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Jessica Toliver struggled to breathe Wednesday when she called a hospital asking about a coronavirus test.
The nurse who answered was so troubled by the 37-year-old’s wheezing, she suggested that Toliver rush to the emergency room.
Doctors at Baylor Scott & White took an X-ray of her chest — which came back clear — then sent the Grand Prairie resident home.
But there was another test she wasn’t given: one for COVID-19, the illness caused by the new coronavirus.
“There are only enough tests for high-risk patients,” said Toliver, whose fever overnight Thursday hovered around 100 degrees. “But I am quarantined with the assumption that I have it, although they can’t say for sure.”
While capacity for COVID-19 testing is ramping up statewide, several factors are leaving people like Toliver without a way to find out whether they’re carrying the virus.
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For weeks, federal, state and local officials have promised a surge in tests, especially once commercial labs began offering them.
But Texas has been slow to show progress. Thursday marked the first major uptick of commercial lab testing. According to state data, commercial labs tested about 2,600 Texans — more than double what government labs have performed since the outbreak began. As of Friday, 5,277 people had been tested by both public and private labs since the state started tracking.
Yet some public health officials are worried it’s too late as the virus spreads rapidly across Texas, touching at least 34 counties — big and small, urban and rural — and killing five people as of Friday in a state with a population of 28 million.
Already, more than 40% of the 95 new known coronavirus cases in Dallas County were attributed to community spread, health officials said Saturday, meaning that they hadn’t traveled outside of Texas recently or had any known close contact with a confirmed case.
Testing helps to understand the breadth of the new coronavirus, which public health experts say spreads “efficiently.” It also helps identify who should isolate to stop the spread.
Part of the reason why cities, counties and entire states are putting restrictions on movement and social gatherings is because there aren’t enough tests to identify everyone who is sick.
Screening in the Lone Star state should have ramped up here much sooner, said Dr. Robert Haley, a longtime epidemiologist and professor of internal medicine at UT Southwestern.
“We’re doing what we can,” he said. “We don’t have enough test kits. They’re still in short supply.”
In states such as California and New York where the global pandemic has hit hard, officials are pivoting away from widespread public testing so they can conserve limited health care resources, The Washington Post reported.
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Testing hurdles
Hurdles to commercial testing remain. Protective equipment that medical workers need to meet potentially ill patients is in short supply nationwide. So are the specialized swabs needed to take patient samples. Some clinics are reporting a wait time of up to six days for test results.
Additionally, in many places, patients face strict testing criteria — in essence screenings are prioritized for the most at risk or health care workers.
Despite growing evidence that the virus has taken a foothold in the state, Texas guidelines, which were updated March 15, still restrict testing to those who have symptoms and have traveled abroad, have been exposed to someone with a confirmed case of COVID-19 or have been hospitalized.
That means people like Toliver, who have symptoms but are not in critical condition, are left with few options.
“The testing expectations that have been put out by the federal, state and sometimes city officials are unrealistic,” said Lisa Rigby, executive director of Woven Health Clinic in Farmers Branch. “There is still a massive shortage of availability in the Dallas area, and probably in Texas.”
Several hospitals and clinics in Dallas County are testing patients for COVID-19. But with limited capacity, most are reserving tests for health care workers, first responders and their own patients who have serious symptoms.
Parkland Health & Hospital System opened Dallas County’s first mobile testing site on Monday. It can test up to 200 people a day — the physical limit of how many samples will fit in vans used to transport the samples. As of Friday morning, however, the county hospital had tested only 169 people. A hospital spokeswoman said that’s how many people met the criteria outlined by the Centers for Disease Control and Prevention.
Unlike the state’s guidelines, the CDC permits health care workers to test older Americans and those with chronic illnesses such as diabetes and lung, heart and kidney diseases.
Public labs, such as Dallas County’s, are strategically limiting their tests.
Dr. Phil Huang, the county’s health director, told the City Council on Wednesday that it is important for his department to limit tests to maximize the greatest public health needs. He said the lab, which recently acquired the ability to get results in 24 hours, can do 160 tests a day.
Put another way, Huang is positioning his lab to test critical patients and health care workers in the hopes they can return to work more quickly if their results come back negative.
But Texas lags behind other big states in the total number of people tested.
According to the COVID Tracking Project, an independent initiative of scientists and journalists that tracks testing data, California has tested 9,845 people and New York has tested 22,284. The state of Washington — which is a fraction of the size of Texas but arguably one of the states hit earliest and hardest by the outbreak — has tested 20,712 people.
Sick with no relief
To understand how Texans are struggling to find a COVID-19 test, The Dallas Morning News asked people to share their stories. Nearly two dozen responded from Bexar to Collin counties. Clear themes emerged from their experiences: fear and frustration.
