When Lauren Pascale realized on Sunday that her four-year-old son, Artie, had developed a fever, she started to panic. She thought about all of the kids he had come in contact with over the past several weeks, at birthday parties, at school, on the playground. In the days before, he was just coughing. It hadn’t seemed like a big deal.
The next morning, Pascale, who lives in Austin, drove to her pediatrician and asked for a test for COVID-19, the disease caused by the novel coronavirus. Artie had recently been exposed to a family friend who had evacuated from China’s Hubei province. She worried that her son might have contracted the virus. Like many sick people across the country, Artie was turned down.
Pascale’s family friend had been working as an English teacher in the Hubei province in China. In January, the friend was traveling in Thailand when the coronavirus became a serious issue in Wuhan—a city in Hubei and the center of the coronavirus outbreak. The friend was working in a part of the province less affected than Wuhan, but out of caution, he quickly returned to Hubei to get his things, then left for Austin, where he’s from.
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Once he arrived in Austin, the friend quarantined himself for two weeks to make sure symptoms did not develop. Then, on February 11, he went over to Pascale’s house to hang out and eat dinner. The friend wasn’t showing symptoms, but just to be safe, he kept his distance and washed his own dish. (Texas Monthly was unable to reach the friend via Facebook.)
It wasn’t until February 27 that Artie became ill, developing a cough and, later, a fever. Pascale said she started “putting all the puzzle pieces together.” (According to the CDC, symptoms of COVID-19 start between two and fourteen days after exposure, but the virus can reportedly persist on surfaces for hours or even days.)
Though President Trump on Friday promised to make millions of tests available, patients across the country are running into a confusing, and often stringent, patchwork of rules about who can get tested. And until recently, Texas officials had provided only cursory information on the number of tests conducted, which has led to widespread confusion over the scope of the pandemic. Finally, on Friday, Governor Greg Abbott announced that only 220 people—in a state of 28 million—have been tested, with 39 testing positive for COVID-19. By contrast, South Korea is testing 10,000 people a day. Abbott also said the state’s public health labs are now capable of handling 270 tests per day and said the capacity should be in the thousands soon.
Pascale said Artie’s pediatrician explained that Texas’s criteria for getting tested for COVID-19 didn’t include her son. “They’re like, ‘He doesn’t qualify for a test,’ ” Pascale said. “ ‘He doesn’t meet the criteria.’ ”
According to the latest guidelines published by the Texas Department of State Health Services, to get tested for COVID-19, you must meet certain criteria—for example, having had close contact with a laboratory-confirmed COVID-19 patient or having traveled from an affected area with sustained community transmission (which could include in Texas)—or have risk factors such as a chronic medical condition or more severe symptoms. Testing at one of the ten state labs is free.
“If a doctor sees someone who doesn’t strictly meet [the criteria] but thinks for some reason that they have COVID-19, we’d still like them to contact [local health districts] to discuss the case and determine whether testing is appropriate,” said Chris Van Deusen, the director of media relations for the Texas Department of State Health Services, in an email Friday.
Pascale has asked her pediatrician for a test every day since Monday. She also kept her son home during that time. On Tuesday, her pediatrician wrote down “coronavirus testing” on a script pad, she says, and told her husband to call the CDC.
“She said, ‘Call the CDC.’ He called the CDC. CDC said, ‘Call the state.’ The state said, ‘Call Austin Health.’ Austin Health said, ‘Call the pediatrician,’ ” Pascale said. “And so he got sent in a total circle, with zero answers, and no one who was actually going to conduct the test.”
But it’s not clear that primary care providers or other local health officials are acting on the messages, sometimes conflicting, coming from top state and federal authorities. Sarah, an Austin-area high school teacher whose name has been changed to protect her privacy, said she called Travis County Health & Human Services on Wednesday, when she developed a fever, sore throat, and light cough. When she asked how she could get tested for COVID-19, the health worker began googling private clinics. “She had been given no direction on what to do,” Sarah said.
On Friday, Sarah went to her primary care provider wearing a mask, even though she was hesitant about potentially infecting people at the clinic. Though she tested negative for the flu, her doctor told her that she didn’t have COVID-19, without explaining why, and recommended that she go back to work once her symptoms went away.
“Honestly, the doctor seemed really stressed out,” Sarah said, “and didn’t know what to do.”
Sarah plans on quarantining herself for the next two weeks, even if that means not going to work after spring break. “I’m taking this really seriously,” she said. “There are a lot of elderly teachers at my school, and I don’t want to put them at risk.”
If a person does not meet the criteria for testing at a state lab, their other option is to do a private test in a commercial or hospital lab.
“We know there will soon be much more testing capacity through private channels than the public health system,” Van Deusen said. “The reasoning behind the criteria is to focus public health testing on the patients who are sickest and/or on testing that will tell us the most about what’s happening with the virus in Texas and that will inform our public health actions.”
On Friday, Abbott declared a statewide emergency and pledged that Texas would soon dramatically ramp up testing. He said a drive-through clinic would open in San Antonio on Friday, followed by similar facilities in Austin, Dallas, and Houston over the next few weeks. Later in the day, President Donald Trump declared a national emergency over the coronavirus pandemic, opening up access to $50 billion in funding, loosening restrictions on doctors and hospitals, and pledging that millions of test kits would soon be available, though the timeline was unclear.
Jane Bolin, the director of the Texas A&M Southwest Rural Health Research Center, said the national emergency declaration puts a focus on providing tests for more individuals, which is going to translate to more tests available in states, individual hospitals, and emergency rooms.
“I understand that federal officials are working to ease the restrictions that hindered rapid production of test kits and vaccines,” Bolin said. “The restrictions have been taken off in order to allow massive ramp-up of production capacity and also for the federal government to begin flowing dollars into the states so that they can even buy those and purchase those and get them out to hospitals.”
Still, the paucity of testing so far almost certainly means that many patients with COVID-19 are unable to confirm whether they have the virus, which increases the odds that they are infecting others. Sarah, who studied public health in college, said she is appalled by how slowly Trump and the federal government have acted. “This violates everything that you’re supposed to do in terms of a gold-standard approach to a pandemic,” she said. “The constant covering-up and not owning up to the fact that [Trump] did a bad job, it’s really sad and disappointing.”
She is thinking about driving to San Antonio as soon as possible to get tested at the drive-through clinic, suggesting that such facilities could be overwhelmed if a lot of worried people are doing the same.
Pascale still isn’t sure whether her son has coronavirus. Artie no longer has a fever, and his coughing has subsided. But on Tuesday, he developed a rash, and the next day he tested positive for pneumonia, which in severe cases can be caused by a coronavirus infection.
She said that even though her son seems to be getting better, she wants to be able to tell others if he could have potentially spread the disease.
“I want to get him tested for peace of mind,” Pascale said. “I can pass the word along to his schoolmates or the places where we’ve gone that they really need to clean their places up and let people know.”