Decision to test based on many conditions
Symptoms, age, health, travel all factor into whether to check for coronavirus
You feel feverish and fatigued. You’ve got a cough. Now what?
In a perfect world, you’d be tested for COVID-19. It would be quick, easy, free and accessible.
We’re not in that world — at least, not yet. To be sure, things are getting better. But despite assurances from Washington, D.C., the demand for testing still outstrips supplies in the Bay Area.
So here’s what to do. First, call a doctor. They’ll likely tell you this:
• If you’ve got mild coldlike symptoms, stay home and self-isolate. You’re not a priority for scarce testing.
• If you’ve got moderate to severe symptoms, or if your illness worsens, you can get a test — especially if you’re older than 65, have underlying medical problems, had contact with a known
case or recently traveled outside the U.S. Your doctor will coordinate your testing through a local community clinic, emergency room or drive-thru test site. If necessary, you’ll be hospitalized.
“The top-line message is: If you are ill with flulike symptoms and you can support yourself at home, stay home. Stay put,” said Dr. Sara Cody, health officer for Santa Clara County, which has 263 cases of the coronavirus and is the hardest-hit Bay Area county.
“There is not the testing capacity to confirm if you have COVID-19 or not,” she said.
On Saturday, Los Angeles County health officials took the formal step of advising doctors to stop testing patients in the hope of containing the outbreak, instructing them to test patients only if a positive result could change how they would be treated, according to The Los Angeles Times.
In the Bay Area over the next few weeks, as testing becomes more widely available, patients with mild symptoms will be offered testing through ever easier pathways, said Dr. Walter Mills, the Salinasbased president of the California Academy of Family Physicians, which represents nearly 11,000 doctors in the state.
Testing all patients will give us a better picture of the true scope of the disease, he said. That would help us plan.
Here’s why that’s not happening yet, and some insights into the other complications of COVID-19 testing.
Q Why aren’t there more tests?
A As of Thursday evening, just 23,200 Californians had been tested at the state’s 21 labs — about 0.063% of the state’s 40 million people, according to Gov. Gavin Newsom’s office. Of the 11,487 results received thus far, 1,006 were positive.
Like the rest of the U.S., California has been hampered by a shortage of test kits and essential chemicals, forcing a confusing prioritization of who is eligible for testing.
Now that more public, private, commercial and academic labs are testing, that’s poised to change “in the next few weeks,” said Dr. David Witt, a Bay Areabased infectious disease specialist with Kaiser Permanente. All five core counties in the Bay Area — Santa Clara, Contra Costa, San Mateo, Alameda and San Francisco — have their own public health labs with COVID-19 testing abilities, but capacity has been limited.
Q I think I’m sick. What do I do?
A First, you should contact your doctor and say what you’re experiencing. Independent testing is not an option. Depending on your doctor’s COVID-19 policies, you may be asked to do a video visit or phone call rather than leaving your house.
From there, your doctor will decide whether you qualify for a test and will tell you where to go. The Centers for Disease Control and Prevention used to have very restrictive guidelines; now it offers a “priority list” but defers to clinicians’ judgment. The decision to test is influenced by your age, underlying health, severity of symptoms and other factors.
If you have mild coldlike symptoms and no history of exposure to a COVID-19 case, even if you’re older than 65, “we strongly recommend to not go to the ER or an urgent care facility to be tested,” Los Altos geriatric specialist Dr. Mehrdad Ayati said. Too many facilities are sending elderly patients to hospitals, he said. It’s possible you have a routine respiratory illness.
“Just stay home in isolation, contact your health care provider and monitor your symptoms,” he said.
“Also, there is a high chance that by going to ER or urgent care, you’ll expose yourself to COVID-19,” he said.
Keep away from other family members, if possible, Cody said. Ideally, stay in your own room. Don’t share the bathroom.
Q I’m really sick. Will I get prioritized for testing?
A It depends. If you meet certain criteria — symptoms and risk factors — you’ll be eligible, but the details depend on your health care provider.
Sutter Health, which serves more than 100 communities in Northern California, said it is following CDC guidelines.
“Sutter is collecting test samples for COVID-19 or influenza in high-risk patients, such as those with certain preexisting conditions or social risks,” a spokesperson said. “Sutter needs to preserve test supplies for those populations, and per CDC guidelines, is only collecting tests from patients with symptoms and these risk factors.”
For Kaiser Permanente and other providers, hospitalized patients get the highest priority. That’s because hospitals need to know who should be isolated, Witt said.
Next in line are what the CDC calls “high-risk” people: Those who are older than 65 or have diabetes, lung disease or other underlying conditions. Thirdtrimester pregnant women also are a priority. Then come health care workers with known exposure to COVID-19 and “first responders” such as medics, police and firefighters.
