What is a coronavirus test like? How are CDC kits handled? Here are the details
Government leaders and health officials have expressed concerns this week over a lack of available COVID-19 test kits, the official laboratory materials that the U.S. Centers for Disease Control and Prevention ships to qualified facilities to test for the coronavirus.
California Gov. Gavin Newsom on Thursday morning said there were about about 200 test kits in the state at that time, a figure he called “simply inadequate,” but said the state was “in conversations with the CDC about ensuring ... physicians or clinicians who ask for the test will more easily be able to (access) it.”
The CDC website indicated at one point Thursday that only 445 tests had been conducted nationwide. As of late Friday morning, that number had increased by six to 451 total across the U.S.
Not counting Americans repatriated on flights from the virus’s suspected epicenter of Wuhan, China, and the Diamond Princess cruise ship “hot zone” that was docked off of Japan, the CDC says 15 people have tested positive for the coronavirus across the United States. According to the state Department of Public Health, California made up nine of those 15 cases as of Thursday.
Concern was heightened by reports this week that the patient who tested positive for the coronavirus, a Solano County resident now treated at UC Davis Medical Center in Sacramento who is believed to represent the first community-transmitted instance of the virus in the United States, had her CDC-issued test delayed by four days.
According to an internal memo sent by top UC Davis health system leaders to hospital staffers, the medical center requested the coronavirus test on Feb. 19, but because she “did not fit the existing CDC criteria,” federal officials didn’t order a test until Sunday.
“Testing protocols have been a point of frustration for many of us,” Newsom said.
Numbers and potential shortages aside, what exactly is a coronavirus test kit? How does it work, what does it look like, how is one made available and what exactly does one test for?
What does a coronavirus test kit looks like?
The CDC on its website provides a photo of the lab test kit for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) the disease named by the International Committee on Taxonomy of Viruses that is caused by the novel coronavirus, also known as COVID-19.
The kit itself contains four small vials inside of a white box of packaging, all of which is bagged in plastic.
What does a coronavirus test include?
There are two main elements to a COVID-19 test, according to interim guidelines shared publicly by the CDC to clinicians.
The coronavirus is a respiratory disease, so the test kits take specimens from both the upper and lower respiratory tracts.
Tests in the lower respiratory tract include a branchoalveolar lavage, a minimally invasive procedure in which the clinician places a bronchoscope through the patient’s mouth or nose and into the lungs. A sterile fluid solution is squirted into a small part of the lung, and a specimen is collected for examination.
The patient then produces a sputum sample: “Have the patient rinse the mouth with water and then expectorate deep cough sputum directly into a sterile, leak-proof, screw-cap sputum collection cup or sterile dry container,” the CDC’s instructions read.
In the second test, for the upper respiratory tract, the clinician will swab the patient’s nostril as well as the throat. The test also collects a 2 to 3 milliliter specimen following a nasal “wash” or aspirate, which involves a soft, flexible tube in the nose.
What happens to the test kit after that?
These specimens are refrigerated until they can be shipped to the CDC for testing.
The kit is to be stored at 35-46 degrees Fahrenheit and kept at that temperature using an ice pack or dry ice as it is shipped to a CDC lab.
Where do the kits get tested?
The CDC on its website says laboratory test kits are shipped “to laboratories CDC has designated as qualified, including U.S. state and local public health laboratories, Department of Defense (DOD) laboratories and select international laboratories,” the latter of which include facilities with the World Health Organization and Global Influenza Surveillance Response System.
The agency said this week that a protocol developed by the CDC and the U.S. Food and Drug Administration, which “uses two of the three components of the original CDC test kit” to detect for the virus, will allow 40 additional public health labs to begin testing.
Newsom said in Thusday’s news conference that the California Department of Public Health would be among those sites performing tests.
How do doctors decide gets tested?
As of this week, healthcare providers have been testing patients for coronavirus only if they met the CDC’s set criteria for that patient to be considered a “person under investigation,” or PUI.
There are now three criteria that can be met to warrant lab testing, according to the CDC website. The third item was added Thursday under revised guidelines, as CDC Director Robert Redfield explained to congressional leaders.
▪ Symptoms that include fever or coughing and shortness of breath, along with the epidemiological risk of having close contact with a lab-confirmed COVID-19 patient;
▪ Symptoms that include fever and a cough or shortness of breath, along with a history of recent travel to coronavirus hot zones; or
▪ A fever and severe symptoms of lower respiratory illness, such as pneumonia, that require hospitalization, even with no source of exposure via travel or contact with a confirmed COVID-19 patient.
How long do the test results take?
The CDC does not specify the time frame for which results should be expected, but its guidelines call for the samples to be shipped overnight.
In the case of the patient being treated at UC Davis Medical Center, the positive diagnosis appears to have been received about three days after testing.
This story was originally published February 28, 2020 at 11:29 AM.
