Delays in Coronavirus Testing Complicate Response to Outbreak

A woman wears a mask and gloves while carrying toilet paper across the street in San Francisco on Tuesday. (AP Photo/Jeff Chiu)

WASHINGTON (CN) — Last month, Corin Barsily Goodwin, a 52-year-old semi-retired tutor from Renton, Washington, visited family in New York City and milled among throngs of international tourists. It wasn’t until she returned home that she noticed her sore throat.

A recurring fever brought her to the hospital within days and that’s where her quest for a test for the novel coronavirus known as COVID-19 began.

Akin to the common flu but without a vaccine, COVID-19 has quickly spread throughout the U.S. since first being detected in China in December. Since President Donald Trump declared a national emergency in response to the virus last week, cases have surged from about 1,300 on Friday to over 6,500 by Wednesday morning, according to a Johns Hopkins University tracker.

A U.S. Centers for Disease Control and Prevention illustration of COVID-19.

Meanwhile, Americans like Goodwin assess their symptoms and plan their next moves.

Goodwin’s experience started with a nurse running down the perfunctory checklist: did she travel internationally or frequent any virus hotspots within the last two weeks? Had she been around anyone with COVID-19?

While relevant, the questions are problematic, Goodwin reflected recently in an email to Courthouse News.

“I mean, JFK and Newark airports get people from all over the world just like Manhattan. How would I know if I had been exposed to anyone when I live in the first U.S. hotspot…And they figure incubation [takes] weeks?” Goodwin said.

The doctor thought Goodwin might have “a bug,” and sent her home. She isolated, but ailments persisted. Then this weekend, Goodwin woke with a dry cough and tight chest.

She called the University of Washington Medical Center, neighborhood clinics and urgent care facilities.

“Finally, I got a call back from someone at UW… And she insisted I go straight to the emergency room. I felt stupid doing that because I wasn’t dying and they had other things to do but she told me it was the only way I could [get] tested,” she said.

The Valley Medical Center ER told Goodwin the only way to be tested was if she was “sick enough” to be admitted.

“I knew I wasn’t,” she said.

Dr. Howard Forman. (Photo via Yale University)

Dr. Howard Forman, a Yale University professor of diagnostic radiology, economics and management and public health, told Courthouse News no one with COVID-19 qualifies as an “emergency patient.” This is partially because of the lack of tests available.

He said if “we had proper testing capacity, all suspected cases would be tested urgently.”

Goodwin went to the ER when she could bear no more. Two X-rays for pneumonia later, she finally saw a doctor.

“[The doctor] would have tested me like they were doing the night before,” she said. “But apparently that morning they were told to stop using the tests.”

Whether tests were unavailable or defective was not entirely clear. A representative from UW Medical Center did not return requests for comment. The ER doctor diagnosed her as “presumed positive,” and Goodwin now recovers at home.

Dr. Michelle Mello, a professor of law and medicine at Stanford University, lamented America’s inadequate number of test kits in a recent interview.

Unlike in South Korea, where busy waiting rooms are dispersed with masses of drive-up testing sites, the U.S. government relies on the Centers for Disease Control and Prevention’s instruction for testing: seek a primary care doctor first.

“As people get diagnosed, more may get admitted to hospitals, but given the numbers… it’s more likely they’ll be sent home or to designated quarantine quarters —such as a hotel room— to manage their symptoms until they need respiratory support in the hospital,” Mello said. “The number of people who need that kind of care is going to continue to grow in the coming days and weeks.”

Dr. Michelle Mello. (Photo courtesy of Michelle M. Mello)

M.K. Tantum, who works at Abbott Laboratories in Santa Clara, California, became ill after co-workers returned from Taiwan and Hong Kong around March 1.

She immediately called her doctor who, she assumed, was on high alert

because Santa Clara had some of the earliest positive cases.

Tantum’s doctor told her to contact the state health department. She did but the health department, in a moment illustrating the chaotic flow of guidance between doctors and the CDC as the outbreak first gripped the U.S., said they didn’t know why her doctor suggested she call.

Later, when Tantum’s 76-year-old uninsured nanny became sick, she called urgent care facilities. The wait would be over six hours. Staff suggested her nanny call a doctor. She didn’t have one.

Tantum’s own fever and cough worsened, so a friend at Stanford Hospital suggested she call a telehealth doctor who would eventually listen to her symptoms and exposure history.

