COVID-19: Who should be tested, how to get tested, and more

By Kari Bray / Snohomish Health District

Testing is one of the key pieces of the COVID-19 response, and it is something that has changed and expanded over time. Testing will continue to play a crucial role in reducing the spread of illness, responding to outbreaks, tracking this pandemic, and – ultimately – being able to reopen more of our economy and activities.

COVID-19 testing is much more widely available now than it was in the early days of the pandemic. Snohomish County currently has more testing capacity than demand. In some ways, that can be good news, as it may signal that fewer people are in need of testing. But ideally, we want to be testing more people so that we can track the status of COVID-19 in the community. It shapes our understanding of this pandemic and informs our efforts to curb the spread of this disease by isolating cases, identifying their contacts, and making sure they’re quarantined.

How much testing do we need?

The goal is to conduct about 50 COVID-19 tests for every positive case in the county. We’re currently at about 25 to 30 tests being done per case, but there is capacity through medical providers as well as Health District testing sites to reach that 50-per-case level.

The goal is to test to the point where we are catching as many new cases as possible before they spread the virus. That means we want to test people with symptoms, people who are close contacts of confirmed cases, people who are at higher risk of infection based on where they live or work – more on that later in the “Who should get tested” section. Ideally, we’d like to see a lot of testing, but not a high positivity rate. If you have 50 tests per positive case, that’s a positivity rate of 2 percent.

Getting the testing numbers to where we’d like to see them in order to feel more confident in reopening requires people to access testing when they need it.

Who should get tested for COVID-19?

The highest priority for testing is still people with symptoms. If you are ill with any of the following symptoms, please seek testing as soon as possible.

• Fever or chills

• Cough

• Shortness of breath or difficulty breathing

• Fatigue

• Muscle or body aches

• Headache

• New loss of taste or smell

• Sore throat

• Congestion or runny nose

• Nausea or vomiting

• Diarrhea

The exception is if your symptom is clearly attributed to an existing condition and is not unusual for you. For example, people may experience headaches or have limited taste or smell due to existing conditions, so the symptom is not new and they do not necessarily need to be tested for COVID-19.

However, if you do experience one or more of these symptoms and they are not attributed to an existing diagnosis, get tested even if those symptoms are mild. Also, if you are not sure whether something is related to an existing condition or whether it may be a new illness, talk to your medical provider and consider getting tested for COVID-19.

People without symptoms may also need to be tested.

There are a number of people who do not have symptoms but should consider testing because they are at higher risk of being asymptomatic or pre-symptomatic cases. This means they could be unknowingly spreading the illness to others.

People who should consider testing even if they do not currently have symptoms include anyone who:

• Is a close contact of a confirmed case

• Lives in a congregate setting, like a shelter, group home or assisted living facility

• Works in a location that has had a case

• Is part of a family or social network that has had a case

• Works in healthcare, EMS, law enforcement or other fields with a higher risk of catching or spreading COVID-19

• Is part of a racial or ethnic group that has been disproportionately impacted by this virus in terms of rate or severity of cases (this includes people who are Black, Latinx, Native American/Alaskan Native, or Pacific Islander)

• Requires testing for employment or travel

• Requires testing prior to a medical procedure.

People also may be tested in a healthcare setting at the discretion of their medical provider. This could include pregnant women who are going into the hospital for labor and delivery, or people who will be participating in procedures or tests that may generate a cloud of droplets and increase risk of transmitting the virus.

Why not test everyone?

A couple of reasons. First, while testing capacity has much improved, resources like supplies, lab capacity, and staffing are not limitless. We need to ensure that there is plenty of capacity for people who are symptomatic or who fit into one of the other categories above. That is the most effective use of testing for disease control.

Also, the test for COVID-19 is highly accurate, but it is not perfect. There can be false positives, though they are rare. Applied over a population of 800,000-plus people in Snohomish County, even rare false positive results would add up and outnumber true positive results, diverting resources for public health follow-up toward these misidentified cases and requiring some people to isolate and quarantine unnecessarily.

How do people get tested?

