How and when you should be tested for the coronavirus in the U.S.

U.S. Vice President Mike Pence on Tuesday said that any American, with a doctor’s order, can now be tested for coronavirus.

The move appears to expand criteria that had previously limited testing to patients who had been hospitalized, absent certain extenuating circumstances such as contact with a coronavirus patient.

Criteria set by the U.S. Centers for Disease Control and Prevention has now called for “any American (to) be tested (for coronavirus), no restrictions, subject to doctors’ orders,” as Pence said when describing the new policy.

Earlier on Tuesday, the CDC suggested that has always been the case — that who should be tested is based on doctors’ discretion.

CDC officials also said this last week, when they expanded their testing criteria Thursday after the first US case of unknown origin was confirmed. That individual would otherwise not have fit earlier testing guidelines.

“As soon as that case was recognized, we met and we revised our case definition for persons under investigation,” CDC Director Dr. Robert Redfield said Thursday.

What do you do if you need a test?

Health officials urge anyone who believes they should be tested to call ahead, rather than showing up unannounced and potentially exposing others to an infectious disease.

“Your healthcare professional will work with your state’s public health department and CDC to determine if you need to be tested for COVID-19,” the agency’s website says.

Should you get tested? What are the guidelines?

CDC’s website currently advises people: “Call your healthcare professional if you feel sick with fever, cough, or difficulty breathing, and have been in close contact with a person known to have COVID-19, or if you live in or have recently traveled from an area with ongoing spread of COVID-19.”

CDC’s testing guidance includes three types of people:

1. Those who have symptoms such as fever OR lower respiratory symptoms (cough or shortness of breath) and have had “close contact” with a confirmed coronavirus patient within 14 days of their first symptoms.

2. Those who have fever AND lower respiratory symptoms, require hospitalization, and have traveled to areas impacted by the epidemic in the last 14 days.

3. Patients with fever and severe acute lower respiratory symptoms who require hospitalization and for whom no other diagnosis has been found — such as the flu. No travel or contact exposure is needed.

On Friday, Dr. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, said, “At this point in our investigation, we are most focused on symptomatic people who are closely linked to confirmed cases or had travel history. But our criteria also allows for clinical discretion.”

Prior to this, only people with travel history to China or contact with a confirmed patient were included in these criteria.

CDC says the criteria “are intended to serve as guidance for evaluation. In consultation with public health departments, patients should be evaluated on a case-by-case basis to determine the need for testing.” The agency adds that they are “subject to change as additional information becomes available.”

Why have people had a hard time getting tested?

Reports have emerged of people having difficulty getting tested for the novel coronavirus.

Despite the CDC saying the decision to test has been up to doctors, it may not have been implemented this way at state or local levels.

For example, the Massachusetts Department of Public Health said that doctors would need to first call a hotline to determine if their patients “meet the CDC definition of a (person under investigation) and be authorized for testing at the State Public Health Lab.”

Dr. Jeffrey Duchin, health officer for Seattle and King County, Washington, previously said that new coronavirus cases could have been identified earlier if not for delays in local testing capability and restrictive criteria about who gets tested.

“If we had the ability to test earlier, I’m sure we would’ve identified patients earlier in the community, possibly at hospitals,” Duchin said on a call Saturday with CDC officials. “But we were also looking at not only availability of testing but whether patients met criteria for testing.”

Duchin said of the first coronavirus death in the US, “Given the fact that we just recently acquired our availability of testing and new criteria were published, this person was brought to our attention.”

Will it be easier to get tested now?

Health officials have announced a number of developments in making tests available after CDC’s initial test kits sent to public health labs were found to be faulty.

The CDC has since fixed that issue, leading a number of public health labs to be able to test for the virus locally, then later get a confirmation by the CDC.

Separately, the US Food and Drug Administration is overseeing a separate pathway through which commercial test manufacturers can make test kits available.

“That means it will be a tool in the toolbox of clinicians in clinics and in hospitals that they can use based on clinical suspicion to test their patients,” said Messonnier. But she added that those tests overseen by FDA wouldn’t automatically count toward the CDC’s official case counts.

Whether Pence’s comments will hit a reset button among local health authorities and individual doctors remains to be seen.

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