Coronavirus testing has been plagued by confusion, delays, and chaos, with the number of available, usable tests far outstripped by the need.
Experts say the situation has impaired their ability to know how many people have the virus — which they suspect is a significantly larger number than that confirmed by state and federal officials.
Yet Gov. Gavin Newsom says help is on the way, from university medical centers, private labs, the tech sector and more. So where are we on this? Who can get tested and where exactly should you go? If you do get a hold of a test, is it going to cost anything? Here's what you need to know.
How Many Tests?
On Sunday, March 15, Newsom said California had conducted 8,316 tests, and had the capacity to run just short of 9,000 more. The number of public health labs conducting testing has since increased to at least 21, and the state also has turned to academic medical centers and private companies to fill in those gaps. UC San Francisco, UC Los Angeles, UC San Diego, and Stanford University are all offering tests for the novel coronavirus — and UC Davis is currently racing to get three different types of tests online.
Nam Tran, associate professor and senior director of clinical pathology at UC Davis, said one of the tests runs on an SUV-sized instrument that will soon churn out 1,400 results per day. He called it a "game changer."
As for private firms, Quest Diagnostics has been running 1,200 tests a day out of its lab in San Juan Capistrano — and could ramp up to 10,000 tests per day across the country with the addition of another laboratory by the end of this week.
Should I Get Tested?
Californians still face delays, or no tests at all. And a surge of demand for testing supplies — swabs, kits for extracting the virus's genetic material, and personal protective equipment for healthcare workers — threatens efforts to scale up tests.
At a time of limited resources, testing should be reserved for people with moderate to severe symptoms and for those with underlying health conditions, said Michael Romero of Placer County's public health emergency preparedness team.
Symptoms can show up between two days and two weeks after exposure to the virus, and include fever, cough, and trouble breathing, according to the CDC. "Our guidance is if you have mild symptoms, just stay home, testing would help you know whether you have it or not, but it wouldn't change anything," because there is currently no treatment, he said.
Can I Get Tested?
One challenge is the patchwork of guidance about whom to test first from California's counties, private testing companies, and health systems, according to Kat DeBurgh, executive director of the Health Officers Association of California.
Guidelines may vary by county because of the uneven spread of the coronavirus, and local public health departments are required to approve the tests run through their labs, DeBurgh said. She's calling for more guidance from the state about whom to prioritize.
In Los Angeles, for instance, the public health lab "will test specimens from high-risk patients requiring a rapid public health response if they test positive." Other patients with fever and symptoms of a respiratory illness who may have been exposed should be tested by a commercial lab instead.
At Kaiser Permanente, clinicians decide who to test, spokesman Marc Brown said. Tests are only available with a doctor's order.
Priority goes to hospitalized patients as well as people with symptoms who also have additional risk factors such as being over 60, heart or lung disease, or being immunocompromised. Anyone exposed to someone with a confirmed or suspected case of the virus, or who recently traveled somewhere affected by it, will also be prioritized.
Where Can I Get Tested?
People should first check with their doctor to ask whether they're collecting specimens, Romero said. If their doctor is not doing testing, they can try calling their local urgent care. Romero said people should not go to the emergency department just for testing.
Some counties, such as Los Angeles and San Diego, ask that people who do not have a primary care provider call the county's 2-1-1 line for information on where they can find providers with tests. Sutter Health, for example, asks that its patients schedule a video visit with a doctor to check whether they meet testing criteria. If they do, then doctors make arrangements with patients about specific locations where they can go for testing.
Are Tests Free?
Earlier this month, Newsom announced that all screening and testing fees would be waived for about 24 million Californians. That includes co-pays and deductibles for a hospital and doctor office visit associated with the test. But if a person is sick and needs further care, that cost is not required to be waived.
Newsom's order does not apply to people who work for large employers and whose private health plans are regulated by the federal government. An emergency coronavirus response bill pending in Congress would require that testing and all related fees be covered by all forms of insurance without out-of-pocket costs for the patient.
The California Department of Public Health has said that people who are uninsured and have symptoms should contact their county for information on how to get tested.
Testing through the Verily screening pilot program screening in Santa Clara and San Mateo counties is a philanthropic effort and also free to the public.
What Will A Test Actually Tell Me?
The current test for the novel coronavirus looks for the virus itself by sniffing out the virus's genetic code. These tests can tell you if you have an active infection. What they cannot tell you is whether you've been infected and recovered.
"Something that is missing from our knowledge of this virus is how many people are exposed to it," said Philip Felgner, director of the vaccine research and development center at the UC Irvine School of Medicine. That data is key for understanding the breadth of the outbreak, and just how lethal it really is.
How Can We Track the Virus?
Researchers across the world are working on developing another kind of test — one that looks for signs of the immune response to the virus, called antibodies. This kind of test — a serological test — would allow scientists to search out people who have recovered from less severe or asymptomatic cases of the virus who never ended up in a hospital.
That could help scientists identify chains of viral transmission, home in on hotspots of the outbreak, and would be a first step towards a fuller understanding of why some people recover more readily than others. STAT has reported that the CDC is working on developing two of these tests, and Science has reported that scientists in Singapore used a serological test to track the outbreak.
Here in California, Felgner at UC Irvine has teamed up with a company called SinoBiological to create tests that can hunt for antibodies to nine different infectious agents including other coronaviruses like ones that cause SARS and MERS, as well as viruses that lead to similar symptoms, like influenza.
Felgner and a research institute in San Francisco called Vitalant intend to validate these tests and other, similar ones, by running them with leftover samples of donated blood from Seattle. Another test will look for the kinds of antibodies that can neutralize infections, giving a sense for how effective the immune response actually is.
Michael Busch, director of the Vitalant Research Institute, clarifies that these tests aren't to screen the blood. "We don't screen blood purposefully for this virus, it's not a transfusion transmissible agent," Busch said.
The goal, instead, is to survey communities to find out just how far the virus spreads, and for how long. "What it does show you is how many people were infected," Busch said. That changes the calculus for what we understand about how often the virus causes severe symptoms, or kills people — and where exactly to be looking for it.
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