By Kari Bray / Snohomish Health District

The situation around the novel coronavirus disease (COVID-19) continues to change quickly. The situation around testing for the virus also is changing.

Over the course of a few weeks in Washington state, we’ve moved from sending tests to the CDC in Atlanta to in-state testing being available at the state Public Health Lab and the University of Washington. We’re also optimistic about news that additional commercial labs are working to further expand testing options.

While testing options have expanded, there still is frustration and concern that we don’t have enough. This topic is at the center of many of the questions and concerns we’ve received at the Snohomish Health District.

We hear — and share — your frustrations. As more cases of the coronavirus are identified in Snohomish County, people want testing to be more readily available, as well.

In this blog, we talk about testing, how it is prioritized, and how it is changing.

Who can be tested?

There are no restrictions on who can be tested for COVID-19. Commercial testing is becoming more widely available, and health care providers may choose to test patients with symptoms like fever, cough or difficulty breathing.

However, testing capacity is not infinite. That’s why it is important that testing is prioritized for certain groups, including:

• Health care workers

• Patients in public safety occupations like law enforcement or firefighters

• Patients who are part of a cluster of illnesses at a specific facility like a school or long-term care center

• Patients with severe lower respiratory illness

• Patients with worsening symptoms

• Patients who are at higher risk for severe illness due to underlying medical conditions, weakened immune systems, age (60 or older), or because they are currently pregnant.

Anyone can contact their health care provider to request testing. However, testing is provided at the provider’s discretion. If you have symptoms like fever, cough or difficulty breathing, be sure to call ahead before going in to a clinic or other health care facility.

Generally, testing is not recommended for people who do not have symptoms, though a health care provider may decide to test if someone has close contact with a confirmed case.

Who should be tested?

Not everyone with symptoms needs to be tested. People who have mild symptoms should stay home and away from others until 72 hours after fever (fever = 100.4 degrees F or higher) has passed or seven days after illness began, whichever is longer. Whether a test were to come back positive or negative for COVID-19, that guidance would not change – stay home, stay away from others, focus on getting well.

People who have symptoms and are part of one of the priority groups listed under the previous question should call their health care provider and ask if they need to be evaluated in person. Your health care provider may want to monitor your health or test you for something other than COVID-19, such as influenza.

People who are not at high risk of severe illness from COVID-19 likely do not need to be evaluated in person or tested for COVID-19.

Why not test everyone?

Ideally, anyone who wanted to be tested could be tested. Realistically, our health care system lacks that kind of capacity and must prioritize testing resources.

The bottleneck at this point is not running the tests, it is collecting specimens. Our health care providers across Snohomish County and the Puget Sound are working hard to perform evaluations, gather specimens for testing, and ensure patient care.

Meanwhile, the Snohomish Health District and other partners are working to alleviate that bottleneck. A plan for drive-through testing is in the works. The idea of a system where people could collect specimens themselves also has been discussed.

All new testing options take coordination and time to set up. If and when they are available, they need to work well and provide accurate results. A rushed or flawed testing plan will not serve the people of Snohomish County well.

We may see bottlenecks elsewhere in the testing process in the future. Public health officials continue to evaluate the situation daily.

Can the Health District test me?

We do not offer testing at the Snohomish Health District. We work with health care providers, and they are the point of contact for patients. Your health care provider is the person who can best help evaluate whether you should be tested for COVID-19, as well as provide you with individual guidance for your care.

Public health and the health care system have overlapping interests but different responsibilities around COVID-19. While the Snohomish Health District and other public health agencies work to support health care providers, we cannot fix the inherent challenges created by limited surge capacity. These difficulties include the staffing, resources and ability to respond to large and extended events like the COVID-19 outbreak.

Responding to COVID-19 is demanding a lot from every level of our public health and health care systems.

How is public health different from health care in the COVID-19 response?

The role of the health care system is diagnosis, treatment, ongoing care, and addressing individual health concerns.

The role of public health is to educate the public and our partners, investigate and track the outbreak, and work to reduce the impact on our community.

While health care providers are experts on individual patient care, the Snohomish Health District’s “patient” is the population of more than 800,000 people who live in Snohomish County.

“We’re all doing the best we can and are working daily with the health care and emergency response system to coordinate,” said Dr. Chris Spitters, interim health officer for the Snohomish Health District. “But this is a rapidly evolving situation with a new virus and uncertainty in how best to manage it, even at the highest levels of knowledge and ability. National and state experts are close at hand guiding and advising us in the response, but there is no magic bullet and it won’t end soon.”

How can I help?

Now is a good time to take a step back, make sure you are getting information from reliable sources, and temper your expectations for rapid solutions to a situation that is constantly shifting.

It’s been estimated that the outbreak will likely peak one or two months from now, and ease up in three or four months. Long-term, we’ll likely see the virus again in future years – mainly during the fall or winter – while enough of the general population builds immunity to slow the spread. Until then, we need to focus on minimizing hospitalizations, deaths, and disruption of our health care system and society at large.

Testing is a valuable tool in responding to an outbreak, but testing alone cannot solve our challenges during a long-term response effort like this one. If you have a fever, cough or difficulty breathing but have not been around anyone who you know has COVID-19, the likelihood that you have COVID-19 is still fairly low.

We are working to remove barriers to testing. Those barriers are a frustration for us just as they are for you. We urge you to continue to watch for updates on this topic, as we hope to have more resources available soon.

Still, our health care system must be able to prioritize patients who are severely ill and need urgent care. You can help by staying home and away from others if you have mild illness, and taking care of yourself with the same steps you would for other illnesses – rest, drink plenty of fluids, eat nutritious food, and avoid work, school or other activities.

The Public Health Essentials! blog highlights the work of the Snohomish Health District and shares health-related information and tips.