As the COVID-19 pandemic progresses, governments around the world are constantly receiving new data from their health services. As this data is collated, testing guidelines are being altered to suit.
For the most part, this process occurs out of the public eye. After the fact however, the scientific literature is revealing glimpses of how that process is working.
On February 26 the first documented case of community transmission in the U.S. occurred. At the time, the guidelines from the American Centers for Disease Control and Prevention (CDC) were such that the patient was not tested.
When the patient presented to the UC Davis Hospital, she had been suffering flu-like symptoms for 3-4 days, and 24 hours after admission, her condition deteriorated. Since she had not visited a high-risk country or recently met with anyone who had done so, she did not meet the CDC criteria for a COVID-19 test.
48-72 hours after she was admitted, standard viral tests had all returned negative. Discussion with her family revealed that while she had not had direct contact with anyone returning from overseas, her workplace hosted many customers from the same county as the facility that was then housing repatriated COVID-19 patients.
In light of this information and the worsening condition of the patient, the CDC recommended COVID-19 testing. Two days later the test returned positive. At the time that the manuscript was written, the patient was in a stable condition.
As a result of this, and other reports from U.S. hospitals around the same time, the CDC have updated their guidelines for testing. Now, any patient that requires hospitalization without a diagnosis can be tested even if no contact with a COVID-19 patient or risk zone has been identified.