Posted By Mercury Healthcare (formerly Healthgrades) on 03/20/2020

What to Know About Coronavirus Testing

What to Know About Coronavirus Testing

The COVID-19 pandemic is driving the need for more coronavirus testing in the United States. In the beginning of the outbreak, as isolated cases were popping up in various U.S. communities, local health departments and providers did not have direct access to testing. That is changing, as the CDC (Centers for Disease Control and Prevention) has distributed thousands of COVID-19 test kits to designated laboratories across the country. The U.S. Coronavirus Task Force recently announced that 2,000 commercial laboratories will be able to test for coronavirus by the end of the week. COVID-19 testing availability is evolving rapidly. Check with your local health department for updates.

Here’s what we know about the main coronavirus test, including how it works, who can be tested, and what happens if your coronavirus test is positive.

What is the coronavirus (COVID-19) test?

The main coronavirus test kit in use is the ‘CDC 2019-Novel Coronavirus (2019-nCoV) Real-Time Reverse Transcriptase (RT)-PCR Diagnostic Panel.’ The panel tests for a SARS-like coronavirus and SARS-CoV-2 specifically. SARS-CoV-2 is the virus that causes COVID-19.

Since COVID-19 is a respiratory infection, the coronavirus test requires a sample from the patient’s nose and throat, and the lungs if the cough is productive. Collecting a nasal or throat swab is similar to how a healthcare provider collects a strep test sample. Lab personnel prepare the sample for PCR (polymerase chain reaction), a process that greatly amplifies genetic material from the virus if it is present. The panel tests for active COVID-19 infection.

Who may be tested for COVID-19?

Symptoms of COVID-19 include fever, cough and shortness of breath. The CDC has issued guidelines to help doctors determine if a person with signs of COVID-19 should be tested for COVID-19. However, CDC is advising doctors to use their own judgement in evaluating symptoms. You may be a candidate for coronavirus testing if:

  • You have symptoms of a lower respiratory tract illness and you live in or have traveled to an area where COVID-19 is continuously spreading (sustained transmission), including within and outside the United States. Check with your state's health department to find out the location and number of COVID-19 cases, if any.

  • You have symptoms of a lower respiratory tract illness and you have been in close contact* with someone who has been diagnosed with COVID-19.

  • You have symptoms of a lower respiratory tract illness and you have been in close contact with someone who lives in or has traveled to area with sustained coronavirus transmission.

*Close contact means:

  • Within approximately 6 feet of a COVID-19 case for a prolonged period, such as while caring for, living with, visiting, or sharing a healthcare waiting area or room with a COVID-19 case.

  • Direct contact with respiratory secretions from a person with COVID-19. This could happen if a person confirmed to have COVID-19 coughed or sneezed on you.

Healthcare personnel (HCP) have less stringent testing criteria. HCP may not need to show symptoms in order to be tested if there is a significant risk of transmission from someone with confirmed COVID-19. Current guidelines include exclusion from work and self-monitoring for signs of COVID-19, such as fever and cough.

Currently, groups who have testing priority include healthcare providers, first responders, people older than 65, and people with a chronic medical condition that increases the risk of developing a severe COVID-19 illness.

Where can you be tested for coronavirus?

The CDC is sending the coronavirus test kit to local and state public health department laboratories and U.S. Department of Defense laboratories. Each kit can test 500 to 700 patient samples. All 50 states have the ability to test for COVID-19, with U.S. territories in progress.

If you meet the criteria above (and you are not already in the hospital with COVID-19 symptoms), call your doctor, who will coordinate with your local or state public health department for testing. If you do not have a primary care doctor, call the public health department. Do not go to the doctor, urgent care, or hospital. If you really do have COVID-19, you run the risk of spreading it to others. The health department will tell you what to do and what precautions to take before, during and after testing is complete. In some cases, healthcare personnel may come to your home to collect the sample from you and anyone else you live with who is experiencing symptoms.

Some U.S. cities have set up "drive-up" COVID-19 testing in which a healthcare professional performs the throat or nasal swab while you sit in your car. They send the sample to a nearby lab. They also take your temperature and check for breathing problems. You still need to have a doctor's order for the test. If you do not have a doctor, contact your public health department.

Is coronavirus testing available at my doctor’s office?

