By TINA KELLEY and PHOEBE PINDER
(Note: Coronavirus news is changing quickly. We’re trying to update as warranted.) As the coronavirus spreads, many Americans with symptoms wonder if they should get tested, and where. (We discuss how much it can cost to do so here.)
Do you have something we need to know about this? Email us at info@clearhealthcosts.com or put your test info into our handy form.
According to the website of the federal Centers for Disease Control and Prevention, “If you are a close contact of someone with COVID-19 or you are a resident in a community where there is ongoing spread of COVID-19 and develop symptoms of COVID-19,” call your healthcare provider, who will decide if you need testing. For a quick checklist, see the bottom of this story.
On Friday, March 20, the New York City Health Department issued a statement saying that — despite a new availability of tests — people should not get tested. “Outpatient testing must not be encouraged, promoted or advertised,” the Health Department said in an advisory.
The New York Times reported: ‘Facilities were asked to ‘immediately stop testing non-hospitalized patients’ for the virus unless medically necessary. City officials said they were worried the testing centers were drawing sick people out from isolation in their homes. To perform each test, health care workers must use fresh protective gear, including masks, which are already in short supply. The Health Department also discouraged hospitals from testing asymptomatic health care workers, alarming some doctors who believe it could lead to increased transmission within hospitals.”
California also strictly restricted coronavirus testing. In other parts of the country, the situation is less clear.
Two kinds of tests
There are two kinds of tests. One is currently the most common — the one that tells whether you actually have coronavirus. That’s usually done with a swab stuck into your nose or elsewhere in the respiratory tract, and the resulting sample is tested at a lab.
Another kind of testing is now being done, serological (blood) testing for the presence of antibodies to the virus. We’ll discuss both kinds here.
Tests hard to find
Across the country, regardless of regulations, tests remain hard to find, according to a New York Times article on March 30. ”Although testing has picked up since a series of setbacks left the United States behind, governors have continued to warn in recent days that their response is still hampered by shortages, including of basic supplies like swabs. Gov. Jay Inslee of Washington, a Democrat, told CNN on Sunday that “we have a desperate need for the testing kits.” And Gov. Ralph Northam of Virginia, also a Democrat, warned last week that there was a shortage of testing materials in his state,” The Times wrote.
On another CDC page, healthcare providers are instructed to give priority to:
- Hospitalized patients who have signs and symptoms compatible with COVID-19 in order to inform decisions related to infection control.
- Other symptomatic individuals such as, older adults and individuals with chronic medical conditions and/or an immunocompromised state that may put them at higher risk for poor outcomes (e.g., diabetes, heart disease, receiving immunosuppressive medications, chronic lung disease, chronic kidney disease).
- Any persons including healthcare personnel, who within 14 days of symptom onset had close contact with a suspect or laboratory-confirmed COVID-19 patient, or who have a history of travel from affected geographic areas within 14 days of their symptom onset.
The University of Utah Health website advises that if you don’t have symptoms, you don’t need to be tested.
It’s best to check your state health department’s site directly for guidance on criteria for getting tested in your state. Here’s a directory.
Here’s our data from our reported and crowdsourced “where to find a test site” collection for the nasal swab type. To add your data, go to this link. Story continues below spreadsheet. (Pro tip: If data is not visible, you may need to scroll to the top of the spreadsheet, or left to right; we are adding data daily, and welcome your contributions.)
[embeddoc url=”https://clearhealthcosts.com/wp-content/uploads/2020/03/CHC-Coronavirus-respiratory-testing-survey-42320201215p.xlsx” viewer=”microsoft”]
Private labs are now joining state and federal ones in processing the tests for COVID-19, but are not necessarily offering them directly to patients. Doctors must order the tests, and patients are not to visit private labs directly, according to the websites of two large private lab companies, Quest and Labcorp. The scene is changing quickly, so check local sources regularly.
For the serological or antibody test, there are two main variants: A hospital (Mount Sinai in New York, for example) is doing a series of tests to see if antibodies are present in the blood of formerly infected people, and what scientific uses there may be for that. These tests tend to be free.
