Health

All Your Questions About COVID Testing, Answered By Doctors

It’s not free everywhere.

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Coronavirus testing isn't as simple as going to a drive-through facility and walking away with a result. You need to be prepared for the process of getting a coronavirus test, from the queue to the results, to take some time. It can also involve more hurdles than you might expect. Plus, you know, the joys of a giant Q-tip up your nasal cavity.

"Testing is critical to slowing the spread of coronavirus and early identification of cases, so appropriate precautions can be taken," Debra Furr-Holden Ph.D., the C.S. Mott Endowed Professor of Public Health at Michigan State University's College Of Human Medicine, tells Bustle. If authorities know, based on test results, that a surge could be coming, they can close businesses, make mask rules more stringent, and put more resources into testing. "It is important that people ask questions to make sure they understand what the requirements are, what their options are, and are able to make an informed decision about what will best serve them."

When Should I Get Tested?

"It’s a good idea for people to check with their health care provider first to review their particular risk for COVID-19 and whether they need a test," Dr. Amy Khan M.D., the executive medical director of Regence health insurance, tells Bustle. "People who do not have symptoms or known exposure to the virus don’t need a diagnostic test." If you've been exposed to anybody who's sick, you might be contacted by a contact tracer and offered a test to see if you have it too. Even if you feel fine, you should take it if you can.

Currently, the CDC recommends that if you have symptoms or are concerned you have COVID-19, you should talk to your doctor, and they'll contact the local testing authorities to give you instructions.

If you don't have symptoms or any known exposure, seeking out a test might not be wise, depending on where you live and how limited testing is in your area. "Generally speaking, asymptomatic people who are not congregating for work or school should not seek out tests, because testing is still not at the levels we need," Dr. Rishi Desai M.D., a pediatric infectious disease physician and chief medical officer at medical education service Osmosis says. "We need to reserve them for those with symptoms and are seriously ill." The New York Times reported in July that cities with surging cases are experiencing testing shortages and long queues at testing facilities. Being tested as a precaution for travel or going back to work is a good idea in theory, but you shouldn't take up testing resources if you're not in dire need.

However, you can use your judgement depending on where you are. "In New York, we have good testing capacity at the moment," Dr. John A. Sellick M.D., professor of medicine at the Jacobs School Of Medicine & Biomedical Sciences at the University of Buffalo, tells Bustle. "In hot spots, the testing supply may be constrained and should be prioritized for people who need may hospitalization or are in the hospital." He also points out that different states have specific testing priorities, focusing on people in nursing homes or travelers returning from high-risk areas.

Asymptomatic testing is also really important for tracking COVID-19. "It is important that we test people who are asymptomatic in order to slow the spread of the virus," Furr-Holden says. "By the time someone is showing symptoms or is seriously ill, that person has likely already infected many other people." So if you feel guilty because you don't "need" to get tested, remember that your results contribute to the overall picture. Tests, both positive and negative, tell authorities how the coronavirus is spreading in every community. Talk to your doctor about the status of testing where you are if you don't need it urgently.

How Much Should It Cost?

The cost of your testing could vary from $20 to over $2,000, depending on where you are, your insurance coverage, the test used, and the laboratory that tests it. In New York, for instance, insurers must cover the cost of all coronavirus testing, regardless of whether people are showing symptoms, but uninsured people can only access free tests through Medicaid in 21 U.S. states. In Starr County in Texas, for instance, uninsured people have to pay $150 per test.

It's a good idea to check with your insurer to understand what’s covered by your health plan," Dr. Khan says. "Depending on the indication, most cover COVID-19 tests at no cost to their members to ensure people can get needed tests without a financial barrier."

What Is The Test Itself Like?

On the testing day itself, turn up early and prepare to wait; queues may be extensive, even with an appointment system in place, particularly if your state is experiencing a surge in cases. "You should expect to have your temperature checked and be taken through a series of questions upon arrival at the testing facility," Dr. Robert Quigley M.D., regional medical director of health security firm International SOS, tells Bustle.

When you (finally) get the test itself, expect a little bit of discomfort. "The main test used to identify whether you currently have COVID-19 is the RT-PCR," Dr. Desai says. "This is usually done as a swab that goes up your nose and feels uncomfortable for about five seconds." The swab is about six inches long and looks like a Q-tip. If you're being tested to see whether you've had COVID-19 in the past, Dr. Desai says, you'll have a test to evaluate whether antibodies are present in your blood. The blood might be drawn using a finger-stick, or from a vein in your arm.

How Long Will It Take To Get Results?

Results may take longer than you expect. "Some facilities have onsite labs and can provide test results within 30 minutes, but most facilities require the sample to be sent off," Dr. Quigley says. If your sample needs to go somewhere else for testing, prepare to wait. "Know up front what the turnaround time is, and plan for it to take longer," Dr. Burchett says. "I constantly hear from patients that they were told two days and it took five, or a week." In some states, laboratory backlogs mean that results may not come for weeks. The current surge may cause further delays, because higher test numbers might overwhelm laboratory resources.

While you're waiting for a test to come back, Dr. Quigley advises staying in strict quarantine to mitigate your risk of exposing others to the virus. If you have rapid testing, you will get a result quickly, but your doctor will probably want to have you take another test to confirm. "Some of the rapid testing recommends that any negative result be followed by the PCR test to confirm the negative result," Dr. Marla McLaughlin M.D., a primary care physician at Spira Care, tells Bustle. "This would require continued isolation/quarantine until confirmatory results are complete."

Once I Know My Results, Then What?

Your results may also not be black and white. "Unfortunately, the COVID PCR swab test is not 100% accurate," Dr. Burchett says. "A positive test confirms COVID, but a negative test does not always mean negative." If you're surprised by your negative results, talk about your symptoms with a doctor. "If the patient has a reasonable combination of exposure, COVID-19 symptoms and blood tests or X-ray findings, it can be reliably diagnosed without a positive test, or even when someone has a negative test," Dr. Burchett says.

And one test doesn't mean you're done. "Testing should be done regularly, and the frequency of testing should increase as a person’s exposure to the outside worked increases," Furr-Holden says. In the U.K., for instance, elderly people in nursing homes and their carers are being tested once every 28 days, regardless of symptoms. In an ideal world, we'll be able to access coronavirus tests easily whenever they're needed. It remains to be seen whether the U.S. testing infrastructure is up to that task.

Experts:

Dr. Larry Burchett M.D.

Dr. Rishi Desai M.D.

Professor Debra Furr-Holden Ph.D.

Dr. Amy Khan M.D.

Dr. Marla McLaughlin M.D.

Dr. Robert Quigley M.D.

Dr. John A. Sellick M.D.