As the number of COVID-19 cases continues to grow in New York, there are still only two places in the state that can test for the coronavirus that causes it.
One is in New York City, focused on testing suspected cases that crop up inside the city limits.
The other is in Albany, and it handles suspected cases from everywhere else in the state.
The virus has now sickened more than 100,000 people around the world and killed more than 3,300. Fifteen people have died in the U.S. in the last week.
New York City's deputy mayor for health and human services Dr. Raul Perea-Henze told federal officials Friday that the city urgently needed more test kits as the number of people under quarantine there passed 2,000.
Meanwhile, the Albany lab can test only about 200 samples a day. Three times that number of people are under quarantine in Westchester County alone after potentially being exposed to a man who tested positive for the virus.
As a result, public health officials and hospital epidemiologists say, people who should be getting tested are not, and health care workers who may have been exposed are being furloughed while hospitals wait for test results.
When doctors at Rochester General Hospital were unable to find any ready explanation for a patient’s respiratory symptoms on Wednesday, they consulted with the Monroe County public health department. The county health department, in turn, consulted with state health officials. They determined the patient met the criteria for coronavirus testing.
County public health commissioner Dr. Michael Mendoza said he expected results within 48 hours.
Then, about 48 hours later, a spokesperson for Rochester Regional Health, which runs RGH, said the hospital did not expect results until the next week.
“The state health department is in charge of all things testing,” Veronica Chiesi-Brown told WXXI News on Friday. “I do not know what the delay was.”
Monroe County officials weren’t sure, either. “To the best of our knowledge, the test went out per protocol,” said county communications director Julie Philipp.
The state health department did not respond to questions about what is causing the delay.
The department was similarly opaque about other issues related to testing. Multiple spokespeople did not respond to specific questions about when testing would be available outside of Albany and New York City or where those tests would be.
Some county health officials were more forthcoming.
Erie County health department spokesperson Kara Kane said the public health lab there will be able to examine samples “soon,” but said she could offer no further details on the timeline.
Onondaga County said it expects being able to test samples for the coronavirus “in the near future.”
In Monroe County, the University of Rochester Medical Center is gearing up to run tests at Strong Memorial Hospital, but administrators there said the ability was likely a month away.
“It’s not like plugging in your TV and turning it on,” said Dr. Paul Graman, the hospital’s epidemiologist. “You have to run a variety of controls and make sure the whole process runs smoothly.”
Earlier this week, the federal Centers for Disease Control expanded its guidelines for who should be tested, but Graman and other hospital officials in Monroe County said the number of tests available cannot keep pace.
Because the capacity statewide is limited, they said, testing is being prioritized for the most important potential cases.
Those are people who present the most obvious signs of COVID-19, and the people for whom infection would present the most severe impacts to public health: hospital workers.
“We don’t want to consume hospital resources isolating a person who doesn’t need to be isolated,” Graman said.
“And we certainly don’t want a person with exposure coming into contact with other people in the hospital.”
In the meantime, Graman said, the 48-hour delay between submitting samples to the state and getting results means public health could be at risk.
“That’s a period of anxiety for everyone concerned,” Graman said.
Graman stressed this is a scenario that has not happened locally, because there has not been a positive case of COVID-19 in Monroe County.
Still, he and other local hospital administrators described a testing system that is unprepared for that situation.
Once a case is identified, the public health department begins what’s called “contact tracing,” where workers try to identify all the people an infected person was near while contagious.
In many cases, those people are quarantined in an effort to prevent them from spreading the virus further. A 48-hour delay in that process exposes more people to the disease -- and the number increases exponentially with time.
“If others are infected, those people need to be identified, separated, and quarantined at home,” Graman said.
“That whole process only starts with a diagnosis. With no test, there’s no diagnosis.”
The county disputed the idea that some people who should be tested for coronavirus are not getting evaluated.
“Monroe County is approving as many tests as are clinically appropriate and presenting them to the New York State Department of Health for approval,” Philipp said.
Dr. Emil Lesho, Graman’s counterpart in epidemiology at Rochester General Hospital, said that’s true, but it's not reflective of the struggle of getting test results when capacity is limited and the tests are run from a single center halfway across the state.
Lesho said in his estimation, the county is doing all it can to expedite results, but the lack of available tests is “a really big threat to public health.”
The holdup started at the federal government, which kept a stranglehold on tests for too long, he feels.
“We should be doing more tests. I’m not afraid to say it," said Lesho. "We should be doing more tests, and we need to be doing them faster.”