Other tests, outside of a research or hospital setting, seem to be pay-as-you-go. We’ve heard prices as low as $59 and as high as $275.
Drive-Through Tests
At least 11 states, California, Colorado, Connecticut, Indiana, Minnesota, New Jersey, New York, Ohio, Texas, Utah, and Washington, have started drive-through testing, where ill patients can be tested from cars, rather than risk spreading the virus, should they have it.
San Antonio opened Texas’s first drive-through testing facility Friday for qualifying first responders and health care workers. It is not open to the general public, and its exact location has not been disclosed. In order to qualify to receive a test, “a person’s employer must confirm he or she is ill and meets the criteria to be tested — having symptoms of COVID-19 and testing negative for the flu.”
Previously, the state’s public labs were only able to perform 270 tests per day, and many patients and medical personnel were turned down. The new drive through-testing should be able to provide “hundreds of tests per day,” according to Charles Lerner, a San Antonio-based epidemiologist. However, the tests results take three to four days to process, compared to the one-day turnaround rate NPR reported in South Korean drive-through facilities.
Kaiser Permanente has set up three drive-through testing facilities in Northern California, in San Francisco, Redwood City, and San Leandro, according to the Los Angeles Times. However, the facilities are not permanent and their undisclosed locations change daily. The facilities are not open to the general public – “only patients who are Kaiser members and have been provided an appointment with the facility by their doctor are permitted access.” Marc Brown, director of national communications at Kaiser, reported that similar drive-through sites will be opening soon in Colorado and Washington, D.C. Kaiser patients “who have double medical clearance from a primary care doctor and an infectious disease specialist are getting tested for coronavirus at the French campus in San Francisco,” according to ABC7.com, which noted that Kaiser has plans to expand to Southern California.
Express Care, Stanford Health Care’s same-day primary care program, offers drive-through testing for people with appointments and identification, according to PaloAltoOnline. Appointments for Express Care can be made online through Stanford Health Care’s portal or app, or by calling 650-736-5211. Officials urged sick people not to take services like Lyft or Uber to drive-through clinics.
In Los Angeles, testing was hard to find. “Los Angeles has taken longer to implement widespread testing, and it has partially shied away from testing, fearing that it would waste resources. Andrea Garcia, a spokeswoman for Mayor Eric Garcetti, said that there were four testing sites in the city, but the locations were only disclosed to those who qualified for the test,” The New York Times reported on March 24.
In New Jersey, Riverside Medical Group, which serves 25 North Jersey locations, announced it had started doing screening for its patients via telemedicine, and if appropriate, referring them to a drive-through location just for Riverside patients in Secaucus, which began operating on Monday.
Hudson Regional Hospital — located on Meadowlands Parkway in Secaucus — will conduct testing by appointment beginning immediately, it announced Tuesday, according to NJ.com. People who have a fever, cough and shortness of breath must first begin the hospital’s screening process by calling 201-388-1097.
Kurt Keydel, 58, from Seattle, was able to get a test, as his workplace requested it when he reported having a fever. He scheduled an appointment for Tuesday at the Polyclinic’s acute respiratory clinic at 1145 Broadway in Seattle, called from his car when he got there, and came up to the office 15 minutes later when a physician assistant could see him. They checked him for Influenza A and B, and a doctor evaluated him. Because he had a heart attack several years ago, and because his employer wanted to know his condition, the doctor, after consulting with other doctors, tested him for COVID-19. “If I do have this thing, I would say I’m probably one of the lucky ones – fever is really my only symptom,” he said, adding that he did not have to pay anything for the test, although the front desk did ask about what insurance he had. His test results came back negative on Thursday.
Anecdotally, as of March 18, we hear that some CityMD locations in New York are doing testing, and that a child of an acquaintance got tested at Mount Sinai Urgent Care. We are adding other locations as we can, and we are building a database that we will post on this page.
