Testing for the novel coronavirus could have started sooner, results could have come in quicker and health care providers could have identified cases earlier, if not for a monthlong lag from federal agencies in getting states the testing capabilities needed.
As Washington and other states work to catch up to the virus’ spread, that delay from the federal government has caused members of Congress to ring the alarm and claim that problems with the federal response continue to impact surveillance efforts locally and limit who, exactly, can be tested.
Or as Sen. Patty Murray, D-Wash., said in a congressional hearing Tuesday, “We are now seeing community transmission of this virus; families deserve to know when testing will actually be ready to scale up.”
Food and Drug Administration officials told Murray and other members of Congress that they are working with private companies to catch up by developing and sending out 2,500 test kits, each with 500 tests, by the end of the week.
“That should give us the capacity, in the hands of laboratories, once they validate, to perform up to a million tests,” Dr. Stephen Hahn, FDA commissioner, told the Senate Health, Education, Labor and Pensions Committee on Tuesday.
Murray isn’t buying that number, however.
“I have not seen any evidence that that is real, nor did they provide any information to make me more secure about that – that’s what concerns me,” Washington’s senior senator told The Spokesman-Review.
Testing for the novel coronavirus rolled out in most states late last week, nearly a month after it was validated at the federal level. Federal officials acknowledged that some public health labs were not able to reproduce and validate the test initially. This meant that all COVID-19 tests in February were sent to Centers for Disease Control and Prevention labs for validation, which meant days would go by before getting results.
Now states are feeling the pressure to provide test results quickly, particularly in Washington, which had not only the first case of the virus but also all nine of the reported deaths in the United States so far due to the virus. Three Eastern Washington counties – Spokane, Stevens and Grant – have waited three days for test results, which in one case has led to the Colville School District closing all schools for three days pending a person’s test result.
King County health officials announced Tuesday additional COVID-19 deaths, including three people who died last week and were confirmed posthumously. Washington has 27 confirmed cases currently, and state and local health officials expect that number to rise with the community spread of the disease already apparent in King County.
The CDC has implemented strict guidelines on who can get tested, and health care providers cannot test just anyone who has symptoms.
“I have people telling me they have symptoms but don’t meet the requirements to be tested,” Murray said.
Current CDC guidelines for testing, which have not been updated since Feb. 27, require that patients not only show symptoms, like a fever, cough and shortness of breath, but also have been exposed to a confirmed case of the virus or have traveled to China, Iran, Italy, Japan or South Korea in the last two weeks. Patients with severe respiratory illness, like pneumonia, who are hospitalized and have no diagnosis can also be tested.
When the CDC allowed health care providers to begin testing hospitalized patients with severe respiratory illnesses, more cases were identified, including in Washington.
The narrow testing criteria leaves patients with severe symptoms that are not severe enough to require hospitalization in the dark, despite their best efforts to be vigilant.
Kyrsten Stien-Weber, who lives in Spokane, knows this all too well. She has had swine flu, or H1N1, before, so she knows what a bad flu feels like. The respiratory virus she has right now is much worse.
“I know how bad the flu can get, but this absolutely leveled me,” she said.
Stien-Weber has a high fever, chest congestion and a nasty cough even on day 11 of her sickness. Her son had similar symptoms for two and a half weeks and stayed home from school. He tested negative for the flu twice when his parents took him to receive care, but his symptoms got so bad, he went to the emergency room and was diagnosed with pneumonia. He was never tested for COVID-19, and he has since recovered and is back at school.
Stien-Weber eventually did go to urgent care last week to get tested for the flu and have chest X-rays completed. She was diagnosed with bronchitis, but the flu test came back negative. Since she went to the doctor, she hasn’t gotten much better, either. Doctors asked her if she had been out of the country or in contact with anyone who has COVID-19, and to her knowledge, she had not. She was not offered a test for COVID-19.
“I’m not saying definitively that I have it,” Stien-Weber said.
But she would like to be tested for her peace of mind and for the sake of her family, which also includes a daughter. She has been self-quarantining at home while she has symptoms, and since this weekend her fever and chest congestion have both gone away.
“My concern is both for my family, my daughter, my daughter’s school,” Stein-Weber said. “It’s also for the community at (her son’s school) with whatever the virus is going around. We haven’t even had the chance to rule out whether or not it’s coronavirus.”
Sen. Murray wants the CDC to make testing more widely available and faster, but Dr. Robert Kadlec, assistant secretary at the Department of Health and Human Services, acknowledged on Tuesday that rapid walk-in style testing in doctor’s offices is still months away.
Without testing for more people with symptoms, regardless of the severity of those symptoms, decision-making gets tough, Murray said.
“If you are a parent or a business owner trying to make decisions – unless you have the facts to know how many people have it and are impacted – it’s impossible to make a decision,” Murray said.
While local and state health departments implement testing, quarantines and monitoring, Congress is considering a bill to help fund local response and research for treatment for the COVID-19 outbreak. Murray said she would like to see the bipartisan supplemental funding passed by the end of the week.
“I would like to see it done by the end of this week, so everyone knows what they will be reimbursed for, not just because they need to be, but if people fear they won’t be reimbursed for those tests, they won’t do them,” she said.
“We are way behind the 8-ball on this, and I am talking to everyone here to get this done and get it right.”
Editor’s note: This story has been updated to correct the spelling of Kyrsten Stien-Weber’s last name as well as include the most up-to-date conditions of her symptoms.
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