No. At this time, the coronavirus diagnostic panel is only available at labs with the equipment necessary to perform the “high-complexity testing” required for the PCR test. This week, officials are expediting delivery of high-speed test kits to thousands of labs across the country, which will increase capacity to up to 2,000 to 4,000 tests per day. 

Call your doctor if you have symptoms of a respiratory tract infection. If he or she thinks you should be tested for coronavirus, your doctor will coordinate with the local public health department for sample collection locations.

How much does the coronavirus test cost?

The coronavirus test is an essential health benefit, according to a recent announcement by the Trump administration. That means Medicare and Medicaid must cover the cost of the test at no cost to you. The administration also announced private insurers will cover the cost of the test without copays. Testing costs may also vary depending on whether your test is completed at a public or commercial lab, such as Quest. Individual states might determine the testing costs. In California, the coronavirus test is free for people who meet the testing criteria. In Colorado, testing is free for those who need to be tested and proof of insurance is not required. 

What happens if the coronavirus test is positive?

The CDC has interim guidance for health personnel in evaluating and testing people for coronavirus (with or without symptoms). You may need to 'self-quarantine' at home while waiting for your results, depending on your specific situation and risk of exposure. 

If you test positive for coronavirus, it most likely means you have COVID-19. If you need medical care, healthcare personnel will admit you to a hospital equipped to care for COVID-19 patients.

If you test positive and you have mild to moderate symptoms that do not require hospitalization, most likely public health personnel will give you instructions to self-quarantine for 14 days—the window of transmission. Isolating yourself at home helps contain the spread of the virus to other people. Even though symptoms are mild for 80% of cases, COVID-19 is a severe acute respiratory syndrome and you are subject to a legal quarantine. You and anyone you live with have to take the necessary precautions to prevent transmission.

Keep in mind the RT-PCR coronavirus test is very accurate and a false positive—a positive result even though there is no virus in your sample—is unlikely.

What happens if the coronavirus test is negative?

A negative test result means the virus was not detected in your sample. It also means your symptoms are most likely due to another illness, such as a cold or flu. (Doctors may test for flu first before ordering a coronavirus test). Next steps depend on your specific situation, including your current symptoms, health status, and risk of COVID-19 exposure. Healthcare personnel will likely take an additional sample and run the test again. With the MERS coronavirus outbreak, people were confirmed negative if two tests came back negative.

Remember the currently available diagnostic panel for COVID-19 only comes back positive if you have an active infection. It will come back negative if you had COVID-19 in the past (and recovered).

What is a false negative coronavirus test result?

A false negative COVID-19 test result is possible—a situation in which the individual is currently infected with SARS-CoV-2 but the test result is negative. It is possible the patient sample, or specimen was not obtained or handled correctly. Another possibility is that it is too early during the infection process and there was not enough virus in the specimen to be detected by the PCR test.

Can you be tested for coronavirus before you have symptoms?

Yes, but it depends somewhat on your situation. The Trump administration recently announced people without symptoms will have access to testing, but you may have to wait if you are not in one of the priority groups. You are considered at risk of developing COVID-19 if you have been in close contact with a laboratory-confirmed case of COVID-19, especially if you or the infected person did not use (or, are not using) personal protective measures. Epidemiologists would consider you a ‘person under investigation,’ or PUI. Contact your state's health department for instructions on what to do, which may include isolating yourself at home for 14 days and monitoring your symptoms. Take steps now to prepare for a possible coronavirus outbreak in your community.

For HCP with possible or probable exposure to COVID-19, monitoring and testing varies by local and state guidelines, as advised by the CDC. Depending on the risk level of exposure, HCP may be restricted from work for 14 days and instructed to self-monitor for signs of COVID-19, such as fever.

Coronavirus testing criteria for the public is changing as more test kits become available. The U.S. Coronavirus Task Force commented to the New York times that up to 1.9 million tests will be available by the end of this week. Manufacturers are producing more coronavirus diagnostic panels and other types of coronavirus tests too. 

Also, state and local jurisdictions can make decisions about isolation, other public health orders, and monitoring that go above and beyond those recommended by the CDC or the U.S. Department of Health and Human Services. Again, contact your state's health department for testing information.

For more information, refer to Questions and Answers About Coronavirus and check your state’s public health website or the CDC website.

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