Here’s a pop-up testing location in Snoqualmie, Wash. A commenter on Reddit said she “walked right in and got tested. I will get results in 48-72 hours. They are open 10am-6pm for anyone else that needs it. It’s free and avoids the beurocracy and incompetence described above.”
“The Medical Board of California is looking into physicians selling COVID-19 tests while sick people around the country can’t get tested because of a nationwide shortage, a board spokesman said Monday morning,” according to The Los Angeles Times. “The inquiry comes after The Times reported that ‘concierge’ doctors who cater to rich people and celebrities have been selling testing to patients and their families, in some cases even if they have no symptoms or any other reason to be tested. Dr. Jay Gordon, a Santa Monica pediatrician, told clients who purchased the tests for $250 each — to be taken at home with a cheek-swab and then sent to a lab to process results — to save the tests until they’re feeling sick.”
In Buncombe County, N.C., testing opened up and closed down three days later. “After three days of providing drive-through testing for COVID-19, Buncombe County has closed its two test sites at Biltmore Church in Arden and UNC Asheville,” The Mountain Xpress reported. “Dr. Jennifer Mullendore, the county’s interim health director, said during a March 20 press conference that the decision was made primarily to conserve resources for ‘the long haul’ in Buncombe’s management of the disease caused by the novel coronavirus. Every test … Mullendore explained, exposes health care workers to potential infection and uses personal protective equipment such as masks and gowns, which are also critical during treatment of the disease. She noted that most COVID-19 cases are mild and can be managed at home with rest and over-the-counter treatments such as acetaminophen for fever reduction.”
There are two locations in New Orleans, according to news reports, but they closed unexpectedly on March 23 because they ran out of test kits. This is common — the sites go up and down, move locations, change requirements for testing. It’s complicated.
The New York Times published this piece about “what it’s like to get tested.” Generally, people started with a call to their primary care doctor. Other bits of advice are also included.
Driving through in New Rochelle
In the New York City suburb of New Rochelle, a drive-through testing facility was set up at Glen Island Park, part of the Westchester County Parks System, over the weekend. People who want to get tested need to drive up to the bridge over a snippet of Long Island Sound that leads to the park, and show that they have registered with the state health department to get permission to get a test. New Rochelle is a locus of infection, with several hundred cases, and that’s why the testing center was set up there by Gov. Andrew Cuomo.
Local people talking about the experience on a local Facebook group said they had sought to register with the health department and waited for permission to go, but did not receive permission and went anyway. They said they were told they could indeed get the test, if they qualified under certain criteria — active symptoms and/or exposure to a known case of coronavirus — even if they didn’t have the permission.
They said they were told results would come in 2-3 days. They said the testing was limited to New Rochelle residents, though several of the local people are from Pelham, a neighboring community.
It appeared to be true that the rules were changing on the ground — it seemed to be that traffic at the site was light over the weekend as it was being set up. Reports on the ground on Tuesday indicated that there were six lanes of testing, with tents and National Guard personnel on the parking lot at Glen Island County Park. According to the Westchester County Health Department website, “the mobile testing center is prioritizing tests for individuals that are part of the highest risk population.” It noted that New Rochelle residents who would like to be tested can make an appointment by calling 888-364-3065.
She did say that the results seemed delayed, so she tracked down the name of the lab processing the tests and called them for results. In her case, the lab was BioReference Labs, telephone 800-229-5227.
Serological or antibody testing: Checking to see if you were exposed
There’s a lot of talk about serological tests, sometimes called antibody tests, that can show immunity from the virus. But do these tests work? Here’s what you need to know.
Serological tests measure the amount of antibodies present in the blood in response to a particular virus – in this case, SARS-CoV-2, the virus that causes COVID-19. The presence of antibodies in the blood indicates a prior infection. These antibodies for SARS-CoV-2 seem to typically appear within the second week after onset of symptoms, making this type of testing ideal for detecting prior infection, according to the World Health Organization. Nasal swab tests, by contrast, seek to detect active infections.
Researchers hope that antibody tests be more accurate than the nasal-swab tests, and also that they could help provide a clearer sense of the number of asymptomatic coronavirus cases in the country.
