How and when you should be tested for the coronavirus

Vice President Mike Pence on March 3 said that any American, with a doctor’s order, can now be tested for coronavirus.

The move appears to expand criteria that had previously limited testing to patients who had been hospitalized, absent certain extenuating circumstances such as contact with a coronavirus patient.

Criteria set by the US Centers for Disease Control and Prevention has now called for “any American (to) be tested (for coronavirus), no restrictions, subject to doctors’ orders,” as Pence said when describing the new policy.

Earlier on Tuesday, the CDC suggested that has always been the case – that who should be tested is based on doctors’ discretion. CDC officials also said this earlier this month, when they expanded their testing criteria February 27 after the first US case of unknown origin was confirmed. That individual would otherwise not have fit earlier testing guidelines.

“As soon as that case was recognized, we met and we revised our case definition for persons under investigation,” CDC Director Dr. Robert Redfield said in February.

There have also been an increase in laboratories that can develop and perform diagnostic testing, as authorized by the Food and Drug Administration’s Emergency Use Authorization issued on February 29. As of Thursday, three tests have been granted EUA approval, including the CDC’s original test, and other commercial laboratory companies are accepting samples to test while awaiting EUA.

What do you do if you need a test?

Health officials urge anyone who believes they should be tested to call ahead, rather than showing up unannounced and potentially exposing others to an infectious disease.

“Your healthcare professional will work with your state’s public health department and CDC to determine if you need to be tested for COVID-19,” the agency’s website says.

Should you get tested? What are the guidelines?

CDC’s website currently advises people: “Call your healthcare professional if you feel sick with fever, cough, or difficulty breathing, and have been in close contact with a person known to have COVID-19, or if you live in or have recently traveled from an area with ongoing spread of COVID-19.”

Earlier this month, CDC’s testing guidance included three types of people:

1. Those who have symptoms such as fever OR lower respiratory symptoms (cough or shortness of breath) and have had “close contact” with a confirmed coronavirus patient within 14 days of their first symptoms.

2. Those who have fever AND lower respiratory symptoms, require hospitalization, and have traveled to areas impacted by the epidemic in the last 14 days.

3. Patients with fever and severe acute lower respiratory symptoms who require hospitalization and for whom no other diagnosis has been found — such as the flu. No travel or contact exposure is needed.

Clinical care providers take swabs for coronavirus on a patient during drive-thru testing by the Fayette County Health Department in Oak Hill, West Virginia, on Thursday, March 19, 2020.

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Updated guidance from the CDC on Sunday reiterated, “Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19” and suggested testing should be prioritized for the following three groups:

1. Hospitalized patients who have “signs and symptoms compatible with COVID-19”

2. Other symptomatic individuals who are older (age ≥ 65 years), have chronic medical conditions, and/or are immunocompromised

3. Anybody with symptoms that had close contact with a suspected or confirmed COVID-19 patient or had a history of travel to an affected geographic area within 14 days of symptom onset

The CDC also “strongly encourage[s]” clinicians to test for other causes of respiratory illness.

Why have people had a hard time getting tested?

Reports have emerged of people having difficulty getting tested for the novel coronavirus.

Despite the CDC saying the decision to test has been up to doctors, it may not have been implemented this way at state or local levels.

Workers disinfect the waiting room of Beijing railway station in the fight against SARS, 25th May 2003. Beijing has seen a "notable downward" trend in the disease known as Severe Acute Respiritory Syndrome (SARS) cases over the past week, officials said, expressing confidence the capital can beat the outbreak but warn of a new challenge as people return to normal routines.

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For example, the Massachusetts Department of Public Health said that doctors would need to first call a hotline to determine if their patients “meet the CDC definition of a (person under investigation) and be authorized for testing at the State Public Health Lab.”

Dr. Jeffrey Duchin, health officer for Seattle and King County, Washington, previously said that new coronavirus cases could have been identified earlier if not for delays in local testing capability and restrictive criteria about who gets tested.

“If we had the ability to test earlier, I’m sure we would’ve identified patients earlier in the community, possibly at hospitals,” Duchin said on a call Saturday with CDC officials. “But we were also looking at not only availability of testing but whether patients met criteria for testing.”

Duchin said of the first coronavirus death in the US, “Given the fact that we just recently acquired our availability of testing and new criteria were published, this person was brought to our attention.”

Will it be easier to get tested now?

In early March, commercial test manufacturers with emergency use authorizations were starting to offer tests that, if positive, were considered “presumptive” positive until confirmed by the CDC.

Passengers wearing face masks check a tablet computer with their luggage at an empty check in hall of a terminal of the Franz-Josef-Strauss airport in Munich, southern Germany on March 17, 2020 where many flights are currently cancelled by the airlines because of the new coronavirus COVID-19. (Photo by Christof STACHE / AFP) (Photo by CHRISTOF STACHE/AFP via Getty Images)

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Though this has increased the number of tests available, demand still outstrips supply, leading to difficulties in getting tested.

Also, even if a test is available, it may not be covered by insurance.