Jennifer England was waiting to board her flight back home to Pittsburgh when she started to feel sick: a sore throat, a cough, body aches, fever.
The 51-year-old had been in Los Angeles for five days for work. Even though thousands of domestic and international travelers pass through LAX each day, England didn’t immediately think she’d caught coronavirus.
“I’m not an alarmist, I’m not a chicken little, especially regarding this sort of thing,” she said. “I was totally nonchalant about flying to L.A., I was actually totally nonchalant about being sick.”
After a couple more days, England went to the doctor; when she saw how staff there reacted, she became concerned.
“The response in the office was very much it’s COVID-19 until it’s not,” she said. “Everybody in … the office masked up, they wouldn’t let anybody else back into the area that I was in … they escorted me out through the back door.”
England said she might never know if she has COVID-19, because she wasn’t tested. She said her doctor’s office, which is affiliated with UPMC, had no way to do a test. Despite this, England’s physician told her to self-quarantine at her home in Morningside for two weeks from the date of her symptoms.
The United States’ capacity to test people for COVID-19 is greatly diminished compared to other countries, said Dr. Amesh Adalja, an infectious disease expert with Johns Hopkins University.
“As a country, we’re doing horribly at testing,” he said. “When you look at what South Korea can do in a day compared to what we’ve done since the beginning of this outbreak, it’s really embarrassing.”
In South Korea, nearly 20,000 people are tested for the virus daily. In contrast, the Centers for Disease Control and Prevention report that about 11,000 people have been tested in the U.S. since mid-January.
Part of the challenge for Pennsylvania health systems, said Adalja, is that the state has followed the CDC guidelines for testing, which means that medical staff who do the tests have to wear certain protective gear.
“That makes it difficult for an office to be able to collect those specimens and not then ... expose their staff and then have their staff quarantined because of that,” he said.
The CDC has since loosened those requirements a bit, but a bigger issue is the availability of the test kits themselves. There has been a shortage of kits in the U.S., and until recently, specimens had to be sent out to labs run either by the state health department or the CDC. Now commercial labs, including Quest and LabCorp, have come online, but that still means that specimens collected at doctor’s offices and emergency rooms have to be sent out for analysis, which can create a backlog.
UPMC said it’s developing an in-house test, but wouldn’t say whether primary care providers have the ability to collect specimens for testing at their own discretion. Instead, a spokesperson said that clinicians can call a hotline and talk with UPMC’s infection prevention team.
“If testing is warranted, it will be accommodated,” the spokesperson wrote in an e-mail. But UPMC declined to share the guidelines they’re using to decide who should be tested.
Kristin Wessell’s 53-year-old husband is self-quarantined at their home in Mt. Lebanon. Wessell said he began experiencing COVID-like symptoms late last week and went to his primary care provider, which is part of Allegheny Health Network.
“The physician’s assistant who examined [him] said, ‘Your symptoms concern me how quickly they came on, your flu test came back negative,” she said.
Wessell said her husband had recently attended a statewide conference and takes public transit every day, so the clinician was concerned about his possibility of exposure to the virus and wanted him to be tested.
“But … I don’t know how to go about doing that,” Wessell recalled the physician’s assistant saying.
Eventually, Wessell’s husband was instructed to go to the nearest emergency room to be tested. At St. Clair hospital, a physician examined him again and determined that he should not be tested, because he hadn’t traveled to one of the regions of the world where cases have become widespread.
St. Clair declined to share their guidance about who to test and why, and AHN didn’t respond to a request for comment.
There are legitimate reasons why providers don’t want people with mild flu and cold like symptoms to show up at doctors' offices and emergency rooms demanding to be tested, said Amesh Adalja. That could further spread the virus and overwhelm our health systems. But in the end, he said, the more data we can collect, the better we can understand and respond to the pandemic.
“A lot of fear, a lot of panic is based on a case fatality ratio that some people think is 3 percent, which is likely not true,” he said. “There may be what’s called the severity bias in the data, in that only the severe cases [are] getting tested; that’s going to give you a different picture of the outbreak [than if] you’re testing mild cases.”
At a press conference Thursday evening, county epidemiologist Kristen Mertz said testing capacity is expected to ramp up next week. Still, testing by the county will likely be focused on people who have traveled to specific areas of the world.
“In the future, if we start getting cases and it becomes widespread in Allegheny County, we’ll start testing people who haven’t traveled,” she said.
AHN and UPMC both participated in the press conference; neither shared their specific testing protocols, but expressed confidence that they’re prepared to manage cases of the infection if and when it hits Allegheny County.