The U.S. government is fighting to contain and slow down the
spread of the coronavirus. Testing is central to these efforts.
Molecular biologist and viral researcher Maureen Ferran answers some
basic questions about how these diagnostic tests work – and if there are
enough to go around. Currently there are two main reasons someone would be tested for the
coronavirus: having symptoms or exposure to an infected person.
The main symptoms of COVID-19, the disease caused by the coronavirus SARS-CoV-2, are fever, dry cough and shortness of breath.
These look a lot like the flu and the common cold, so it takes a
physician to determine if testing for the virus is necessary.
Initially, the Centers for Disease Control and Prevention recommended
testing only people with symptoms and who had potentially been exposed
to the virus. But to the surprise of public health officials, several of
the first people in the U.S. who tested positive for the virus had no
obvious exposure. This development suggested that the virus was being
transmitted locally, meaning it was spreading from person to person
easily and/or that people may have been transmitting the virus without
experiencing serious symptoms.
As of writing this, there are no specific treatments available for
COVID-19, but that does not mean testing is pointless. Perhaps most
importantly, testing is done so that infected patients can be
quarantined and the spread of the virus slowed. Another benefit of
testing is that it lets public health workers build a more accurate picture of the number of cases and how the virus is spreading in the population.
While collecting a sample is easy, actually determining whether a
person is infected with the coronavirus is much more complicated. The
current method looks for the virus’s genetic material (RNA) in a
patient’s cells.
In order to detect the presence of RNA in the patient’s sample, labs perform a test called reverse-transcription polymerase chain reaction.
This method first converts any viral RNA to DNA. Then the DNA is
replicated millions of times until there are enough copies to detect
using a specialized piece of equipment called a quantitative PCR
instrument.
If genetic material from the virus is found in the sample, then the patient is infected with the virus.
It takes 24-72 hours to get the results of a test. During the early ramp-up of testing, there were some concerns about the test’s accuracy
after one study found 3% of tests in China came back negative when the
samples were actually positive. But this type of genetic test is generally very accurate – more so even than rapid flu tests – and the benefits of testing outweigh the risk of an error.
The availability of tests has been a big issue. Prior to Feb. 29, the CDC was the only place approved by the FDA to develop, produce and process tests. However, as the number of suspected cases climbed and doctors approved more people for testing, demand to be tested soared.
As pressure on the federal government to make tests available
increased, the FDA announced a new policy on Feb. 29 that made it easier
for commercial and academic laboratories to develop their own tests and allowed other certified labs to test patient samples.
Integrated DNA Technologies, a CDC contractor, shipped 700,000 tests
to commercial, academic and health care laboratories on March 6. Quest
Diagnostics and LabCorp, two large commercial test manufacturers,
started making their own test kits, which became available on March 9. Many companies, hospitals and other institutions are now racing to develop more tests to diagnose COVID-19.
Realistically, it isn’t feasible to test everyone who is sick in the
U.S. Therefore, most health officials believe it is important to prioritize the testing of people who need it the most:
those at high risk such as health care workers who have been in contact
with COVID-19 patients; symptomatic people in areas with high infection
rates; and people 65 years of age and older with chronic health issues,
such as heart disease, lung disease or diabetes. As more tests become
available, it will be possible to test more people.
There’s also a need to develop faster tests that do not require
special equipment and personnel. Testing allows experts to better
understand how the outbreak is progressing and try to predict the impact
the virus will have on society.
As with all outbreaks, this pandemic will end. In the meantime,
however, people need to wash their hands and try to minimize their risk
of exposure. There is much to be learned about this novel coronavirus.
Only time will tell if it disappears from the human population, as SARS
did in 2004, or becomes a seasonal disease like flu.