The situation is complicated by the fact that the nation – and the world – is in a panic. Public health officials, businesses, and ordinary people are looking for answers in an uncertain situation, hoping for a test that has a definitive answer. But experts disagree on how accurate the tests actually are, and caution on relying too heavily on serological testing at this stage in the pandemic.
For details on how the antibody tests work, and whether they work, see our full post here.
Here’s our data from our reported and crowdsourced “where to find a test site” collection for the serological or antibody test. To add your data, go to this link. Story continues below spreadsheet. (Pro tip: If data is not visible, you may need to scroll to the top of the spreadsheet, or left to right; we are adding data daily, and welcome your contributions.)
Click here to download a list of sites.
In late April, the New York State Health Department began a large-scale study, using serological testing (blood antibody testing) to analyze 3,000 people across the state in order to determine what percentage of New York’s population has actually had COVID-19. “That will tell us, for the first time, what percent of the population actually has had the coronavirus and is now at least short-term immune to the virus,” Governor Cuomo said during a press briefing. (https://www.ny1.com/nyc/all-boroughs/news/2020/04/21/new-york-begins-antibody-testing-of-thousands-to-gauge-infection-rate) “Any plan that is going to start to reopen the economy has to be based on data, and that means it has to be based on testing. This is a new world for all of us.”
Temporary testing sites were set up in 20 grocery stores scattered throughout the state, including at least one in each borough of the city. Consenting grocery store patrons were selected at random to provide fingerstick blood samples to be submitted for serological testing. The grocery stores say they do not plan to continue to provide testing after the study’s completion. The samples will be tested by Wadsworth Center, a state-run lab in Albany. (https://www.marketwatch.com/story/new-york-begins-widespread-random-antibody-testing-but-questions-remain-about-effectiveness-and-immunity-2020-04-20) The test being used was developed by the Wadsworth Center and has received emergency FDA authorization.
Weill Cornell Medicine, Columbia University Irving Medical Center, and NewYork-Presbyterian are looking for plasma donors to potentially help those currently suffering from COVID-19. In order to donate, you must meet the following criteria:
-”Have had a previously confirmed diagnosis of COVID-19 made through testing of a nasopharyngeal swab, oral swab, or sputum (spit).
-Recovered fully from COVID-19, showing no symptoms for at least 14 days.” (https://www.nyp.org/covidresearch)
Mount Sinai Laboratory received emergency use authorization from the (FDA) for an antibody test that was developed, validated, and launched at Mount Sinai. https://www.mountsinai.org/about/newsroom/2020/mount-sinais-blood-test-to-detect-antibodies-to-covid19-receives-emergency-use-authorization-from-us-food-and-drug-administration-pr
Mount Sinai is testing people to give plasma, too. The web form to fill out to gain access is here; it says “If you had COVID-19 and have recovered you can help save a life. Your blood may contain antibodies that fight the virus and can help critically ill people. Mount Sinai is looking to screen you as a volunteer. Please fill out this form to see if you are eligible.”
New York Blood Center is also seeking convalescent plasma donors who have recovered from COVID-19. They say that they do not test for COVID-19. (https://www.nybc.org/donate-blood/covid-19-and-blood-donation-copy/)
ONLINE SCREENING
(Updated) In mid-March, President Donald Trump announced that the White House is collaborating with Google to build a website to help Americans find coronavirus testing nationwide. However, Trump seems to have been confusing several different projects currently at work. It turns out that neither works very well.
Other online screening options generally involve a call to a telemedicine or other provider, who will determine if you qualify for a test.
Fake testing efforts
People should also be aware that there are fake testing efforts. More are likely to pop up in this atmosphere of scarcity and confusion.
‘A yellow box truck spotted in Nashville advertising coronavirus testing for everyone is linked to a disgraced weight-loss doctor who lost his license due to unscrupulous medical claims and sexual misbehavior,” Brett Kelman and Adam Tamburin wrote in the Nashville Tennessean.