Priorities may differ from county to county. In Contra Costa County, for instance, sick people in jails, assisted living facilities, and board and care homes are at the top of the priority list, county health services spokesman Will Harper said.
Q So what’s your recourse for testing if you’re not high-risk and haven’t had contact with a confirmed patient but have COVID-19 symptoms?
A “At this point, none,” Witt said, encouraging people to follow statewide orders to stay at home and assume that the illness could be COVID-19.
If you have severe respiratory symptoms, such as trouble breathing, your doctor may want you tested.
Because very few physicians’ offices are offering onsite tests, you may be sent to an urgent care clinic or hospital. If your provider offers testing, it might not be at your regular office. Kaiser Permanente and Stanford Health Care, for example, are piloting drivethru testing sites in the Bay Area to make sure that infected people don’t come in contact with other patients or clinicians.
The pilot screening program by Verily — the Google affiliate extolled by President Donald Trump in a recent address — kicked off last week in Santa Clara and San Mateo counties. Individuals complete an online screening evaluation and, if prioritized for testing, are contacted by phone to schedule an appointment at a mobile test site.
The site aims to supplement overburdened hospitals by focusing on highrisk people who aren’t so ill that they require immediate medical attention. More than 174,000 people visited the site when it was unveiled, Newsom said last week, with about 320 people tested on Tuesday.
The screening “is dynamic and the criteria may change over time, based on epidemiological data,” a spokesperson said.
Q What if I don’t have a primary care physician or am uninsured?
A If you just lost your job, don’t panic: You can still get insurance. Effective Friday, the state announced that anyone uninsured and eligible for Covered California can sign up through the end of June.
But if you’re in limbo, the best place to start is to call your local public health department, which can connect you with local resources. For example, Santa Clara County’s 211 service will help you get in touch with Santa Clara County Valley Medical Center, the area’s public hospital system.
If you’re ill enough to go to the emergency room, providers are obligated to help you, but health professionals warn against relying on the ER solely for testing to avoid crowding.
Most California hospitals have set up triage tents outside the ER for patients with respiratory symptoms, according to Mills. You’ll be assessed and possibly tested there, with results sent out to commercial labs, or admitted to the hospital if you’re sick enough.
Q How much will it cost?
A Earlier this month, the state directed commercial insurers and Medi-cal, which cover about 24 million Californians, to eliminate patient cost-sharing when it comes to COVID-19 testing. That means no copays, deductibles or coinsurance for “medically necessary” testing and testing-related visits.
But you should always ask your insurer how exactly you will be billed and what the out-of-pocket cost will be, as the directive does not waive fees related to followup care. The waiver does not apply to self-insured coverage plans.
Q How long will the test take?
A The actual test — typically a nose swab — takes just a few minutes. But some commercial tests take two to seven days to report results, which is frustrating for providers forced to retest patients, Witt said. Results from inhouse labs could return within a day or less.
Q Is it reliable?
A In general, the test for COVID-19 is very reliable, especially in people with symptoms. The test is called Reverse Transcriptase PCR (RT-PCR). It measures the presence of the RNA viral genes, located in the epithelial cells of a person’s airways. The test extracts the RNA and transcribes it into DNA. Then it amplifies it using Polymerase Chain Reaction, so there’s enough to be detected.
There are no known false positives. But there are increasing reports of false negatives, when people are wrongly told that they’re free of the virus when they are actually infected. That seems particularly common early in the course of the disease.
COVID-19’S incubation period — the time between infection and symptoms — ranges from one to 14 days, with an average of five days. That means you might test negative 12 days after exposure, then test positive on Day 13.
But if you were exposed more than two weeks ago and you’re still healthy, you’ve escaped infection.
If you’ve been infected but have two consecutive negative tests, you’re all clear.
Q How do doctors decide whether to test?
A This is the guidance given by Walnut Creek’s John Muir Health, based on infectious disease experts and the latest CDC guidelines:
• Is patient experiencing fever or respiratory symptoms of cough, shortness of breath?
• Has patient traveled internationally (to countries or on cruise ships with known COVID-19 outbreak) or been in close contact with someone who has within the past 14 days?
• Has patient been in close contact (within 6 feet) with someone who is suspected of or has tested positive for COVID-19?
• Is the symptomatic individual an older adult (65 or older) and with chronic medical conditions and/or an immunocompromised state that may put the person at higher risk for poor health outcomes (e.g., diabetes, heart disease, chronic lung disease, chronic kidney disease, resident of long-term care or residential facility, or receiving immunosuppressive medications), or a symptomatic health care worker?
If 1 and 2 or 1 and 3 are yes, then consider testing for COVID-19.