When Dino Vournas started experiencing symptoms of the new coronavirus, COVID-19, he knew that he was a likely case.
“It had popped into my mind pretty quickly,” Vournas, 71, of Hayward, California, tells PEOPLE about his onslaught of symptoms beginning March 13. “I was skiing in Tahoe and on my way home I had a temperature and a cough. My cousins had tested positive and I had just seen them.”
But getting tested was another story. He tried his local hospital first, but was told they weren’t doing any testing and to let them know if his symptoms worsened. Vournas continued asking around, and through a friend, learned that he could drive to a small urgent care clinic in Oakland and get tested. It came back positive for COVID-19.
Vournas’ experience is one that has been repeated throughout the country — people have symptoms and are likely to have the virus, but due to the severe shortage of tests, are unable to get tested. President Donald Trump claimed on March 6 that “anyone who wants a test can get a test,” but weeks later, that is still not the case.
CDC testing regulations gives first priority to those who are hospitalized, health care workers showing symptoms, and high risk cases
In the U.S., there are a few options for COVID-19 testing — people can contact their local hospitals, urgent care clinics, personal physicians offices or try to get an appointment at a drive-thru testing facility. But not everyone can get tested.
The Centers for Disease Control is currently recommending against wasting tests on people who are asymptomatic, or even those who have the symptoms and are likely to have COVID-19, but will be able to recover at home. As of March 27, the CDC’s guidelines for medical practitioners advise grouping patients into three categories when deciding if they should get tested:
The highest priority goes to people who have COVID-19 symptoms and are already hospitalized, or to health care workers with symptoms. The next level is people at a “high risk of complication of infection” who are already experiencing symptoms — those over 65, patients with preexisting conditions, those in long-term care facilities and first responders. The third tier is anyone else with symptoms, but only if “resources allow.” Those individuals are told to contact their local health care providers.
“If you have symptoms of COVID-19 and want to get tested, try calling your state or local health department or a medical provider. While supplies of these tests are increasing, it may still be difficult to find a place to get tested,” the CDC said as of Friday.
Those without symptoms are a “non-priority.” While that’s currently necessary due to the lack of testing kits and a major shortage of masks and gloves (which are needed for the medical professionals doing the testing), experts have repeatedly said that testing everyone — even those who are asymptomatic or have mild cases — is needed to fully stop COVID-19 from spreading in the U.S.
“One of our key failures in the U.S., compared to other countries, is not to have tests available,” Dr. William Haseltine, an infectious disease expert and Chair and President of ACCESS Health International, tells PEOPLE.
In New York City, the original goal was to test anyone with moderate symptoms or those at risk of developing more severe symptoms, Dr. Andrew Wallach, Chief of Ambulatory Care at NYC Health & Hospitals/Bellevue, tells PEOPLE. But with the massive spike in cases in New York, which has around one-third of all cases in the U.S., the Department of Health said on March 20 that they had to readjust their strategy.
“They recommended that we focus on patients that are hospitalized,” Wallach says, explaining that only testing those patients cut down on their workload, freeing them to focus on patients who are severely in need. “There are treatments, there are medications that we can give to patients who are admitted to the hospital.”
Plus, limiting the types of cases that could get tested shortened the wait time for test results.
“Since this strategy went into effect as of last week, we’ve seen a significant decrease in that turnaround time,” Wallach says. “It had been at a baseline at anywhere from three to five days, if not longer, to now consistently less than 48 hours and in many cases the same day.”
And even with these restrictions, New York state is testing at the highest rate nationwide, with around 18,000 tests a day, Gov. Andrew Cuomo said.
Expanding testing
There is hope of expanded testing. After the Food and Drug Administration announced earlier in March that private companies could create their own tests, several have submitted theirs for approval, including molecular diagnostics company Cepheid, whose rapid test was the first to be cleared by the FDA on March 21.
But not all private testing kits will be approved. Several start-ups have created at-home test kits that they planned to make available for anyone to purchase, but the FDA said on March 20 that these kits are “fraudulent” and are not proven to work.
“The FDA sees the public health value in expanding the availability of COVID-19 testing through safe and accurate tests that may include home collection, and we are actively working with test developers in this space,” they said in a statement. But “fraudulent health claims, tests and products can pose serious health risks. They may keep some patients from seeking care or delay necessary medical treatment.”
