She started coughing on a Sunday, woke with a fever the following Monday, and by that afternoon, Alex Leuzzi was trying to get her doctors to test her for coronavirus.

But her doctors, in a phone call from the Swedish Medical Center clinic in Bellevue, informed Leuzzi “that because my fever wasn’t 100.4 degrees, they weren’t able to test me. I was only at 100 degrees.”

If she had difficulty breathing, her doctors advised, Leuzzi, 36, should go to an emergency room. Otherwise, stay home.

She took their advice, but still wanted a test. After another Swedish clinic denied her, Leuzzi drove on Friday from her Maple Leaf apartment to a naturopathic clinic in Mukilteo, where a staffer swabbed her nose through her car window. Test results came back this week: positive for COVID-19. But why was it so hard to find out, Leuzzi wonders.

“It’s insane how disorganized the process seems and all the conflicting information we’re getting,” she said. “I’m still confused about who is actually allowed to get a test.”

Even as Washington’s coronavirus testing capacity continues to ramp up, complaints persist that it’s a  struggle to get tested. The problems now seem to lie squarely on the front end — with doctors, hospitals and clinics that make judgment calls about who should be tested and when.

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Health care providers across the state have been “advised to limit testing to symptomatic individuals” and prioritize first responders, health care workers, and persons in congregate settings, Keith Seinfeld, a spokesman for Public Health — Seattle & King County, said Thursday.

“There are still some gaps for our highest priority areas,” Seinfeld said. “In some cases, the issue is spotty supplies of swabs and transport media needed for testing, but that situation is improving, and we’re helping to connect supply to where it’s needed.”

Meantime, public and commercial laboratories in this state and others, led by the University of Washington Medical Center’s virology lab, keep beefing up capacities to test thousands of specimens from Washington residents each day — so many, in fact, that the Department of Health (DOH) has been swamped keeping up with numbers.

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On Monday the state only reported 248 positive results and nothing for negative or inconclusive tests, which are the bulk of the daily report. The previous day the state had reported 33,933 tests had been completed by the four labs handling the state’s tests, with about 93% of tests coming back negative.

The problem was attributed to enhancements made to the DOH systems to handle the higher-than-anticipated volume of reports coming from the laboratories.

“Since then, we have increased our system’s capacity to intake new labs and all backlogged results have been uploaded into the system,” said Jamie Nixon, a DOH spokesperson.

Alex Leuzzi, 36, struggled to get tested for COVID-19 despite having most of the symptoms. When she did get a test, the test was positive. “I’m still confused about who is actually allowed to get a test,” she says. (Courtesy of Alex Leuzzi)
Alex Leuzzi, 36, struggled to get tested for COVID-19 despite having most of the symptoms. When she did get a test, the test was positive. “I’m still confused about who is actually allowed to get a test,” she says. (Courtesy of Alex Leuzzi)

Labs expanding “substantially”

The University of Washington Medical Center Virology lab continues to handle most of the testing in Washington, running nearly 84% of more than 34,000 tests performed statewide as of Wednesday.

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The UW lab had tested 28,780 patients for COVID-19, with 2,324 of them — or 8.1% — testing positive, according to its publicly posted data.

“I think we are still way ahead in per capita testing” compared to other states, Alex Greninger, the assistant director of UWMC’s clinical virology laboratories, said in an email. You “could even argue that Washington state is starting to bend the curve.”

Actually, New York now slightly tops Washington in per capita coronavirus testing, with a rate of .006 tests performed per person compared to Washington’s .oo5.  With more than 122,000 tests performed in the Empire State, New York accounts for nearly one-quarter of the 519,338 tests nationwide, according to the latest statistics from The COVID Tracking Project.

By comparison, Washington’s 34,292 tests, which trailed only New York in sheer number of tests performed as of Wednesday, made up 7% of all tests nationwide.

