The patient was at risk.
A fever somewhere above 101. Hypoxia, shortness of breath. And two critical check marks for risk: advanced age and a compromised immune system.
In the eyes of the medical staff, the cause could be bacterial, but odds were that a virus had found its way to the most receptive cells and hijacked their RNA. One became two, two became thousands, filling the lungs.
Another ILI, an influenza-like illness.
The patient, who had just arrived in the emergency department of the Ronald Reagan UCLA Medical Center in Westwood, had to be treated.
But treatment required precaution, and precaution required testing.
Three months since the novel coronavirus and COVID-19 appeared on the world's stage, few modern illnesses have proved to be as contagious.
Since the first case _ a viral pneumonia reported in China on Dec. 8 _ was reported, the World Health Organization has recorded more than 1 million cases and over 55,000 deaths.
For an illness with no vaccine and limited treatment, testing and isolation are the best methods for stopping the spread, and even though the virus's genome was sequenced within a month of that first case, testing in the United States has lagged, hindered by cumbersome bureaucracies, shortages and antiquated practices.
For Omai Garner, who directs clinical microbiology testing for UCLA Health, laboratories like his are central for ending this pandemic. Their protocol, initially developed in the 1980s, has been on the front line of viral diagnostic testing for almost two decades.
Of the viruses that Garner has encountered, the coronavirus is one of the most sinister, a Trojan horse disguising itself in symptoms of the flu.
The next few weeks are critical, he said, to get an accurate picture of where we are in this outbreak: "What you will hear from most health care professionals is we have no idea."
He is skeptical of a new test, fast-tracked by the U.S. Food and Drug Administration and coming on the market next week, that promises greater convenience and faster results. Neither he nor his colleagues, he said, have been able to compare its results with their own.
"We need to do a lot more inquiry before we know how effective it will be," he said, "because it is not based on the established standard for infectious disease diagnoses."
In a series of phone interviews last week, Garner shared details about the testing protocol that his laboratory followed in its analysis of one possible COVID-19 case.