“Nashville police and the Tennessee attorney general’s office are investigating the truck and testing effort, which is being led by Richard Feldman, 72, a Nashville doctor who lost his license 12 years ago and has never gotten it back.”
In Pelham, N.Y., next door to New Rochelle, police issued a warning about a nationwide home testing scam, in which people go door to door claiming to be from the C.D.C. and offering home testing. They said anyone with such a case should call the police. Here’s the story.
Home testing
Several companies have offered or promised home testing kits. At this point, according to The New York Times, the FDA has not approved any home testing kits, and at least two of the companies promising them — Nurx and Carbon Health — have withdrawn their offerings.
The Times’s full story is here.
Celebrities
It seems at this point that athletes and celebrities are not having trouble getting tested. Among those testing positive are actors Tom Hanks and Idris Elba, and four members of the Brooklyn Nets.
Non-celebrities like Tim Herrera, a 33-year-old New York Times editor and writer, have a harder slog. Herrera wrote of his journey: “Almost a dozen calls with five health care providers over five hours. Two hours of hold music. Two hours in a hospital. Four days of anxiously checking an online portal for results. And lots of confusion. That’s the winding path through bureaucracy that took me from placing my first phone call last Wednesday to getting my positive coronavirus test results on Monday night. Five days in limbo.”
What you can do
- Try to stay healthy by washing hands regularly for 20 seconds each time.
- Practice social distancing to slow the spread of the disease. If you’ve been exposed, this will keep you from passing it on to anyone else even if you have symptoms, and whether or not you have tested positive.
- If you have symptoms similar to those of the coronavirus, fever, and a cough and/or difficulty breathing, call your doctor and follow instructions as to getting tested. Directions seem at this point to vary state by state and jurisdiction by jurisdiction.
- Do NOT show up unannounced to a doctor’s office or hospital if you have symptoms.
- If you don’t have a doctor, call ahead to a walk-in clinic or a federally funded health center.
- There are efforts to extend testing, but right now the availability seems to be limited. Asking friends and neighbors if they got tested and how seems to be a good strategy. If you are genuinely in need, be persistent. Some people said they had been turned away from several testing sites, while others eventually prevailed.
- Remember, though, that keeping the limited testing capabilities open for people who are in great need is a social good. If you aren’t experiencing symptoms and you don’t meet local official testing requirements, don’t try to insist on getting tested.
Resources
GENERAL
The national hotline for coronavirus is here: 1-800-525-0127.
Medicare and coronavirus (Kaiser Family Foundation)
Medicare and coronavirus (Centers for Medicare and Medicaid Services)
Center for Disease Control and Prevention Site
NYTimes Coronavirus live updates
Johns Hopkins Bloomberg School for Public Health Center for Health Security COVID-19 site
Johns Hopkins COVID-19 live tracker
C.D.C. list of state and territorial health department websites
Directory of hundreds of mutual aid resources nationwide
List of Coronavirus/COVID-19 hoaxes from Buzzfeed News
How states are responding to coronavirus, in 7 maps.
Small business resources, particularly for women who are founders, from The Helm
CALIFORNIA
City of Los Angeles COVID-19 test referral site
CONNECTICUT
Two medical institutions in Connecticut have set up telephone hotlines for people of Fairfield County who are experiencing symptoms that they are concerned could be linked to the coronavirus, according to the New Haven Register:
Norwalk Hospital: 888-667-9262 / 8 a.m. to 6 p.m. Monday to Friday.
Stamford Hospital: 203-276-4111 / 7 a.m. to 7 p.m. Monday to Friday.
FLORIDA
News 6 “Click Orlando” map of COVID-19 testing sites in Florida
MASSACHUSETTS
Massachusetts essential services
NEW YORK
NYC United Against Coronavirus resources-donations, deliveries, relief funds etc.
New York County county breakdown of cases from health.ny.gov
Tricks for navigating New York’s archaic unemployment web site
Westchester County Health Department site
New York City MTA transit updates
Washington
Online screening and test referral for Snohomish County residents
Health insurance and COVID-19 FAQ from the Office of the Insurance Commissioner of Washington State
