
  
  For one you will come into contact with a lot of people in close quarters many of them with conditions that put them at an increased risk even fully vaccinated. You probably shouldn't look regardless but with a full refund at your disposal you really don't have a good reason to knowingly be putting others at an elevated risk.
  
  That said the people most at risk will be those spending the most time close to you. So maybe you are fine, but that guest with you in that small cabin probably gets a sufficient viral load that maybe they get it too. Even if they are vaccinated they could get a break through case. And their case may not be as mild as yours and at sea you won't have the best care options available for them.
  
  You get a 100% refund for you and them. If you get a positive (suspected false or not) present it to RCCL and book another cruise.