“It’s not as easy as taking a swab. It requires the involvement, I kid you not, of 40 people. If that’s not a barrier to care, I don’t know what is,” the doctor said.
Understanding the testing situation requires walking through hypotheticals. If an American with a state or city’s first community case of COVID-19 walked into an emergency room—short of breath, exhausted, and perhaps coughing up blood—would he or she get tested? It depends on the state, the county, sometimes even the individual hospital.
The person would probably not get tested in New Hampshire, which had the strictest guidelines among the dozens of states we asked to share basic information about their current testing criteria. If someone has not had contact with a COVID-19 case, has not traveled from a country where the CDC or World Health Organization says the coronavirus is in community spread, and is not sick enough to be hospitalized, then a flow chart published by the state recommends “no testing; usual care.” (After publication, New Hampshire said it had updated its rules. Under the new guidance, a doctor could test such a person if they were exposed to large numbers of people or were judged to have a “risk of exposure to COVID-19.”)
Read: What you need to know about the coronavirus
Most other states publish criteria only for how to prioritize tests. Hawaii, Idaho, and Vermont hew to something like the basic CDC criteria, asking doctors to focus on patient symptoms, travel history, and known exposure. North Carolina, among the most lenient, will allow doctors to test a symptomatic patient if the person has failed a rapid flu test. Some states—such as Missouri, Wisconsin, and Colorado—allow for testing a hospitalized patient if the person is in severe respiratory distress and has no other diagnosis.
Some states admit they have to be more stringent with tests than the CDC recommends. In Missouri, a spokeswoman told me that the state public-health lab had to reserve its “finite number of tests … for those in greatest need.” The state has testing supplies for only about 1,000 samples, she said, and additional testing kits and supplies had been back-ordered from the CDC for two weeks.
Some states, such as Illinois, Colorado, and Washington, prioritize testing when officials or doctors suspect there might be a cluster of cases, such as in a school or nursing home.
Most state guidelines do not apply to tests conducted by private laboratory firms that do routine medical testing, such as Quest Diagnostics and LabCorp. Those firms say they can test 5,000 people a day, combined, but they take three to four days to deliver results, compared with 24 hours for a state public-health or on-site hospital lab test.
What about a doctor or nurse who has COVID-19 symptoms and wants to get tested? Again, it varies by state. Washington, the site of the country’s largest confirmed outbreak, says it will test health-care workers as well as people in other “public-safety professions,” such as police officers, firefighters, and EMS. Colorado allows symptomatic health-care workers to get tested, even if they don’t know whether they have had contact with a COVID-19 patient. But Illinois says that health-care workers can get tested only if they have met a patient with a lab-confirmed case of COVID-19.