At the end of last week, I got the sort of text we’re all dreading right now: The parent of a kid in my son’s carpool had tested positive for COVID-19. After privately freaking out, I emailed the family asking if they would please let us know the test results for the child who had been in the van with our son. In my naiveté, I assumed that if you had shared a bathroom and a kitchen and any number of meals with someone who had the virus, if that person had walked you hand-in-hand to catch the van to school, had helped you with your homework at night, had maybe even brushed your teeth, you would automatically get tested. I was very, very wrong.
In our cascading awareness of the severity of the COVID-19 threat and of the colossal SNAFU in getting functional testing kits out to the American public, that moment of blissful ignorance feels a lifetime away. We now know — rather than just suspect — that the virus has been spreading undetected in the United States for weeks, that our government has massively, stupidly, dangerously failed where other governments have heroically succeeded, and that lack of information about who has the virus in its early stages on our shores has turned a deadly problem into an exponentially deadlier one. But still, the question remains: Who gets tested for coronavirus, and how? To find out, I got on a (socially distanced) phone call with Dr. Leana Wen, emergency physician and public health professor at George Washington University, and the former health commissioner for the city of Baltimore. What she shared was informative — but sobering.
When and how and where should a person get tested if they think they have COVID-19?
This is an evolving situation, and so the circumstances will be different depending on the location that you’re in and depending on when you end up seeking a test. Right now, if you have no symptoms, it is unlikely that you will be able to get a test. If you have mild symptoms, you should call your doctor. Do not go to the ER. Call your doctor and see what the availability of testing might be in your area. Very likely, there will not be enough tests, and therefore your doctor will recommend that you self-isolate at home and that you manage with what we call “symptomatic management,” which is fluids, rest, and over-the-counter medications. If you are feeling very ill — for example if you have severe shortness of breath — your doctor will recommend that you go to the ER, and it’s possible that you may be able to get testing there. But do not go to the ER unless you would have otherwise gone. As in, do not go to the ER seeking a test because you will likely not be able to get a test and in fact you will end up potentially exposing yourself to other pathogens or spreading the disease to others, and you will take up valuable capacity in hospitals because many patients need in-patient acute care.
It seems there’s been a lot of confusion, though, with some doctors sending people to the CDC, the CDC sending people to their state health departments, the state health departments sending people back to the CDC or their local doctors. Is there no clear chain of command?
This is an extremely frustrating time for patients and clinicians. Patients just want answers, and clinicians just want to do their best to help patients. Unfortunately, this is the situation that we’re in, because we don’t have nearly enough tests. I ask for everyone to give each other some grace, because we all want the same thing. And there were missteps that were made by the federal government, but we have to move forward with what we have. Hopefully we will get these tests going very soon, because ideally, everyone should have access to a test if they need it and want it. But unfortunately, that’s not what we have now. We need to make do with what we have, and what we all should be doing right now — the most important thing that we should be doing right now — is to practice social distancing, because that’s the single most important thing to reduce the transmission of disease in our communities.
The people who do get tests, how long are they waiting for results?
This currently varies. Some places, the results come back within two to three days. Other places, it may come back the same day. But this again, though, is a significant area that needs prompt action, because ideally tests are available at the point of care, meaning that when patients come in, they can immediately get the results of their tests. But that is not the situation that we have right now.
Are health care workers getting tested as needed?
Well, health care workers are among the most vulnerable and should be prioritized when it comes to testing. How this works out in practice, and how soon they get the tests, appears to be variable across the country.
Do you see a point in time when everyone will be able to get tested and know whether they had the virus? Will there be antibodies present even if someone is no longer showing symptoms, so we can see, at some point in the future, how America was affected by this?
Ideally, we can get to that point within a few weeks. And we should get to the point of at least knowing what the spread of the disease is in our communities. To your question about antibodies, there is so much unknown, because we have to remember that this is a new disease, and tests still have to be developed. But the most important thing is we need to know who currently has the disease because we need to know who is actively infectious and therefore able to transmit the disease to others.
Can you give a sense of the extent to which things might be different now if we had been able to test broadly a few weeks ago?
It would be dramatically different. We would have a much better handle on the number of people who have COVID-19 and the degree of spread of coronavirus in our communities. It would change completely the clinical management for patients, and it would dramatically change our public health response if we knew the true extent of coronavirus in the U.S. We are we weeks if not months behind where we should be. That said, we need to take action to address what we should do now rather than finger-pointing and looking backward. In time, we need to look back and see what we should have done differently, but now is a time for us to figure out how we can come together as a society to help those who are most in need.
Are we at the point of no return, or is it still possible to slow the spread of this virus?
We are not powerless against the virus. We have a very narrow window, but that window is closing.