Updated March 10, 2020 @ 7:18 a.m.
Colorado has identified 12 cases of the novel coronavirus as of March 9. The state says it has conducted nearly 300 tests overall. But who gets tested — and how it works — have caused a lot of confusion in Colorado and around the country.
In other states where the COVID-19 virus has broken out, tests have been delayed or have malfunctioned. Far fewer people have been tested in the U.S. than in other developed countries where the virus has appeared, so some public health experts say we don’t really know how widespread the virus actually is. But NPR reports that test kits are now becoming more widely available in the U.S.
Initially, the Centers for Disease Control and Prevention had to process every test, which created a bottleneck.
Colorado now has the capacity to test for COVID-19, and the state health department says it can conduct up to 160 tests a day. So far, the state has run far fewer tests than that each day. For example, between Saturday and Sunday, the state conducted 83 tests.
So why isn’t the state conducting as many tests as it can handle?
“We have a limited number of tests,” said Jessica Bralish, communications director for the Colorado Department of Health and Environment. “We have to prioritize the ones that meet the criteria.”
The criteria the state has set for getting tested in Colorado are very specific. One of these scenarios has to be in place:
- The patient has a fever OR signs/symptoms of lower respiratory illness, such as cough or shortness of breath, AND the patient has been in close contact with someone confirmed with COVID-19, within 14 days of when symptoms started.
- The patient has a fever OR signs/symptoms of lower respiratory illness (and other diagnoses such as influenza have been ruled out), AND the patient recently traveled to parts of the world where infection rates are high or community spread is occurring, within 14 days of when symptoms started.
- The patient has a severe acute respiratory illness (e.g., pneumonia, ARDS) requiring hospitalization AND without an alternative explanatory diagnosis (e.g. influenza).
Michelle Barron, medical director of infection prevention at UCHealth, said people should call a doctor if they show a combination of fever, dry cough and shortness of breath. She also said if someone shows signs of the flu and has underlying asthma or lung disease, they should be extra cautious particularly if they tend to have breathing problems when they have a viral illness. The elderly and people with chronic medical conditions should also pay particularly close attention to their symptoms, as well as people who have traveled to countries that have dealt with high numbers of the virus.
In reality, the state has tested far fewer people than the number of tests reflect.
In many cases, one patient will have two samples tested. According to Gabi Johnston, a spokesperson for CDPHE, the number of tests conducted so far reflects the number of samples — not the number of people.
“Most people require two samples,” Johnston said, though she couldn’t specify how many exactly.
The state expects to expand capacity for testing soon.
It will do that by adding private labs like LabCorp and Quest to the list of places that can process tests.
“However, we’re also unsure of the total availability of the kits to do the testing and the reagents to do the testing,” said Scott Bookman, incident commander for the state’s public health response to COVID-19.
Bookman said that Colorado initially received two kits from the CDC that each contained 1,000 tests. He said on Sunday, “We’ve ordered more from the CDC and don’t have more information on their arrival. We have enough supplies on hand to continue testing at this rate for a minimum of 9 days without additional supplies.”
The ability to provide tests is limited by many factors.
“We know supply chains are impacted around the world,” he said, “so there are a lot of great unknowns.”
Staffing is another issue: CDPHE is currently hiring two new employees to help with testing.
Barron said the tests themselves are like a flu swab.
A nurse takes a swab of the throat and the nose then puts it in a liquid that allows the virus to survive until it’s tested. When people are tested, they’re also asked whether they've traveled, whether they think they’ve been exposed and the symptoms they’re experiencing.
When a test is positive, it’s considered “presumptive positive.” Then it’s sent to the CDC, and if that test is positive, then the diagnosis is official. The person would then be put in isolation for a 14-21 day period. Isolation may begin before the CDC confirmation, as well.
The test is currently free to patients and facilities, according to CDPHE. It is covered under state outbreak funding. Even if it wasn’t, the state and federal governments have ordered insurance companies to cover the cost of the test.
But that only matters if the person meets the state’s criteria for testing.
CPR’s John Daley and Kate Schimel contributed reporting.