Most testing continues to be done through medical providers. You can contact your regular healthcare provider or local clinic to ask about testing. Please call ahead and follow instructions from your provider, particularly if you are experiencing symptoms. It is also a good idea to check your provider or healthcare organization’s website. A number of them have information regarding their COVID screening and testing, and some have online screening tools or risk assessments.

For those who do not have a regular healthcare provider or otherwise need another testing option, the Snohomish Health District is offering drive-thru testing sites on multiple days each week. These testing sites use nasal swabs that are sent to a lab, and results are expected to be communicated back to people within 2-3 days. The Health District’s testing sites are being operated with volunteer support from the Medical Reserve Corps and in an ongoing partnership with Sno-Isle Libraries and Snohomish County Parks and Recreation.

Schedules for drive-thru testing, and the link to register for an appointment online, are available at www.snohd.org/drive-thru-testing.

If you are severely ill, do not wait to set up an appointment or hear back from your medical provider. People in need of urgent care should go to an urgent care clinic, hospital emergency room, or, in a medical emergency, should call 911.

Won’t more testing make it harder to reopen things?

We’ve heard some concerns that more widespread testing will detect more cases, thereby triggering renewed restrictions on business and activity.

To be clear: Do not avoid testing if you have symptoms or fit into one of the other categories for which testing is recommended.

In order to continue reopening, we need to maintain adequate testing. This is crucial to meet the state’s requirements for moving through the phased Safe Start reopening plan. More importantly, it is an integral piece of monitoring outbreaks, intervening, and reducing the spread of this disease. Widespread testing has been found to be a key ingredient for success in nations where COVID-19 has been well-controlled.

If people avoid testing and cases are not identified, we will still find out when there is an uptick in transmission – but instead of learning in time to take action, we will learn when numbers of emergency calls, hospitalizations and deaths begin to go up. Avoiding testing is not a good way to encourage opening the economy. In fact, it is likely to have the opposite effect.

Do I have to quarantine if I get tested?

Yes. While you are waiting for your test results, you need to stay home and avoid close contact with others.

What if I’m a close contact of a confirmed case but my test comes back negative?

A negative test result can be a big relief, but it does not mean you are able to ignore the required 14-day quarantine period for close contacts of a confirmed case. It can take up to 14 days after exposure for symptoms to develop. If you are tested five days after your last exposure to a confirmed case and get a negative result two days later – so seven days after your last exposure – you still need to quarantine at home and monitor for symptoms for the remaining seven days of the quarantine period.

If you are tested as a precaution but you are not notified that you are a close contact of a confirmed case, you should quarantine until you receive your result but may end your quarantine if your test comes back negative. An example would be if there is a case in your workplace and you are tested as a precaution but were not in close contact with the case. For an asymptomatic person who is not a contact to a case and who is waiting for results, it would be acceptable for them to do essential errands as long as they follow guidelines for use of face coverings, physical distancing, and hand hygiene when they leave home.

What does the test entail?

The most common test is done with a nasal swab. At the drive-thru testing sites, a mid-nasal swab is used. A trained staff member or volunteer will provide you with a sterile, sealed swab and a small container of liquid. You open the swab and insert it about halfway into your nose. It is uncomfortable (speaking from experience) but shouldn’t be painful. You wiggle the swab around in one nostril, then the other. Then you deposit it into the container of liquid and screw the cap on tightly before placing it into a bag, sealing it, and returning it to the staff member or volunteer. From there, the specimens are sent to a lab for processing.

Some people may be interested in serology or antibody tests, which involve drawing blood and testing for antibodies. These would indicate a past infection rather than a current one. The Snohomish Health District does not offer antibody testing at this time, but people can contact their medical provider to see if their provider offers antibody testing and whether they would be a good candidate. It is a good idea to check with insurance on coverage for antibody testing. While the nasal swab tests like those at the Health District sites are covered with no co-pay and at no cost to the client, antibody testing may not be covered or coverage may vary based on your insurance plan.

The details of testing plans may continue to change, but we know that testing will remain an important piece of the COVID-19 response. For people who fit into any of the categories for testing – especially people with symptoms – getting tested promptly is one way to help us fight this pandemic.

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