Tantum recalled: “He says, and this is not a joke, ‘I wouldn’t worry too much. I’m going to call in a prescription for Tamiflu as well as a decongestant.’ When I pressed him on getting a test, he said he doesn’t know… he suggests I call — wait for it — the department of health.”

She has still not been tested.

After eight hours in the ER, Tantum’s uninsured nanny was tested. The results were negative. The test cost $3,200, she said.

Tantum last week was still unwell. Nervous as she stays home with a 2-year-old, between her doctor and the pediatrician there’s been little response on next steps for testing.

“For now, we’re just praying it’s the flu and that we will be okay,” she said.

Testing is the only way to isolate the virus and quell the influx of patients to hospitals nationally, a concept often described as “flattening the curve.”

Health care providers need help from federal agencies and new testing centers to achieve this, Dr. Forman said.

“Testing is critical in order to suppress spread,” he added. “You do not want someone who feels well to enter the community and continue to spread.”

Consider the case of Abigail Wondrasek’s teenage daughter. She exhibited symptoms last week, so Wondrasek took her to a crowded Illinois doctor’s office. The 49-year-old teacher’s assistant inquired about testing but was told no tests were available. She received instructions to contact CDC but was warned: they just tell people to call their doctor.

“So, it’s just a circle?” Wondrasek responded.

Wondrasek’s situation in Illinois echoed the case in Washington for Goodwin, who during an interview this week described the testing pursuit as one that went “round and round in circles.”

Staff reminded Wondrasek her daughter could go to the ER but if deemed asymptomatic, there would be no test or answers. Returning home, her daughter’s fever broke and she’s recovering. But then Wondrasek and her husband became ill.

They self-quarantined without tests, leaving Wondrasek to mull around with her family. Did her daughter have coronavirus? Were her symptoms mild because she is young?

“I’m not as concerned about her health as I am those she may infect if she’s positive,” Wondrasek said. “I don’t know if we’ll ever have the answer but for the sake of the rest of the country, we should have access to that information.”

An electron microscopic close-up of an isolate from the first case of coronavirus in the U.S. (Image courtesy of CDC)

On Tuesday, during a conference call with reporters, Senator Mark Warner, D-Va., expressed dismay over slow-going tests in Virginia as COVID-19 cases rose from 50 to 67 in a single day.

Virginia’s public health lab runs 400 tests per day, Warner said, and commercial labs are slowly coming online. When reached for comment, Dena Potter, spokesperson for the Virginia Department of General Services, said she expects capacity to grow to 600 tests per day thanks to a shipment received Tuesday.

“They have greater capacity but it’s difficult to get a breakdown from them on how many tests there are in Virginia,” Warner said.

The University of Virginia begins testing soon but is experiencing a shortage on reagents, the chemical stabilizer necessary for kits.

As testing capacity beefs up, positive diagnosis rates will too. Warner was hesitant as he considered whether that uptick can be interpreted as definitively good or bad for now.

“I hope many of these symptoms are common flu and not coronavirus but it’s too early to presume we’re seeing a flattening of the curve,” he said. “Once we get more tests out and we don’t see a spike in numbers, I’ll be able to breathe a better sigh of relief.”

Warner’s Virginia counterpart in the House of Representatives, Democrat Don Beyer was exposed to coronavirus on Feb. 28 after attending a dinner party with a guest who would later test positive.

Neither Beyer nor his wife were tested because they appeared asymptomatic. To reduce the risk of community spread, they self-quarantined.

In an email, Beyer described the lack of testing as “disastrous,” though he acknowledged the situation on the ground was improving.

“But there are still far too few tests available. There’s also too little data available about testing availability,” he wrote.

The lawmaker recently issued a letter to CDC Director Robert Redfield and Stephen Hahn, head of the Food and Drug Administration, demanding agencies improve transparency on testing capacity and tracking.

As to the playbook for controlling infectious disease outbreaks, that is pretty well established, Dr. Mello said. The difficulty came with the Trump administration’s slow-rolled response during the first two months of the outbreak, which left states to respond to CDC guidelines driven by test scarcity.

Vaccine trials are being sped up, Mello pointed out, with researchers being given the green light to test vaccines in animals and humans simultaneously.

Short of a vaccine, experts like Mello and Forman say the formula is straightforward.

“Until we have a pharmaceutical intervention – which may be a year off – we need suppression and mitigation strategies,” Forman said.

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