Greninger noted he “would never call a peak” in Washington’s COVID-19 cases, saying “one death is one too many.” But the percentage of positive tests in Washington is 7 to 8%, compared to the 25 to 30% in the New York area, and the deaths are rising at a slower rate here than other states, he said.

In fact, Washington’s mortality rate for positive cases —  which spiked amid an early outbreak at a Kirkland nursing home —  has dropped from about 8% on March 11 to 5% on Thursday. Meantime, New York’s death rate has climbed —  from about 0.4% of positive cases on March 14, to more than 1% as of Thursday.

Yet, even when Washington reaches the apex of its curve, public health officials have warned that social-distancing measures will still be necessary to prevent a new surge of positive cases.

The UW virology lab, which at a high tested 3,071 individual patient samples in one day on March 18, has been able to keep up with the testing demand with a typical turnaround of test results in 10 to 12 hours, Greninger said. The lab also will expanding its capacity soon, he added.

“By early next week we bring on three new instruments and a new laboratory devoted entirely to COVID-19,” Greninger said. “You will see volumes increase substantially in the coming days.”

The state testing lab doesn’t plan to, nor does it have the resources to, match UW’s capacity and is aiming to hit about 400 tests a day, Nixon said.

“The Public Health Lab is not, nor was it ever intended to be, a high throughput facility,” he wrote in an email.

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Beyond the UW and state lab, testing capacity continues to expand, officials say.

Kaiser Permanente Washington has seven drive-thru testing sites throughout the Puget Sound region for its patients who meet the state DOH guidelines and have been assessed by their health care provider. The DOH testing guidelines will continue to be followed by Kaiser Permanente, said Linnae Riesen, a Kaiser Permanente Washington spokesperson.

The Seattle-King County public health agency is starting a testing clinic for symptomatic homeless people and those who serve them, Seinfeld said, and already operates “a mobile services team to screen illness clusters at congregate settings,” such as nursing homes and shelters.

“We recommend that people call ahead to their providers” to confirm availability of testing appointments, Seinfeld said.

“Couldn’t get a test”

But for some people, getting an appointment hasn’t been easy.

Initial federal restrictions limited testing mostly to recent international travelers experiencing fevers or other flu-like symptoms. Those were lifted weeks ago, and now DOH leaves testing decisions up to doctors.

But the state health department also has offered recommendations that only patients with symptoms receive tests, with priority to given to several at-risk groups. Those include patients who’ve been hospitalized with pneumonia-like illnesses; workers in health care, long-term care or public safety jobs; those in institutional settings, such as prisons, jails or homeless shelters; and people who work in “critical infrastructure” businesses, such as grocery stores, pharmacies, gas stations and public utilities.

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Patients at high risk to get seriously ill — people over 60, pregnant women, or those with underlying health problems — should contact their doctors and be tested if they see their symptoms worsen or if doctors recommend testing.

The health department’s latest guidelines, issued March 17, also note that people under 60 who are generally healthy but experiencing mild symptoms don’t need to be tested and recommend against testing people who don’t show symptoms. One of the benchmarks for testing is for those with a fever of 100.4 or above.

That excluded Leuzzi by .4 degrees, but she pointed out that the triggers for testing seem to be maddeningly inconsistent from clinic to clinic.

“I was frustrated,” Leuzzi said. “I had the fever, the cough, the sore throat, a hard time taking full deep breaths, extreme fatigue and a headache. I checked all the boxes, but couldn’t get a test.”

She acknowledges that the COVID-19 diagnosis didn’t really affect her situation. Even before she got the result, she assumed she was infected, so she isolated herself at home and notified others with whom she’d recently come in contact. And even now that she knows for sure, Leuzzi said, there still is no cure.

“Honestly, I think my friends and family were more curious,” she said. “If anything, it gives me some peace of mind so that when I’m able to go back in the world, maybe I’ll have built up some immunity and have less chance of getting it again.”

But scientists aren’t yet sure that someone who has been infected once with COVID-19 will be immune from getting it again, according to various reports.