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The fever hit 57-year-old Kathy Warren on Monday at 5 p.m. It came suddenly, accompanied by head-to-toe body aches and a rasping bronchitis.
When her husband, David Warren, fell sick with similar symptoms the next day, she called a doctor. Nurses at the Plainfield Health Center ruled out the flu and pneumonia for the Montpelier couple, but not COVID-19, Warren said.
Neither qualified for a coronavirus test — even though Kathy has allergy-induced asthma and David is 70. Nor could they get a test on Thursday, after Kathy returned to the doctor wheezing and short of breath. By that point, doctors considered them “‘suspected cases” for the coronavirus, Kathy Warren said.
Still, neither has been tested. “We are slowly but progressively getting worse,” she said.
The Vermont Department of Health has issued guidance to providers on how to prioritize people for testing: the immunocompromised, health care workers, incarcerated individuals, and other vulnerable people.
At a press conference Thursday, Levine broadened the scope. The state is testing people “if they’re symptomatic,” he told reporters. “Those priorities are quite standardized and they’ve been disseminated to all clinicians around the state.”
But it hasn’t proven so simple. The state has had no choice but to ration tests because of a nationwide shortage.
VTDigger spoke with half a dozen people with symptoms similar to the coronavirus who were self-isolating but have not been able to get a test. Most spoke on the condition of anonymity.
Local residents interviewed for this story said shifting state guidance has led to inconsistent standards for who gets tested. They are uncertain about how to care for themselves, apprehensive about family members and contacts, and question how vulnerable they’ll be to the disease after the self-isolation period ends.
Reports show that widespread testing is essential for mitigating the spread of the disease, enabling more effective isolation of those who are infected. Even as the virus spreads, testing can help hospitals save scarce resources and governments focus their containment efforts.
By Saturday, the department reported that it had run 978 tests since the beginning of March. So far, 49 patients have tested positive, including one health care provider. Two of those patients have died. But across the U.S., testing kits have been in short supply. Vermont is no exception.
The state now has the capacity to test between 600 and 800 people, according to state epidemiologist Patsy Kelso. That number will grow, as more supplies recently arrived from the federal government, she told legislators Friday.
“We should have thousands of these tests, and we don’t,” said Sen. Ginny Lyons, D-Chittenden, chair of the Senate Health and Welfare Committee. The state can’t even process the tests it does have, she added. “It’s a bit of a paradox.”
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The testing limitations have raised questions about whether the state has a comprehensive understanding of the extent to which the virus has spread.
On Friday, a medical provider at Central Vermont Medical Center tested positive for COVID-19. The provider has been in self-isolation since experiencing symptoms, but previously interacted with patients and staff.
Researchers in the Netherlands started testing providers in hospitals where cases had been reported and found that many workers “were mildly ill and infectious.”
In an interview Saturday, Health Commissioner Levine said the state doesn’t have enough tests to ensure every health care worker is COVID-19 free.
But starting today, Levine said, all personnel at Burlington Health and Rehab must now go through an infrared temperature check before entering the facility. A dozen residents of Burlington Rehab have tested positive for COVID-19. One woman in her 80s died Thursday. Another individual has been hospitalized.
Levine said the state has not considered mandating this new procedure for all health care providers.
People with symptoms turned away
Gail Simon, who lives part time in Montpelier, tried to get a test in two states after returning last Sunday from a trip to Italy, Austria and Switzerland. Customs authorities asked her to fill out a form, but did not interview her about whether she had experienced any symptoms of the virus and offered no admonition to self-quarantine for 14 days. “They didn’t tell us anything,” Simon said who was traveling with her husband. “We self-isolated because we were aware we needed to.”
Her doctor in New York City, where she lives part time, turned down her request for a COVID-19 test when she reported flu-like aches. So did her Vermont doctor when she called a day later.
The federal government’s policy seems to be “if you don’t test for it and you don’t count it, it doesn’t exist,” Simon said.
Others echoed Simon’s concerns.
