Late Wednesday, after an ambulance crew arrived at the Kent home of Fahimeh, a 29-year-old married mother and Iranian refugee, she texted her older brother, Morteza.
“They said that I have coronavirus,” she wrote in her native Farsi. “But please, if anything happens to me, I want you to swear to God you will take care of my daughter.”
When he woke the next morning to find the text, Morteza’s heart raced. He frantically called his sister. Through a raspy cough, she said that a coworker at her security job in Seattle had died of COVID-19. A few days later, when she started feeling sick, she went to Valley Medical Center. A doctor told her she didn’t have the symptoms for the novel coronavirus and did not test her.
“She said the doctor got angry and said, ‘Why are you even here?” Morteza said Friday.
But late Wednesday, when Fahimeh had a fever and couldn’t breathe, she finally called 911, she told her brother. The medics “told her that she has all the symptoms of COVID-19, but because hospitals are not ready and equipped to test or take patients, they couldn’t take her,” Morteza explained.
“Where are the test kits that the vice president and president are talking about? Why are hospitals not ready?”
Fahimeh finally got a test Thursday and is awaiting her results, he said.
But despite Seattle’s unwelcome role as the U.S. epicenter of a pandemic, panicked local residents consistently complain that they can’t get tested. Behind the complaints are delays in making reliable tests available, red tape that has slowed labs from testing and a bottleneck of test orders within an overburdened health care system, hindering a clearer understanding of the fast-spreading virus, public health officials say.
A botched roll-out of Centers for Disease Control and Prevention diagnostic tests early last month allowed an outbreak to spread undetected for weeks in Washington before fixes came and politicians vowed to ramp up testing capacities nationwide.
At least four labs now testing in Washington — including those operated by the state health department, the University of Washington Medical Center, LabCorp and Quest — are capable of assessing several thousands of specimens a day, as federal regulations and criteria have been eased to increase testing capacities. The Bill & Melinda Gates Foundation also has developed a home test that’s now awaiting federal approval, public health officials say.
President Donald Trump announced Friday that the government is partnering with private companies to increase capacity even further, including potential drive-through testing sites.
But the delayed response, coupled with hospitals and physicians already swamped and reluctant or unable to order tests, continues to turn back those who want to be tested. All of it has meant that the nation’s system for testing for the disease is “failing,” Dr. Tony Fauci, the nation’s chief infectious disease doctor, told a congressional committee this week.
Seattle’s top public health officer said Friday the federal delays in getting a worthwhile COVID-19 diagnostic test available have left the local health care system scrambling to fully understand the most pressing questions at this stage in the outbreak: How quickly is it spreading and where?
“The lack of testing definitely hampers our ability to understand the precise epidemiology of this disease, [and] the extent of spread,” Dr. Jeffrey Duchin of Public Health – Seattle & King County said. “If we’d had our testing earlier, we’d probably have a better understanding of the disease.”
The challenge in bringing testing up to speed is threefold, said Dr. Kathy Lofy, the state’s health officer. Building capacity to widely test patients — from an initial narrow approach of testing only high-risk patients who’d recently traveled — took time. Getting health care providers to collect and submit specimens is another issue.
“And the new challenge is finding some testing supplies,” she said, as swabs and other necessities are running low.
“Send me in a circle”
Washington’s Department of Health now advises health care providers “there are currently no restrictions on who can be tested for COVID-19.”
The agency lists among the highest priority for testing health care workers, first responders and those who are part of a known illness cluster in a nursing home, shelter, school or other facility, although some workers at the Kirkland nursing home with the most local cases have only recently been tested.
Also recommended for priority testing are those who’ve had close contact with a confirmed case or traveler to a high-risk country, and those in general at-risk categories: people over 60, pregnant women and those with underlying health conditions, like respiratory ailments.
“Any other patients can be tested per health care provider judgment,” the state health department’s advisory says.
People who feel sick and want to be tested should call — not show up to — their doctor, Duchin said. For those who don’t have a regular doctor, Duchin suggested calling – not visiting – a hospital or emergency room.
