Who gets tested? COVID-19 test shortages force county to make choices
When Rebecca Goldfeder first came down with a sore throat Sunday evening, she figured she didn’t have to worry about COVID-19 unless she developed a cough.
By the next morning, she had a cough. And the sore throat was worse.
Goldfeder, 50, called her doctor’s office. “Don’t come anywhere near here,” she recalled the doctor saying.
As protective equipment for medical staff grows more scarce, the Monroe County public health department has been asking primary care offices to guide people toward phone consultations or triage sites for coronavirus concerns.
True to the county’s instructions, Goldfeder’s doctor told her to call the health department’s hotline. She did. She asked for COVID-19 testing. She was referred to another hotline, she said, and then told she couldn’t get a test unless her symptoms included a fever.
She resigned herself to staying indoors for a while.
By Tuesday, her cough had worsened, and she had a fever.
She called back. Her temperature was right around 100 degrees. Not high enough, the hotline representative told her.
On Wednesday, she said, her temperature was nearly 102.
“I tried to make a run around all the bureaucracy,” she said. “I emailed the county health department.”
The health department called her back. “Unless you are hospitalized, you will not be getting tested,” she said the department told her.
Goldfeder’s experience was an early indication of a policy the health department officially announced at a news conference Thursday morning: limiting COVID-19 testing to high-priority cases.
County public health commissioner Dr. Michael Mendoza laid out the groups for whom testing is a necessity:
- Symptomatic health care workers, emergency medical technicians and other people “directly involved in addressing the COVID crisis.”
- High-risk patients -- people who are hospitalized or live in long-term care facilities, and people whose health is compromised.
- Patients who have developed symptoms shortly after being in close contact with a large number of people. If these patients test positive, the county wants to contact the people they’ve been near.
For the first group, Mendoza said, the test won’t affect their medical treatment, but a negative result would allow them to return to work sooner, propping up the health care workforce at a time when it’s under significant stress.
For the second group, he said, test results “will help to guide their care.”
Mendoza said that for the vast majority of people with COVID-19, test results make no difference for treatment.
He and other doctors said the therapy for most people with respiratory symptoms is to stay home, rest, and keep hydrated.
Staying home is the most important part of managing COVID-19 on a community level, said Dr. Michael Apostolakos, the chief medical officer at Strong Memorial Hospital.
“If we are vigilant -- if we are aggressive about social distancing, that is how we control this,” Apostolakos said.
The county’s acknowledgement that testing capacity lags far below demand came after both hospital systems locally started processing samples in the last week.
Rochester Regional opened a drive-up testing site on Monday, but some doctors in that system have described waiting since then for results to return.
At the URMC lab, officials there said, they get several hundred samples a day at a facility that can only process about 100 a day.
The lab can usually return results on high-priority samples within 24 hours, officials said. Other samples are forwarded to either to state labs, where the processing time is up to four days, or commercial labs, where turnaround times are even longer.
Dr. Dwight Hardy, who directs microbiology at URMC, described shortages in every level of specimen collection and testing.
He said they had a limited supply of the swabs that they stick up patients’ noses to collect samples, vials to hold the swabs, and reagents to separate the virus’s genetic material from everything else in the sample.
In Buffalo, the Erie County public health laboratory stopped testing this week after running out of supplies.
Mendoza said he expected the local shortage to be temporary. URMC administrators said the conditions will likely last for months.
Eventually, the doctors said, they want to be able to run extensive tests to determine the prevalence of the virus in the community. That’s part of how they’ll determine when the spread slows and restrictions on daily life can be lifted.
Until then, Apostolakos said, people should stay home. “What we need to do is practice social distancing,” he said.
“If people do that, I guarantee you, we will have plenty of supplies, plenty of space, and the ability to take care of our patients. If we can’t do that, who knows,” he said.
Noelle Evans contributed reporting.