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© Francisco Kjolseth
(Francisco Kjolseth | The Salt Lake Tribune) Medical workers provide drive-thru COVID-19 testing at University of Utah Health’s Redwood Health Center in Salt Lake City on Friday, March 27, 2020.
As the number of confirmed coronavirus cases in Utah continues to rise, health officials are now pleading that all residents with a fever, a cough or difficulty breathing get tested.
Figuring out who is infected, they say, will be key to tracing and limiting the spread in the weeks to come. And the state finally has the testing capacity to do so — spurring state epidemiologist Angela Dunn to remind care providers and patients that those with even just one of the signature symptoms should seek a test.
“This is essential information we need as a public health agency to contain the epidemic here,” Dunn said.
While some states are still struggling to provide tests for people who are ill, Utah is in a rare position. The state is even in discussions with the Centers for Disease Control and Prevention to possibly start testing those who don’t have symptoms, Dunn said — a move that may be available soon.
But for now, the state’s resources are still focused on those feeling sick. And with multiple hotlines and resources available, it can be hard to know where to start. Should you get a test if you only have a mild cough? What’s covered by your insurance? Do you start with your doctor or a hotline?
Here’s the step-by-step process that health experts recommend for those concerned about having the virus:
Step 1: Call or go online first to be evaluated
Before rushing into a hospital or clinic, you should call your primary care provider or fill out an online survey about your symptoms if you can.
This is the most important thing you can do, said Todd Vento, an infectious disease physician at Intermountain Healthcare. Unless it’s an emergency, checking in ahead of time lets staff know about a possible patient and allows them to prepare. It could also stop you from possibly exposing yourself to the virus.
“The first step is to call someone and then the next question is, who do you call?” Vento said.
There are a lot of options for this, he noted, but the point is to have a professional assess whether you should get tested. All of the hotlines in the state are free and, at this point, it doesn’t matter if they’re not offered by your usual provider; there’s no benefit to choosing one over another.
For simplicity, Vento suggests starting by directly calling your family doctor. But you could also reach out to the Intermountain hotline at 844-442-5224 or the University of Utah Health Care number at 801-587-0712, which are staffed by on-call nurses.
If you prefer, you can fill out a questionnaire online, too. The state recommends the one at testUtah.com.
Any of those services will ask about your symptoms and possible exposure to COVID-19. The screening takes about five minutes. By the end, you should get a recommendation about whether to get tested or not.
Both Vento and Dunn said that the state used to want you to have multiple symptoms, but now any one of the following is enough: a cough, a fever or difficulty breathing. “Those are the ones that should definitely be considered,” added Vento, even in mild cases.
The most significant one is having difficulty with breathing, though, Vento noted. People who are symptomatic should monitor how their lungs feel, and if they’re having trouble getting deep breaths they should call a doctor. This is also the one exception to calling ahead. If people can’t breathe, they should get emergency care immediately. It’s serious and, in some coronavirus cases, the condition has deteriorated rapidly.
“It’s really important not to ignore shortness of breath,” Vento said. “There have been cases where people can feel like they have a little shortness of breath, and that can progress really quickly where they need oxygen.”
Other symptoms “that might also be suggestive,” Vento added, are muscle aches, fatigue and decreased sense of smell or taste. Richard Orlandi, the chief medical officer for ambulatory health at University of Utah Healthcare, said he’d also put stomach pains and diarrhea on the list.
“There are some more subtle symptoms and some nuance that we’re learning about with this virus,” Orlandi noted.
Even though doctors want to track the spread, they do not recommend tests for people who are asymptomatic. Orlandi said someone without symptoms is likely to get negative results. And he fears giving them “a false sense of security.”
The phone or online evaluation should let you know if you need to report to a testing center or not.
Step 2: Get tested, preferably at a center supported by your insurance provider
Regardless of which service you use for your screening, if you need a test and have health insurance, you should go to a center set up by your health insurance company. The assessment should help you select one that will work.
Providers are waiving fees for the coronavirus test, according to a new federal law. But staying in network will still be helpful in the long run, said Tom Hudachko, spokesman for the Utah Department of Health.
There are about 30 testing centers across the state, with locations listed on the department’s website at coronavirus.utah.gov/testing-locations.
Once you’re done with your initial evaluation and are told to get a test, the center you go to will either receive an order from your doctor or you’ll be given a QR code to present when you get there. All of the sites are drive-thru. A medical professional will come to your car and do a nose swab.
If you have various symptoms, you may also be asked to do a routine seasonal flu test, too.
Step 3: Wait for your results and isolate
Next, your test sample will be sent to a lab and you’ll need to wait for the results.
At Intermountain, Vento said, samples are being prioritized for those who are hospitalized and health care workers who feel ill. Right now, the turnaround can be anywhere from one to three days.
At the University of Utah, Orlandi said staff are trying to have most returns within 24 hours.
All individuals with symptoms, both physicians said, need to isolate. After every test, a patient is given an instruction sheet on how to do that, but it mostly includes staying home and away from anyone else.
“If you’re getting tested, it should mean that somebody felt that you might have it,” Vento said, “so you should act like you do until you know. Don’t share toothbrushes, don’t share cups. Keep in a room away from family.”
Step 4: If you’re positive, watch for worsening symptoms
If your test comes back positive, you’ll get a call or an email from your county health department.
You’ll need to strictly quarantine for 14 days. And health officials will talk to you about where you’ve been and who you’ve been in contact with up until two days before you started showing symptoms. That’s known as contact tracing.
The point is to figure out who else might have been exposed and get them to also isolate. At that point, community alerts may also go out to where you work or go to school to let people know someone there has been sick. Anyone you live with will also be asked to stay home to avoid spreading the disease.
During the time you’re sick, Hudachko said, it’s important to watch for worsening symptoms.
“Difficulty breathing is definitely one of the symptoms that should trigger a call to your health care provider or a visit to the emergency room or even a call to 911,” he noted. “You should always call ahead, if you can.”
More than 85% of the cases in Utah have not required hospitalization, Vento added, so most people should be able to recover at home.
But some cases may progress and those individuals could need care in an ICU. Fewer still may require a ventilator to support breathing.
“Because most people won’t require hospitalization, though, it’s really important they stick to the home isolation measures,” the physician said. “They can still spread to others. And we’re trying to keep the number of cases throughout our community low. If they adhere to home isolation, we can reduce transmission.”
If your test comes back negative, Vento still recommends staying at home and isolating as much as possible. If you have symptoms, he said, you’re likely still contagious with something, though false negatives with the coronavirus are rare.
For those who are sick, the health department will continually check in to see how you are recovering. Once you have healed, you will be tested again until it comes back negative.