A 73-year-old man with asthma said he tried to get tested on March 12, but was turned down — even though he had a fever, body aches, and had shortness of breath. A 54-year-old Williston woman also couldn’t get a test, though she knew how she had been exposed to the virus; she caught it from a friend in Colorado. The response from a triage nurse at Thomas Chittenden Health Center when she described her fever and body aches? Stay home, and self-isolate.
“When we see the statistics about how many Vermonters have it, I just think that’s completely wrong,” she said. “How many other people can there be?”
The decision for who gets tested falls on primary care doctors along with the Department of Health. But guidance from the state and federal governments has shifted fast, becoming unclear, and at times, contradictory. Some patients said they were told to self-quarantine for a week; others said two weeks.
Testing was initially only available to those who had traveled to one of the five countries where the coronavirus was widespread — China, Italy, Iran, Korea or Japan. By the first week of March, the federal government has loosened testing guidelines, expanding eligibility to anyone who had traveled and had flu symptoms of any kind is eligible.
President Donald Trump announced March 6 that anyone who “wants a test can get a test” — though federal officials quickly walked back that claim.
On March 18, the health department said the state would “prioritize samples from health care workers who are symptomatic and from patients who are hospitalized.”
The following day, Levine said that those who were symptomatic could be tested.
The state was also publishing advice dissuading Vermonters from relying on testing: “Testing is not treatment and not everyone needs to be tested,” the department said in its daily update.
A 27-page handbook from Copley Hospital instructed those who receive patient calls to first ask about travel to five high-risk countries — even though the disease has since spread to 185 countries. All doctors are required to get permission from the state epidemiologist before requesting a test, the handbook noted.
By March 20, state officials noted repeatedly that the state would prioritize a set of people: health care workers with symptoms, patients who are hospitalized, long-term care facility residents, people who are incarcerated, who are immunocompromised, and “other high-priority groups.”
It’s ultimately up to the doctor to make the final decision, said Erik Filkorn, a spokesperson for the Vermont Department of Health.
Risk is “a combination of age/general health/environmental issues,” he wrote in an email to VTDigger. “If you are 62, have diabetes and live in a long-term care facility, you’re at greater risk than say, Bruce Springsteen, who is over 65 and pretty darn healthy.”
The state would still accept tests for everyone, but the results would take longer for those at lower risk , he said.
Up until now, the state lab in Colchester has been conducting all the tests for COVID-19.
On Friday, Levine announced that the state would be sending tests to out-of-state private labs. That would allow the state to process more specimens — but it wouldn’t increase the number of people tested, said Filkorn.
“The ultimate solution to the problem is obviously making sure that there’s adequate testing reagents, buffers, all of the components of what go into doing the test,” Levine said on Friday. “Though there are a few gaps in our geographic region, we know how to fill them, and they will be filled effectively.”
The lack of clarity affects not just those with symptoms, but their contacts as well. A woman, who’s a clinician at a small hospital, said her partner was denied testing when he experienced flu-like symptoms — even though she works with high-risk populations and is vulnerable herself.
He was staying in the second floor of their home, wearing a mask, washing everything he touched, she said. But the uncertainty left her in a delicate position. If she decided not to work, it would strain the hospital’s limited staff, she said. If she continued to work, she could infect vulnerable hospital patients. “It is a double-edged sword, really,” she said.
Kathy Warren works as a child care provider for a primary care doctor. She’s self-isolating, and as a precaution, so is the doctor who employs her.
That means that other patients are also getting less care, Warren said.
While the Warrens self-isolate and wait in uncertainty, they are trying to make the best of things. Kathy put up Christmas lights in the windows because they “lift your spirits.”
“We are monitoring ourselves, taking every precaution, doing all we know to do to get through this,” she said.
Deb Richter, a primary care physician from Montpelier, says the lack of testing is the biggest issue in controlling the spread of the coronavirus.
“We are vastly under testing,” Richter said. “Because it’s invisible, people are being exposed, and that’s no fault of ours. We don’t have any choice. We’re rationing testing because we have to.”
Editor’s note: Editor Anne Galloway contributed to this report. This story was updated at 2 p.m. to include comments from Deb Richter.
