Running a fever and suppressing a cough, Renee returned home Monday from the Fort Worth-area hospital where she works. Three days later, still sick, she had not been able to get tested for the new coronavirus she fears she may have contracted.
Renee, who is in her late 50s, is an oncology nurse in Tarrant County. She works at the bedsides of elderly cancer patients — many in their 80s and 90s, some with suppressed immune systems. She does not know if she has COVID-19, the coronavirus-caused disease that’s reached pandemic proportions, but if she does, she believes that to expose her patients could effectively be a death sentence for them.
Still, she does not appear to meet the state’s strict criteria to be tested for COVID-19 at one of 10 public health labs in Texas. For that reason, she said, three doctors she’s consulted this week all declined to collect and send nasal and throat swabs for free testing at the local public health lab.
Doctors ruled out strep throat and the flu, Renee said. But to be eligible to test for coronavirus under state rules, she would need to have traveled recently to countries such as Italy or South Korea, where infections are rampant, or come into contact with one of roughly 40 Texans — in a state of almost 30 million — who have tested positive so far.
“[The doctors] are saying since I don’t have exposure, no, I can’t test you,” Renee said from her home, where despite her attempts at self-quarantine, her retired husband has also developed a cough. Renee is being identified by her middle name because she feared retaliation from her hospital, which has not authorized her to discuss her illness.
While the number of known U.S. cases of coronavirus infection has surpassed 1,400 and at least 38 people in the country have died, cries to expand access to testing have grown louder in recent weeks. U.S. health officials conceded in congressional testimony Thursday that the nation’s system for disease testing was “failing.”
And now that Texas health officials have identified two possible cases of community spread, in Montgomery and Dallas counties, scrutiny of the state’s limited testing network is fiercer than ever.
Who’s getting tested?
Chris Van Deusen, a Texas Department of State Health Services spokesman, said he did not know the number of people who’d been tested at public health labs in Texas. On Wednesday, he estimated that figure was in the “dozens.” Three state lawmakers said Gov. Greg Abbott told them Thursday that 104 people were being tested or monitored for the virus, but Van Deusen said he could not “confirm that number.”
State Rep. Erin Zwiener, a Driftwood Democrat, wrote on Twitter that state officials “are not testing for community spread right now.”
“I have concerns about this,” she wrote about the number of tests. “I am asking more questions about why the testing protocol is so narrow, but I don’t have good answers yet.”
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Lisa Rigby, executive director of the Dallas-area Woven Health Clinic, which primarily serves uninsured patients, is also worried about access to testing. She said she sent one of her seven health care workers home because he was exhibiting symptoms consistent with COVID-19.
“But we couldn’t get him a test,” she said. “Basically, if you’re not hospitalized, which means you’re very severe, you’re not going to be able to get a test. I’m very concerned.”
While a lack of testing has been a nationwide issue, Texas’ limited disclosures about the scope of its efforts stand in stark contrast to those of several other states.
Colorado has tested at least 350 people for the virus, and 160 people gave samples at a Denver drive-up testing site — an option not yet available in Texas cities — according to local media reports Thursday. California, the state that touts the greatest testing capacity, reported testing more than 500 people last week .
Van Deusen said Texas’ public health laboratory capacity is a finite resource and that labs “still need to target that testing at the people who have [COVID-19].” State and local labs can test roughly “200 or 250” people per day, he estimated, adding that the figure should grow to 500 or more by next week.
But Van Deusen said that the demand for testing samples is not outpacing their limited capacity.
“We are looking for this disease, and we want to know what’s happening in Texas, and we need people to be tested to do that,” he said.
Forty-two Texans have tested positive for the virus as of Thursday, and 11 of those were among people brought to a federal quarantine site at Lackland Air Force Base in San Antonio.
Health care workers first
Other states, such as Colorado, have loosened their criteria for who may be tested. If Renee lived in Colorado, she would presumably have qualified under a guideline that health workers who have symptoms consistent with COVID-19 may be tested if they’ve had direct contact with symptomatic patients.
Texas officials said this week they are “focusing on [testing] health care professionals since they are key to upholding our whole health care infrastructure.”
“We do occasionally test outside of our testing criteria,” Jennifer Shuford, the state health department’s infectious disease medical officer, said on a Tuesday conference call with Texas doctors.
Texas hospitals with their own laboratory capacity will be able to test for coronavirus under an emergency agreement with the U.S. Food and Drug Administration, state officials said this week. But until then, ensuring the health care workforce can receive testing for the virus is a huge concern for the industry.
“One of the biggest issues we are facing is the lack of clarity around access to testing, prioritizing patients and turnaround times for results,” said Carrie Williams, a spokeswoman for the Texas Hospital Association. “It’s an issue that has to be addressed, and we are all working hard on that together.”
Williams said hospitals were “pushing the message that tests are for health care workers and vulnerable populations.”
“We have to put them first right now,” she said. “Not everyone [else] needs a test.”
Despite being a health care worker, Renee is still waiting.
A 30-year veteran of the nursing industry, Renee said she believed there was a decent chance she had not contracted COVID-19. She said she planned to work once her fever subsided.
“But shouldn’t you make sure?” she said during an interview in which she coughed intermittently. “If [the cancer patients] were to get what I have right now, they probably wouldn’t survive.”