Who Needs a Coronavirus Test and How to Get One

Adding to the unease about the new coronavirus and COVID-19 is the bumpy and stalled U.S. rollout of testing for the virus. “People are just clamoring for these tests,” says John Swartzberg, M.D., a clinical professor emeritus of infectious diseases and vaccinology in the UC Berkeley-UCSF Joint Medical Program.

More coronavirus test kits are now to be made available, and while widespread testing will be helpful in many ways, not everyone will be an obvious candidate for testing right now.

Fixing the national coronavirus testing shortage

The low number of people tested as of this writing wasn’t only because of a test kit shortage but also because of the high bar patients had to clear to get tested. Some people with symptoms of COVID-19 haven’t been tested because they hadn’t traveled to specific countries or been around someone who had.

The self-imposed barriers creating a national testing shortage began ease up when the U.S. Food and Drug Administration (FDA) said academic and hospital labs could develop their own tests, which could greatly expand the country’s testing capacity. In addition, the CDC has addressed problems with its test that led to crucial failures. The CDC opted to develop its own tests rather than use kits offered by the World Health Organization.

By the end of the week, public health labs will be able to test about 75,000 people in total, says Kristen Nordlund, spokesperson for the U.S. Centers for Disease Control and Prevention (CDC).

In addition, Vice President Mike Pence said Wednesday that 2500 diagnostic kits could be ready to go by the end of the week. Experts suggest it may take longer than that. Although that number of kits might not sound like a lot, they each allow for a few hundred tests and should cover testing of more than a million people. How long it really will take for these additional kits to be produced and implemented is not clear.

When will additional coronavirus test kits be available?

Ramping up the test kit distribution that Pence pledged could still take weeks, Swartzberg says. “What Pence is talking about is something that is certainly not available today and there is absolutely no hint that it is going to be available tomorrow or any time soon,” he says. “I will be very surprised if anything approaching what he’s suggesting will be available within the next one or two weeks, and it could be longer.”

In the meantime, Swartzberg says, local county health departments and emergency room clinicians are “starved” for the ability to test. Under the new FDA policy, university medical centers can feed that need while health departments await their kits. Two San Francisco-area hospitals have already announced their own on-site coronavirus testing with rapid results turnaround.

Who can be tested?

Pence mentioned in his comments that “any American” can get tested now with a doctor’s order. The CDC initially required some association with travel to China, either personally or with a personal contact. The CDC has now expanded the criteria, and doctors can use their judgment about testing, based on symptoms and their severity.

That expansion may be crucial now that COVID-19 is likely spreading among people without known travel-related contact. Schwartzberg describes the plight of one patient and their doctor in the San Francisco area: the patient’s chest scans showed signs typical of COVID-19, and the doctor strongly suspected coronavirus. But before the CDC expanded testing criteria, the doctor couldn’t have the patient tested because there were no known travel-related contacts. In the meantime, the patient had to be isolated in costly hospital isolation rooms, a potentially wasteful use of scarce resources in the absence of a confirmed diagnosis, says Swartzberg.

Why testing is important, and why not everyone is getting it

Widespread testing is important, Swartzberg says, because it can give a better a number for mortality rates. The current estimate, he says, calculated from known deaths and known cases, would be lower if testing could identify milder cases more readily. “I am sure it is going to be far lower than the 3.4 percent reported,” he says, “but without testing, we are not going to know.”

If you have mild symptoms, stay home and self-isolate, Swartzberg says. (See the CDC’s guidance on isolating at home.) “Ideally, those patients should be tested, and when we have more tests, we should include them.” Until that happens, “the last thing we need is people flocking to the ER asking to be tested.” If your doctor sends you for a test and the test is positive, keep in mind that doctors can only treat symptoms and in severe cases, manage any respiratory distress and co-infections.

How they test for coronavirus

Testing involves a swab of the nose and throat. If the patient is coughing up material from the lungs, that can be sampled, too. The collected material will undergo analysis in either a public health lab, which will use CDC-developed testing, or eventually in academic or hospital labs that are using their own tests. A result is considered positive if the sample contains evidence of the virus’s genetic material.

What will coronavirus testing cost?

Pence described the testing as “an essential health benefit,” which is policy speak that means it should be covered by health insurance and federal insurance plans.

In the meantime, the U.S. House of Representatives voted overwhelmingly for $8.3 billion in federal funding for prevention and treatment of COVID-19. The Senate is expected to approve the funding, with Trump expected sign off on it on Friday.

At this writing, the total number of global cases had topped 96,000. Of those, 164 have been identified in the United States, with 11 deaths.

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