For New Yorkers who suspect they have Covid-19, the disease caused by the novel coronavirus, it may not immediately be clear what they should do about it. Some public officials state that communities are over-testing and that tests should be reserved for the sick; others cite the growing number of tests that will satisfy growing demand.
So which is it? Is New York, the nexus of coronavirus cases in the US, testing too much or too little?
The answer, in short, is that the state is testing far too little, and that means it has to ration tests for those who need them most. The same is true for most areas of the United States.
On its website, the New York department of health lists its protocols for who should be tested:
New York state has ramped up its capacity to conduct 6,000 Covid-19 tests per day, according to its website. That is likely still not enough, given that the state currently has more than 75,000 confirmed cases, making up 42% of all cases in the US and 9% of all cases in the world.
Right now the decision to test a patient is, rightly, in the hands of physicians. Most often, tests go to people who are already sick and have sought medical care in hospitals (people can also request a test from their physician via telehealth or an online screening tool). It’s important for doctors to know if a sick patient tests positive for Covid-19 because the diagnosis may alter doctors’ plan for care, especially if the patient has other health conditions.
“When you only have a few tests, you use them to confirm infections in hospitals,” says David W. Hutton, an associate professor of health management and policy at the University of Michigan School of Public Health. “Unless [a case is] really severe, they want to save those tests for people in the hospital. As we get more tests, they’ll expand who gets tested.”
But it’s important for the state to increase its testing capacity, too. That’s in part because New York has, by most estimates, not yet reached its peak number of infected cases, which means health providers will need to test a growing number of patients.
Looking farther into the future, more widespread testing can help reduce the number of cases after governments have lifted stay-at-home orders. “I think eventually we are going to reach a plateau in the number of new cases per day. If and when we’re going to lift a lot of these [social distancing] restrictions, we’re going to need new tests to drop the number of new cases close to zero,” Hutton says.
That means you can expect to see changing guidelines for when to seek testing. “There’s a lot of value in testing people in the community to be sure they isolate themselves,” Hutton says. “Messaging will shift over the next weeks and months that more people should be tested in part because we will need to do that to get out of this.”
It’s helpful to remember that the situation around Covid-19—the number of cases, the number of tests and other resources available, and hospital capacities, in New York and elsewhere—is constantly evolving. Clear communication from public officials is critical to keeping people as safe as possible as information is updated. “There are a lot of contradictory messages,” Hutton says. “I think [public health officials] have to be honest and frame it as: ‘We don’t have as many tests as we would like, we’re working on it and hope to have more tests in the near future. We’re prioritizing tests for these populations because we still don’t have as many tests as we’d like to have.”
Patients who are unsure of whether they should get a test should consult their state’s health department web site, or ask a physician—remotely, if at all possible. If telehealth isn’t an option for you, be sure to call your healthcare provider before simply going to their office.