Most people have been unsuccessful, living with symptoms that are common among those who have caught COVID-19, such as a fever, body aches and a dry cough.
Michelle Lester, 40, said she’s experienced symptoms similar to those of actor Tom Hanks, who announced last week that he tested positive. She has suffered from body aches, dramatic shifts between chills and hot flashes. While she has not traveled, she was notified that one of her co-workers was exposed to someone who tested positive for the virus.
Lester has attempted to get tested but said that her primary care physician, the Collin County health department, and Baylor Scott & White have all turned her away.
Lester said she’s mostly worried about the possibility of passing the virus to her son or her 64-year-old husband, who has diabetes and is fighting prostate cancer.
“I have no idea how to get a test,” she said. “Until my doctor can understand what to do … I don’t know. I just realize this hasn’t been planned for and people are trying to get it together, and I just hope it happens sooner rather than later.”
The lack of testing is creating a divide among Texans, economically and socially.
Health officials also worry people may not take their symptoms seriously if they don’t have a test to confirm they have the virus and need to stay home.
“If you are saying ‘we’re not sure, could be a cold, maybe allergies, just to be on the safe side, stay home,’ that’s kind of hard for somebody who relies on a paycheck,” said Dr. Sathya Bhandari, president of the Denton County Medical Society.
The lack of widespread testing could put workers in a bind. Some employers are requiring a positive coronavirus test to allow people to work at home or claim sick time. Others are demanding a negative test to allow employees to return to work.
Lester’s son, for example, won’t get paid if he doesn’t show up to work or gets tested, which the family has realized is unlikely to happen.
Meanwhile, Texans uncertain about their health are making the heart-wrenching decision to isolate themselves from their families — just in case.
Jenni O’Brien, a 38-year-old Arlington resident who works in the travel industry, has had a dry cough and body aches since last Friday.
“I was trying to cough something up, but it wasn’t coming up,” she said.
She has bounced back and forth between her primary care physician who refused to see her and referred her to the emergency room, and urgent care, which tested her for the flu and strep. Both have come back negative.
Some days this week were better than others. She acknowledges that if she has the virus, it’s not as serious as most. And yet, she doesn’t want to pass it on to the rest of her family.
“I’m too afraid to expose my 60-plus-year-old parents and son,” she said, noting that COVID-19 is much more dangerous for those over 60.
She’ll continue to wait until she can find a private clinic that will test her.
“It’s a circle of unanswered questions,” she said, trying to make light of the situation. “I’m 50/50, or even 70/30 on whether I have it. It’s the not knowing which is making me feel worse.”
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Testing capabilities
UT Southwestern Medical Center can test between 40 to 60 people each day, until it receives “processing equipment” needed to expand the capacity, spokesman Russell Rian said.
Catalyst Health Network, which has clinics across North Texas, set up three locations that, as of Friday, could test up to 100 patients each, said network president Dr. Christopher Crow. The capacity is driven by the number of test kits the network receives from a commercial lab, which has been steadily increasing, Crow said.
Still, those caps can be limiting.
Rigby, whose clinic caters to low-income patients, is allowed five test kits at a time by her commercial lab, she said. The kits include synthetic swabs to take samples from deep within the patient’s nose and transport vials to send frozen specimens to the lab.
Rigby can order more when her supply runs out, but getting the new test kits takes up to three days, she said. She doesn’t know why the cap is in place. But her clinic is trying to get around the bottleneck by buying its own supply of swabs and transport vials.
What’s more, she said, there appears to be a growing backlog in testing. It used to take three days for results to come back. Now it takes five or six, she said.
“Are they trying to limit it because they can’t process that many? Is it because they don’t have the supplies to send to us?” asked Rigby, who requested to withhold the name of her commercial lab.
Quest Diagnostics is limiting the kits given to clinicians because of global shortages of swabs and other key testing materials, spokeswoman Wendy Bost said. The commercial lab can run upwards of 10,000 tests a day, she said.
“We would prefer to be able to provide more collection kits than we can at the present time, and we are working closely with health care leaders and government leaders in different regions of the U.S. to provide the collection kits where the need is the most urgent,” she said.
More testing relief should arrive in Dallas County this week.
Two large-scale testing sites are expected to open this weekend. However, older Dallasites and those with health issues will be given priority.
“They will be for symptomatic people,” said Dallas County Judge Clay Jenkins. “They won’t be for people who don’t have a fever and don’t have the symptoms. It’ll be mostly people over 65 with underlying conditions.
“Hopefully the testing will expand so we expand it to more people.”