CLEVELAND, Ohio - Testing for the new coronavirus is multi-step process that involves genetics, compounds and cotton swabs.

The federal government, which has been criticized for shortages in testing kits, has developed standards for a procedure that’s being used by thousands of clinical laboratories across the country, including at the Ohio Department of Health and in other hospital and private labs.

(Read below for more on the testing kit shortage.)

The test is known as Polymerase chain reaction, or PCR. It’s also called nucleic acids extraction. It’s a process to make copies of genetic material in a test tube from a human sample -- followed by testing to determine if there is a genetic match between the genetic material being tested and the genetic material of the coronavirus.

The test itself is not new.

Many strands of the flu are tested by PCR.

The difference is that many flu testing kits contain all the parts needed by clinical laboratory scientists. Since coronavirus is new, the only part of the testing kit that comes from the federal government are compounds. The rest of the parts must be stocked by the lab or hospital.

Dr. Christine Schmotzer, University Hospitals’ chief of the division of clinical pathology, explained the testing in simple terms for non-scientists.

University Hospitals has testing kits and is under a process of validating the compounds and determining how much genetic material is needed for an accurate test. If all goes well, testing should begin in days.

Step 1: The swabs

The federal Centers for Disease Control and Prevention now requires two swabs - nasal and oral.

Many medical facilities, including University Hospitals, are swabbing patients away from the general public, in an isolated area.

At UH, the area is part of the emergency department, but it is a negative air pressure room, which has a ventilation system to prevent infection from being spread to other parts of the hospital.

At UH, medical workers wear a mask, gown and gloves in the room, Schmotzer said.

The swabs are stored in a sterile, plastic tube and transported to the lab.

Step 2: Removing the virus from the swab

At the lab, the swab is put into a liquid at a clinical laboratory scientist’s work station.

One person can test for coronavirus from start to finish.

The sample undergoes a process in which the virus falls off the swab into the liquid, Schmotzer said.

It can take about an hour.

The entire testing takes four hours -- although Schmotzer cautions that a four-hour turnaround for test results is not realistic.

“A lot of preparation is in between -- making sure you have the right patient and the right sample and making sure you’re doing it safely,” she said.

Step 3: Enter the testing kit

The testing kit sent to the state by the CDC contains compounds. They’ve also been called reagents.

“Reagents are sequences, mini-gene pieces that will pair up with the virus’ genes,” Schmotzer said.

The lab scientist uses a clear, plastic plate the size of a 3-inch by 5-inch or 5-inch by 7-inch index card.

On the plate will be a number of patient samples.

The scientist will add gene pieces called primers from the reagents. The primers will match up with coronavirus’ genetic material if the virus exists.

“As it reacts, it can create a fluorescent signal, detected on instruments,” Schmotzer said.

Why the shortage in testing?

In the U.S. there has been a shortage of the reagents, and Ohio is no exception.

First Ohio and other states experienced delays in getting an effective lab test kit. Ohio’s first kit arrived in February, but the CDC detected problems with it, and the state had to wait for another kit, the first of which arrived last week. A lab can test hundreds from one kit.

Testing began Saturday, and Ohio has a protocol for testing due to the shortage. Two more arrived Wednesday.

The highest-priority cases get to jump the queue and get tested directly by the Ohio Department of Health. Lower-priority cases require elimination of other illnesses and a doctor or other provider’s order before people can get tested at a hospital or private lab, which can take longer than the state.

In addition to preventing the testing of a wide population, the lack of testing has made it difficult to pinpoint the direction the virus is going to take.

Dr. Amy Acton, director of the Ohio Department of Health, said the testing delays have made it more difficult to track the pandemic’s progression in the U.S.

“Some of the early modeling is suggesting that potentially there could be a late April, early May peak to this," Acton said. "But again we don’t have all the data. Our delays in being able to test delayed our understanding.”