Last week, a medical student working with Dr. Stanley H. Weiss at Rutgers University got sick with what seemed like a cold.

He went to health services and asked to be tested for coronavirus, but was told they had no test to give him and he should just isolate, according to Weiss, a professor of medicine at Rutgers New Jersey Medical School and of epidemiology at Rutgers School of Public Health.

Many people around the state and the country are being told they don’t meet the CDC’s criteria to be tested because they’re not at high risk or really all that sick, haven’t traveled abroad and can’t point to a specific contact who might have had the virus.

So should the student have been tested out of an abundance of caution?

For Weiss, the answer, on an individual level, is no.

“If your treatment doesn’t change on the basis of the test and at the moment you're not extremely ill... you don't need to test. You need to assume you might have it” and self-isolate, Weiss said in an interview Wednesday.

But on a public health level, knowing whether the student had the virus is vital because if he does, officials can trace his contacts and limit the chance that anyone else could have contracted it from him and be spreading the disease further. Plus, it would give the state a more accurate picture of how many people are sick and how they caught it, Weiss said.

“In terms of public health surveillance, when we can test enough people it would give us a lot more data to judge what our recommendations are” for trying to flatten the curve.

The state’s public health system has been performing this balancing act regarding testing since fears of coronavirus started to grow at the end of February.

State officials say they want to know who has the coronavirus so they can quarantine and contact trace. But they also want people to stay home and not get tested if they’re not that sick, since most people won’t require hospitalization.

“There’s a difference between really needing the test and wanting the test,” Health Commissioner Judith Persichilli said in an interview Tuesday. “I don’t believe anyone who needs the test is not getting it. We do not have a backlog with the commercial labs.”

While there was initially a limited number of tests available to the state from the CDC, doctors are now able to order tests from private labs regardless of the criteria. However, residents who contacted NJ Advance Media say doctors still tell them they are limited by CDC guidelines.

Does this mean coronavirus case numbers in New Jersey are totally wrong?

Weiss said there are many more people with coronavirus walking around than the state numbers announced daily indicate. The state isn’t alone in this either.

“We know for certain that has happened in other countries. We know that for every case a person is symptomatic there are additional people that we don’t know of yet,” he said. “We don’t know if that’s five times or 10 times or 100 times.”

Many of those people could have no symptoms at all — though they could still spread the disease — but there are likely some symptomatic people who could get tested if there were fewer barriers.

State officials acknowledged the limited testing is skewing their data. At a press conference they said the state’s high hospitalization rate of 55% is likely more a result of testing only the sickest than an indication that more than half of patients will require hospitalization. A CDC study released this week found only about 12% of detected cases in the U.S. were hospitalized.

Weiss said that while testing and data is vital to inform state officials and experts about how to handle the pandemic, he thinks it’s a mistake for the layperson to focus on the number of cases and deaths announced every day. They will either scare people or make the outbreak seem not that bad, he said, “and both are bad.”

“Those numbers are way behind the times as to what's really going on, that we are certain about,” he said.

The good news: Coronavirus testing in New Jersey is expanding

Testing in New Jersey has already expanded thanks to the federal government allowing private labs to process tests, but people seeking tests — like Weiss’ student — were still told their medical provider didn’t have access to them.

Hackensack Meridian Health — which developed its own rapid test for the virus last week — had been telling patients that they were only testing those who were “severely ill and already in isolation and treatment.” But Daniel W. Varga, chief physician at Hackensack Meridian, said the system has partnered with private labs to be able to test more high-priority patients.

Health Commissioner Judith Persichilli said she hopes that eventually everyone who wants to be tested will be. For now, anyone who is symptomatic and meets the CDC criteria should be tested, she said.

Tuesday, March 17, 2020 - Interview with Judith Persichilli, R.N., B.S.N., M.A., Commissioner of the New Jersey Department of Health for the State of New Jersey, in the midst of the coronavirus pandemic.Michael Mancuso | NJ Advance Media for NJ.com

If you are symptomatic but don’t meet the criteria, she said, “you should stay home, watch yourself for 72 hours, take your temperature twice a day, hydrate. We’re in flu season, it could very well be the flu.”

It’s not clear how soon the state will open up testing to more patients, but one big step forward took place Friday when the first state testing site opened at Bergen County College — to a line of waiting cars three miles long. FEMA is helping the state launch the testing “pods” at the college and PNC Arts Center in Holmdel, and will be supplying 2,500 test collection kits to each of these sites per week, according to the Department of Health.

Persichilli said that the state wants people to show up with prescriptions from their doctors — and obvious symptoms — but there will be pre-screening available for those who are symptomatic and do not have a primary care doctor.

It’s not clear when people with milder symptoms will be able to get tested.

“Everybody who wants the test — a second cousin once removed of someone who tested positive — eventually you should be able to get the test,” Persichilli said.

Did we miss our chance to contain the virus with widespread testing and contact tracing?

Weiss is somewhat hopeful that New Jersey can still use testing and contact tracing to limit the spread of coronavirus.

“In some portions of the country it may be too late to do that. Here in New Jersey it is not too late, in my opinion,” he said. “If you wait two more weeks, I’m reasonably confident it will be too late.”

He said the criteria for testing “clearly needs to be broadened as soon as we have enough test kits available so that makes sense.”

Data shows that the countries that have been able to stop the number of cases from growing exponentially, Weiss said, have done extensive contact tracing — think thousands of contacts.

Not testing everyone who may have the virus significantly limits the state’s ability to do comprehensive contact tracing, so does not having enough people to actually do that tracing work.

“In other countries they have rapidly mobilized to create a much greater enlarging of their public health workforce to help them do that type of contact tracing and to protect workers doing it,” he said. “We should be doing the same.”

Whether the state or the country could replicate that even on a much smaller scale remains to be seen.

For the average person, Weiss said, their main concern should not be testing — anyone who is unsure should assume they have it and self-quarantine, he said. They should be focusing on mitigating the spread by staying home and practicing social distancing.

“I have the expectation that the results of a number of clinical trials in progress around the world that were going to begin getting solid results from those towards the end of April,” he said. “If we can postpone many people from becoming ill for two or three months from now, our abilities to treat them may be greatly improved."

He does not think there will be a vaccine or a cure in a few months. But even small steps could greatly improve the survival rate or decrease the infection rate. For instance, he said, studies have shown that giving people Tamiflu when they’ve been exposed to the flu can reduce their chance of becoming ill.

“People need to know that if they can reduce their chance of getting this virus now, the chance of being able to successfully treat them in the future is going to be far greater,” he said.

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Rebecca Everett may be reached at reverett@njadvancemedia.com. Follow her on Twitter @rebeccajeverett. Find NJ.com on Facebook.

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