And on Wednesday, two members of the House of Representatives, Raja Krishnamoorthi of Illinois and Katie Porter of California, sent letters to three of these companies marketing at-home tests, asking them to explain how they planned on using the biological data they collect from users. Additionally, Congress agreed that testing would be free to all Americans, and private companies had already started selling their kits at a cost.
“Do you intend to refund all consumers all amounts they paid for at-home coronavirus test kits, and if so, when and how you will you do so?” Krishnamoorthi and Porter asked in their letters, according to The New York Times.
Private testing for the wealthy
Along with the federally available testing and the short-lived at-home test kits, there’s been another option for people to learn if they have COVID-19 — but only for those who can afford it.
On March 11, the NBA’s Utah Jazz announced that one of their players, Rudy Gobert, had tested positive for COVID-19 well before testing was widely available in the U.S. The rest of the team — 58 members and staff — were tested as well. In their case, they had been playing in Oklahoma City, and state health officials determined that it was medically necessary to use their available tests on the team because they were “super spreaders” due to their close proximity to each other, fans and the general public as they played and traveled for games, USA Today reported.
After Gobert’s positive result, several other NBA teams opted to test all of their players, leading to questions from the public as to why they’re able to get tested while other Americans can’t.
The Brooklyn Nets reportedly paid an unnamed private company to get their players tested (four tested positive, including star forward Kevin Durant), according to TIME. And some actors, including Idris Elba, were able to get tested despite not showing any symptoms because their production companies paid for tests based on concerns that they had been infected. Elba was in the U.K., not the U.S., but they were seeing a similar shortage at the time.
Others, however, have stuck with publicly available testing options. Actor Daniel Dae Kim developed symptoms in his hometown of Honolulu, Hawaii, and was tested at one of the then-newly opened drive-thru facilities.
And comedian Kathy Griffin has been unable to get tested at all, she said on March 25. Griffin went to the emergency room at Cedars Sinai Hospital in Los Angeles for an abdominal infection, but her symptoms — nausea, chills, sore throat — were also in line with COVID-19. Griffin wanted to get tested, but was told she didn’t meet the CDC requirements.
“I just think it’s so obvious that those tests have to be accessible to everybody,” Griffin told the Los Angeles Times. “A lot of people, when they hear the president saying everyone who needs a test should get one, then shouldn’t have to then go to a hospital where, frankly, they may be exposing themselves or exposing others.
But getting tested has been easier for a subset of wealthy Americans who pay for concierge doctors — physicians who limit their private practices to clients who can pay yearly retainers of upwards of $1,000. One concierge doctor quoted in the Los Angeles Times said he bought up rapid testing kits from China and South Korea and intended to offer them to anyone, but at a fee of $500 to $600.
“We have had a lot of new patients contact us who money wasn’t a factor for; they were willing to pay whatever was needed,” Dr. David Nazarian, a physician in Beverly Hills, told the outlet. “But we’re not looking at this time in regards to ‘How can we make more money doing testing?’ or ‘Who we can charge more to do a test.’ It’s actually really trying to take care of the patients we already have and then figuring out how we can increase testing and do things for the good of the community.”
New frontiers in testing
Regardless of who can get the nasal swab tests that are currently available in limited amounts, experts say that the U.S. needs to eventually move to a blood test that would identify if a person has antibodies for COVID-19 in their bloodstream.
While the nasal swab test can correctly identify if a person with symptoms has COVID-19, it cannot detect the virus in asymptomatic people or those who have already recovered. An antibody test would be able to identify the virus at all stages, help to diagnose thousand more people a day and determine immunity, plus it would aid virologists in finding a cure or vaccine.
Researchers at Icahn School of Medicine at Mount Sinai Hospital in New York City are close to creating an antibody test, Science magazine reported. Dr. Florian Krammer, a microbiologist on the project, told The New York Times that the test would be able to give, “basically, a yes or no answer, like an H.I.V. test — you can figure out who was exposed and who wasn’t.”
As information about the coronavirus pandemic rapidly changes, PEOPLE is committed to providing the most recent data in our coverage. Some of the information in this story may have changed after publication. For the latest on COVID-19, readers are encouraged to use online resources from CDC, WHO, and local public health departments and visit our coronavirus hub.
- With reporting from SUSAN YOUNG and DIANE HERBST
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