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It’s difficult to know how widely the virus has spread, due in part to gaps and delays in testing. Getty Images
  • The CDC has expanded the criteria for testing, giving the go-ahead to doctors to order tests through public health labs.
  • To test someone for coronavirus, a primary care doctor or other health professional collects a sample of saliva and mucus from the patient’s nose, throat, or both.
  • But experts warn it will take longer for labs to put those testing materials to use.

In the United States, more than 800 people have developed COVID-19, according to data from Johns Hopkins.

The actual number of people who’ve contracted the virus (SARS-CoV-2) that causes COVID-19 may be much higher, but it’s difficult to know how widely the virus has spread, due in part to gaps and delays in testing.

“There’s no physician in the United States, whether clinician or public health, that doesn’t have a list of concerns,” Dr. William Schaffner, an infectious disease specialist at the Vanderbilt University Medical Center in Nashville, Tennessee, told Healthline.

“And we have concerns because obviously testing was delayed, and we’ve been testing many fewer individuals than have other countries,” he said.

Although federal and state health authorities have been taking steps to expand COVID-19 testing capacity, Schaffner expects it may take weeks for tests to become widely available.

“We’ve had very optimistic statements made at the national level, but they’re unfortunately overly optimistic,” he said.

“Both providers and patients have gotten inappropriate impressions about how readily testing will be available,” Schaffner added.

To test someone for coronavirus, a primary care doctor or other health professional collects a sample of saliva and mucus from the patient’s nose, throat, or both.

In some cases, they may also collect samples of sputum from the patient’s lungs.

Then, they send those samples to a laboratory for testing.

Until recently, all samples collected from patients who met the COVID-19 testing criteria were sent to public health labs operated by state authorities or the Centers for Disease Control and Prevention (CDC).

But over the weekend, the Food and Drug Administration (FDA) gave the green light to outside labs to design and conduct their own validated tests for the virus.

Now more than 70 public health labs across all 50 states and the District of Columbia are offering COVID-19 testing, reported Scott Becker, CEO of the Association of Public Health Laboratories, on Monday.

Several private labs have also begun to offer testing or have announced plans to begin testing soon. These include LabCorp and Quest Diagnostics — two of the largest clinical testing providers in the country.

According to The Seattle Times, the Gates Foundation is also funding the development of a home testing kit. The kit would allow individuals to swab their own noses at home and send the swabs to a lab for analysis.

Under the CDC’s original guidance for healthcare professionals, doctors could only order COVID-19 testing for patients who met certain criteria.

A patient had to have symptoms consistent with COVID-19, such as fever, cough, or difficulty breathing. They also had to have at least one of the following:

  • been in close contact with someone who had tested positive for the virus
  • recently traveled to a part of the world where the virus is widespread
  • been hospitalized, with no other identified cause for their symptoms

The CDC has since expanded the criteria for testing, giving the go-ahead to doctors to order tests through public health labs for anyone who has symptoms of COVID-19.

In theory, that means that many people may now be tested for COVID-19.

But in practice, the capacity for testing remains too limited to meet the demand.

“Although the CDC has opened up its guidelines for testing,” Schaffner said, “practitioners still can’t take advantage of that because the testing facilities are not able to handle what is likely to be a substantial demand.”

“Our state was one of the very first to begin testing here in Tennessee,” he continued, “and they still have a limited testing capacity. They have limited number of kits and limited number of personnel who can do the test.”

As a result, health authorities in some parts of the country have continued to impose restrictions on who can be tested for the virus through public labs.

During a White House briefing on Monday, FDA Commissioner Stephen Hahn announced that labs across the country would have the materials needed to perform “close to 1 million” COVID-19 tests by the end of this week.

But experts warn it will take longer for labs to put those testing materials to use.

“We’re getting this spin that we’ve got a million tests ready to go, but no one who actually does the testing or knows anything about testing believes that’s true,” Dr. Dena Grayson, an expert in pandemic threats, told Healthline.

“There’s a lag time. It’s not like you open up the box and plug it in. There are procedures you have to do to make sure that the test is performing as it’s supposed to,” she continued.

It will also take time for private labs to develop their own tests and get those tests validated.

“Although testing resources are now being brought to bear on the public and private side, those [testing services] are slow to come online,” Schaffner said.

“They may take another week, 2 weeks, or 3 weeks to come online,” he added.

According to a spokesperson for the CDC, states have so far been covering the costs of COVID-19 tests that are ordered from public labs.

“The decision of whether or not to charge for novel coronavirus testing is a state decision,” CDC spokesperson Richard Quartarone told Healthline.

“However, we do not know of any state public health labs currently charging for testing,” he continued.

But when a doctor orders a test from a private lab, the patient or their health insurance provider may receive a steep bill.

“The administration said to the commercial labs, go ahead and get your own test. But the problem is, who’s gonna pay for it?” Grayson said.

“If you don’t have insurance or if that lab happens to be out of network, you’re going to have to pay a lot of money for a test,” she continued.

When people have to pay out of pocket for not only testing but also the costs of quarantine and treatment, they’re less likely to get proper care, Grayson warns.

“You can’t charge people to test and then put them in quarantine in a hospital. They’re not going to come, and then they’re going to keep spreading this,” she said.

To meet the country’s testing needs, Grayson says a better coordinated, more adaptable, and innovative response is needed at federal and state levels.

She also calls for funding to ensure that COVID-19 testing and treatment are free to all patients.

“The whole name of the game is containment,” Grayson said, “and the key to that is early detection, aggressive contact tracing, and then quarantine.”

“If we don’t act now, the mistakes become logarithmically bad,” she continued. “The virus expands and spreads exponentially.”

In the meantime, Grayson encourages people who think they might have symptoms of COVID-19 to call their doctor or local hospital. It’s better to call first rather than just show up, she says.

“Don’t go if you don’t need to because you could then be exposed if you’re not infected, and God forbid there’s people around that are,” she explained.

“And if you do have the virus, we don’t want people showing up in every emergency room and clinic infecting others,” she added.

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