Who Can Get A Coronavirus Test?

As cases of COVID-19 spread, many people are hearing of friends and family who have been exhibiting symptoms. But many of those people are having a hard time getting approved to take an official test to confirm it.

Those who have been refused tests are being told to quarantine at home and to manage symptoms by their own accord unless they become ill enough to warrant a trip to the emergency room. So what’s the deal? Why are we hearing about celebrities like Idris Elba ― who wasn’t experiencing any symptoms at the time of his diagnosis ― getting tested while other who are sick are not?

Here’s a (brutal, frustrating) breakdown on how the testing process is working and some advice on how you can potentially get screened:

According to Dr. Gary W. Procop, vice chair and director for virology at Cleveland Clinic, medical facilities are working with limited resources. As a result, they’re prioritizing testing those with symptoms in high-risk groups, like older adults and those with compromised immune systems. Anyone admitted to the hospital and demonstrating a more serious illness in line with COVID-19 is being tested as well.

“So we’re not testing, let’s say, a young, otherwise healthy individual who has an upper respiratory tract infection, as we really would not do anything to change the recommendation to that person,” Procop said. He added, “If we had all the tests in the world, we’d test them. But the fact of the matter is testing is limited and there’s not all the testing in the world.”

Dr. Tista Ghosh, medical director at the Grand Rounds health care company, said the current guidelines are breaking people into three priority categories:

Priority one: Hospitalized patients and medical staff.

The goal here is to treat those who are the sickest and also to control health care-associated infections, Ghosh said. “We want to make sure health care workers know who they’re being exposed to so they can take precautions because they’re going to be a limited resource in the coming week,” she said. “So hospitalized patients and health care facility workers with symptoms are priority number one.”

Priority two: Those in high-risk groups who are showing symptoms.

“Those might be patients in longterm care facilities or patients 65 and older because they have higher death rates,” Ghosh said. She added that patients with underlying conditions who are experiencing symptoms are also included in this group. “For example, people with diabetes or heart disease or high blood pressure, asthma, if they have symptoms,” she said. First responders who are symptomatic are included in this category.

Priority three: Community testing.

“This is really, as resources allow, individuals in the community and the area where they’re seeing increasing cases,” Ghosh said, adding that the goal of testing this group is to be able to tell how much the virus is spreading in one place. This includes testing critical infrastructure workers. “We want to keep our power on, we want to keep clean water, that kind of thing. So critical infrastructure workers are definitely higher up in that priority three,” Ghosh said.

The symptoms that doctors are looking for include a fever (typically over 100.4 degrees), cough and shortness of breath. “So that’s why having symptoms is one of the key criteria to get you access to a test and then being in those three priority groups,” Ghosh said.

Until the availability of testing increases, screenings will have to be reserved for higher-risk patients, said Dr. Carl Fichtenbaum, a professor of clinical medicine in the division of infectious diseases at the University of Cincinnati College of Medicine.

The majority of people will have a “mild” case of COVID-19, which can include a lower-grade fever, cough and fatigue. Fichtenbaum said that if you have those symptoms, the advice is going to be the same whether you have a positive test: “Stay home untll you’re better. Quarantine yourself away from family or roommates or friends. Get rest plenty of liquids. Take some cough syrup or Tylenol for aches and pains.”

If symptoms progress to a more severe state, then it’s time to call your physician.

In the face of a massive shortage of tests, new tests are in development.

“More and more of the commercial companies have received FDA approval for their emergency use of their platforms,” Procop said. “And these platforms are more widely available. So, as those companies gear up, they will be able to offer more testing locally.”

Reports of public figures like NBA players, actors and lawmakers testing positive for the coronavirus is becoming more common. However, it’s often the case that many of them weren’t even showing symptoms when they were tested. If regular people can’t get tests when they’re asymptomatic, what gives here?

Procop said the reason someone like Sen. Rand Paul (R-Ky.) ― who has said he was not exhibiting the symptoms of COVID-19, the disease caused by the coronavirus, when he was tested ― was screened is because of how fast he could have infected others.

“When you get into individuals, like senators or police officers or firefighters, you’re actually looking at this a little bit differently,” Procop said. “You’re trying to protect the entire Senate. And so by identifying those people early, you’re actually pulling them from spreading it into a group that’s really important for society.”

Still, it’s also very likely that some people with bigger pocketbooks are calling in favors, said Dr. Nishant Rao, chief medical officer of the telehealth care company, DocTalkGo.

“Facilities locally may have some inventory of tests for certain clientele that they’re saving those for, which isn’t really ethical,” he said.

Ghosh said she’s hopeful that health care providers and health departments across the country do their best to follow the Centers for Disease Control and Prevention guidelines on who gets tested, “because there really is a shortage and we need to reserve these resources for those who need it most.”

The first step in trying to get a coronavirus test is to call your doctor and discuss your symptoms. You can also make a telemedicine appointment, where a physician like Rao will evaluate you and then provide a lab requisition form if you meet the criteria for a test.

“That doesn’t necessarily guarantee they’ll get tested because, currently, it will depend on their location and the inventory of test kits where they are,” Rao said. But if kits allow, having a script that says that you meet the criteria will make you a priority, he explained.

“Patients can present themselves to a local center. They don’t have to have a doctor’s recommendation,” Rao said.

However, many of these facilities are operating on prescheduled appointments and are overbooked. So driving up to a location on your own may be futile.

Fichtenbaum suggested calling a testing center to explain your situation and to see if you need a referral.

“Most of the drive-thru centers are not like McDonald’s, where you just show up and order something. Most of it is controlled,” he said. He also noted that most locations only have a certain amount of tests they can administer each day.

Most importantly, take care of yourself if you’re sick. Make sure you isolate away from others and monitor your symptoms. A positive test is useful for data, but the major way to stem this pandemic is preventing the spread as much as possible.