A doctor, in turn, can ask questions to determine whether the patient should get an appointment for a test. But there’s a difference between wanting a test and needing one, Duchin added.
“We’re really trying to facilitate the health care system … so everyone in the community who needs to be tested can get tested,” he said. “But we don’t have the capacity to test everyone who wants to get tested at this point. We do have the testing capacity for everyone who needs one, I think.”
Dr. Nariman Heshmati, the secretary-treasurer of the Washington State Medical Association, said that, “It comes down to who needs a test and where it clinically makes a difference.”
At the Everett Clinic, where Heshmati is a surgeon, doctors have been evaluating symptoms and, based on public health guidance, have been ordering tests on a case-by-case basis. When someone has severe symptoms and underlying health conditions, or in a case of a local geographic outbreak – where public health officials have a chance to investigate and contain the spread – a test might make sense, he said.
But the criteria could change at any moment as more tests become available, Heshmati said: “This has really been so fluid.”
Complaints from people like Morteza have revealed multiple people who appear to be high priority but still have been turned away when they asked doctors to test them for COVID-19.
At The Sophia Way shelter for homeless women in Bellevue, just six miles south of the skilled nursing facility where 25 people died of COVID-19 as of Friday afternoon, people are sick but aren’t able to access coronavirus testing, said executive director Alisa Chatinsky.
“The county has been talking to us, trying to get hotels to isolate people,” said Chatinsky, whose organization works with homeless women, one-third of whom are over the age of 55. “But because we’re not testing, how do we know if they have COVID or a cold or a flu or what? That has not happened yet.”
A single father with three teenage daughters complained in an email to The Seattle Times this week that after his oldest daughter came down with a fever, chills and breathing problems, she was diagnosed as a suspected COVID-19 case and tested at UW Medicine’s Northwest Hospital emergency room. But the rest of the family couldn’t get tests, he said, and a doctor instead gave him a number to call.
“It sounded like a very busy call center at a telemarketing firm,” said the man, who asked not to be named due to privacy concerns. “The person on the line seemed to know nothing. And then she started to send me in a circle.”
Eventually, he was told to call his doctor.
“My physician had told me he didn’t have the proper isolation rooms to do such tests and so he had given me the number” to the call center, he said. “…If people can’t be tested, if this incompetence isn’t shamed to the point of correction, things will only get worse.”
Disease’s six-week head start
The discretion to test rests with doctors, who are navigating a minefield of factors in determining who gets tested and who doesn’t, Duchin said. Keeping contagious patients from contaminating clinics, personnel and other patients is a high priority.
Duchin put the blame largely on delays in making tests available. “Despite what some of the reports coming out of Washington, D.C., are, we don’t have the capacity to test everyone who wants to get tested at this point.”
From the beginning, the lack of tests put Seattle public health officials at a disadvantage, Duchin said. They were chasing a disease that had a six-week head start.
Now, the value of testing is shifting, he said. In the early days of the outbreak, public health officials wanted to know if a seemingly isolated case of a Snohomish County man who got sick after a trip to China had infected anyone else. Now, “We have enough testing to know that we have widespread disease in the community,” Duchin said.
The greater value currently is tracking whether spread of the disease is still growing or slowing down.
“From the public health perspective, the more cases of the disease that we can detect, the better understanding we can have about where the disease is spreading in our state, and the more people who know [they’re infected], the more likely it is they will be to staying away from other people,” Lofy said.
Theoretically, that includes people like Morteza’s sister, Fahimeh. After twice being denied tests, she had chest X-rays taken and a test at Overlake Medical Center in Bellevue, Morteza said. She’s now self-quarantined at home, with her husband and their 3-year-old daughter, waiting.
“They told her it takes 48 hours for the test results,” Morteza said. “So we’re all waiting and nervous to hear.”
Seattle Times staff reporters Mike Reicher and Sydney Brownstone contributed to this report.