Current Status of COVID-19 Testing
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As the nation continues to struggle to manage the COVID-19 (COVID) pandemic, one crucial element to mitigating the crisis- testing- has continued to present a variety of challenges to health care providers. Barriers to effective COVID testing include shortages of testing supplies, doubts about accuracy, and evolving recommendations around who should be tested.
Types of Tests
Currently, available COVID tests analyze tissue or fluid samples to assess the current or past presence of the SARS-CoV-2 virus. The types of tests include molecular, antigen, and antibody testing. Most of the COVID-19 testing currently being conducted in the U.S. uses polymerase chain reaction (PCR) technology to amplify and detect the presence of viral DNA.
Each type of test has its advantages and drawbacks. The FDA published the table below to help inform both providers and the public about the various types of testing being completed in response to COVID-19.
Different Types of Coronavirus Tests (source U.S. Food & Drug Administration)
Molecular Test Antigen Test Antibody Test Also known as… Diagnostic test, viral test, molecular test, nucleic acid amplification test (NAAT), RT-PCR test, LAMP test Rapid diagnostic test (Some molecular tests are also rapid tests.)
Serological test, serology, blood test, serology test How the sample is taken… Nasal or throat swab (most tests) Saliva (a few tests)
Nasal or throat swab Finger stick or blood draw How long it takes to get results… Same day (some locations) or up to a week
One hour or less Same day (many locations) or 1-3 days
Is another test needed… This test is typically highly accurate and usually does not need to be repeated. Positive results are usually highly accurate but negative results may need to be confirmed with a molecular test. Sometimes a second antibody test is needed for accurate results. What it shows… Diagnoses active coronavirus infection Diagnoses active coronavirus infection Shows if you’ve been infected by coronavirus in the past What it can’t do… Show if you ever had COVID-19 or were infected with the coronavirus in the past Definitively rule out active coronavirus infection. Antigen tests are more likely to miss an active coronavirus infection compared to molecular tests. Your health care provider may order a molecular test if your antigen test shows a negative result but you have symptoms of COVID-19. Diagnose active coronavirus infection at the time of the test or show that you do not have COVID-19
Despite the variety of tests being used, availability has been a challenge for some states. Shortages of transport media, pipettes and other supplies have compromised patients’ ability to get tested. However, the Yale School of Public Health recently developed a new method of processing saliva samples that does not require any special type of swab or collection device; a saliva sample can simply be collected in any sterile container. Because of the flexibility in how samples are collected, this new test should mitigate current the shortage in lab supplies and bolster the nation’s response to the pandemic.
Who should be tested?
The CDC continues to recommend testing for people who:
- have symptoms of COVID
- people who have had close contact (within 6 feet of an infected person for at least 15 minutes) with someone with confirmed COVID
- people who have been asked to get tested or referred for testing by their healthcare provider, local or state health department.
Other recommendations for prophylactic testing include hospitalized patients, health care facility workers, first responders with symptoms, and residents in long-term care facilities or other congregate living settings who are showing symptoms.
Somewhat controversially, the CDC recently changed its COVID testing guidelines to state that individuals who have been exposed to COVID and are asymptomatic do not need to be tested for the virus, unless they are in at high-risk for severe illness and/or have been advised to be tested by a health care provider or public health authority. On 9/18/20, the CDC issued a partial reversal of those guidelines to state that all exposed individuals should be tested, regardless of symptomology. Meanwhile, many states have not changed their recommendations subsequent to the revised statement from the CDC, and continue to recommend exposed individuals to be tested for COVID regardless of symptomology.
Mandatory Testing for Patients and Employees
Some medical practices, depending on the type of care they provide, require COVID testing for patients and/or employees in certain situations, or as a screening measure. For patients, it is entirely appropriate to require COVID testing prior to certain treatments or medical procedures, both to protect the patient and inform plans of care, and to protect providers and their staff from inadvertent exposure to COVID.
However, it is important to remember that patients must expressly consent to testing, and in the event a patient refuses, it be difficult to know the best way to proceed. In those situations, MIEC recommends that providers consider the medical necessity or urgency of care, and consider whether it would be most appropriate to treat the patient with the assumption of COVID positivity and take all appropriate protective measures, or decline to provide care based on the patient’s refusal to be tested. If there is a situation in which a patient refuses COVID testing and you are unsure how to proceed, contact the MIEC Claims Department for advice.
Likewise, COVID testing for providers and staff may be mandatory on a routine basis, or following suspected exposure to the virus. For information on the best approach to testing staff, see the CDC’s Guidance on Testing Healthcare Personnel.
The U.S. Equal Employment Opportunity Commission, which enforces workplace anti-discrimination laws, allows for mandatory medical tests, including COVID testing, for employees for screening before they are allowed to enter the workplace.
If an employee or clinician tests positive for COVID and they are known to have interacted with patients over the prior 2 weeks, MIEC recommends that you identify and notify those patients that they have potentially been exposed, and recommend that they seek testing and/or consultation with their primary care physician. You are not required, nor are you permitted, to disclose the identity of the individual to whom patients were exposed.
Despite the varying information and recommendations from the CDC regarding distance, time, and personal protective equipment (PPE) and how they might affect level of exposure and recommendations for COVID testing, MIEC continues to recommend notifying patients following even a low-risk exposure event- it is the safest course of action from both a liability and public health standpoint. If you have a situation involving possible patient exposure to COVID in the healthcare setting, please contact MIEC Claims for advice.
*Updated 9/21 to reflect updated CDC guidelines.