A little over a week ago — on March 8 — Andi Schuster and her fiance returned to Minneapolis from three days in Boston, where a cluster of COVID-19 cases has been identified.
Soon after their return, Schuster said she and her fiance started coming down with symptoms consistent with COVID-19: fevers and respiratory illness. Schuster was seen immediately by providers because of her symptoms and travel history.
She also has asthma — but said she was never tested for COVID-19.
“The doctor and [physician’s assistant] and infectious disease [specialist] all argued over whether or not I should be tested,” she wrote in an email Monday. “I had been traveling and in a city with a lot of cases, but since I hadn’t for sure been around anyone with a diagnosis, they decided not to test me.”
Instead, Schuster said, she was tested for the flu. That test came back negative, and she’s been living in a self-imposed quarantine ever since.
Meanwhile, Schuster’s fiance, who had the same travel history and symptoms, went to a different clinic — and was tested immediately for the coronavirus. His test came back negative.
The couple’s experience underscores broad variation in the ways health care professionals are responding to requests for testing — which has created confusion among patients.
It highlights an issue of grave concern for providers and state health officials: That a shortage of COVID-19 tests may mean they’re missing cases among people with mild symptoms — who could be spreading the virus without even realizing it.
In a letter to the Trump administration last week, Gov. Tim Walz wrote that the ability to test widely is critical to the state’s response to COVID-19.
“We have been forced to ration the number of tests performed at our public health lab,” Walz wrote. “I call upon you to help ensure we appropriately prevent and mitigate the spread of the COVID-19 pandemic.”
Typically, providers take samples from potential COVID-19 patients and send them to the state Health Department for testing. Providers are using guidance from the Centers for Disease Control and Prevention in deciding who to test, but have discretion on who meets that criteria.
Walz said the state needs a minimum of 15,000 tests per month. So far, Minnesota has tested only 1,900 people. As of Monday, the state had 54 confirmed cases of COVID-19.
In a call with reporters Monday, state health officials said due to the shortage, testing remains limited to people who are in hospitals and health care workers — because a positive test in either of those groups of people would have the most serious implications on community health.
Reports abound from people saying they or a loved one have been sick with symptoms similar to those associated with COVID-19, and have been denied testing for myriad reasons.
Some of those patients told MPR News that even though they had been in contact with people who have traveled outside the country, their doctors have told them they couldn’t be tested because they hadn’t traveled outside the country themselves.
Others said doctors told them they couldn’t be tested because their symptoms weren’t severe enough — for instance, they don’t have a very high fever or a dry cough — or that they don’t have a history of underlying health concerns like congestive heart failure or asthma.
In some cases, patients who spoke with MPR News have been health care professionals who come in close contact with patients, while also having symptoms themselves.
Victoria Granger, 24, who lives in Minneapolis, said she came down with respiratory symptoms shortly after returning from a trip to Morocco, Spain and France last week. When she called a University of Minnesota screening center, she said she was told she didn’t qualify for testing.
She’s concerned about limited access to testing.
“It is possible that I do have the virus, considering my travel history and symptoms, but without the test, I am not being accounted for,” said Granger. “I fear that this outbreak is so much bigger than is being reported because people like me are not being tested.”
Screening on the front lines
In Rochester, Minn., Dr. Jay Myers, an emergency room physician at Olmsted Medical Center, is on the front lines of triaging patients who may have the novel coronavirus.
He said his staff is screening every patient who walks through the door for symptoms of upper respiratory illness.That can be especially tricky at this time of year, with colds and influenza circulating throughout in the population as well.
From there, Myers makes a series of calculations. He tests many patients with upper respiratory symptoms first for the flu. If that test is positive, the patient likely doesn’t also have COVID-19.
But if a patient’s flu test is negative, Myers may then swab the patient’s nose and throat on site to send to the state to be tested for COVID-19. The turnaround time for results is between 24 and 48 hours.
Myers sends patients with mild symptoms to a drive-through testing site hosted by Mayo Clinic in Rochester. That, he said, is in the interest of public health.
“We’re trying to keep this testing out of the ER and out of waiting rooms as much as possible,” Myers said. “If we have all these other patients with minimal symptoms here just to be tested, now we are bringing all of them into an already congested health care system, and that’s a recipe for disaster.”
Initially, Myers said that when COVID-19 first began to show up in the population, health care professionals were asking patients about their travel history — but they’re less concerned about travel and more concerned about symptoms because they may miss cases as a result.
Until recently, Myers said the nation was “kind of one step behind with our questioning.”
Mayo Clinic developing its own tests
As state and public health officials criticize the Trump administration for being too slow to respond to the pandemic — and for not releasing enough tests to states, Rochester’s Mayo Clinic has developed its own COVID-19 test.
Since late last week, Mayo has performed at least 500 tests — and found some positive cases — according to Matthew Binnicker, Mayo Clinic’s director of clinical virology.
That test is available to Mayo patients — and, increasingly, to non-Mayo clients served by Mayo Clinic Laboratories. The clinic’s current capacity is between 200 and 300 tests a day, though Binnicker said Mayo hopes to ramp up to be able to test 1,000 samples daily sometime this week.
The Mayo test is only effective on people who are experiencing coronavirus-like symptoms.
But Mayo is developing a test that would determine if a patient has developed an antibody response to the infection — indicating that the patient had been exposed to the virus, but hadn’t gotten seriously sick.
“This approach is important because we’ll need to have a method available that can determine how many people in the population have been exposed to this virus,” Binnicker said in an email.
“Identification of immune individuals may play a role for treatment,” he added. “Use of plasma from immune individuals may be used to provide passive immunity to ill patients and potentially to at-risk health care workers.”
Next steps unclear
In Minneapolis, Monica Rauchwater isn’t sure what to do next. She’s a healthy, 33-year-old, whose 94-year-old relative has been hospitalized with a confirmed case of COVID-19.
She said the last time she saw her relative was on March 4, when she picked him up to take him to breakfast. That was fewer than 14 days before he was diagnosed with COVID-19. While health officials are still learning about the nature of the disease, the federal CDC says symptoms usually appear between two and 14 days after a person is infected — which means that Rauchwater could have been directly exposed to the disease.
But she was surprised when she didn’t hear from anyone at the state Health Department, which she thought would be tracking down anyone her great uncle may have come in contact with.
So, Rauchwater called her doctor to find out what to do next. She was passed on to the Minnesota Department of Health’s hotline, where someone took her name and information.
“I got no instructions,” Rauchwater said. The person on the other side of the line told her to stay home — but nothing else. “Absolutely nothing.”
Rauchwater has other relatives who had contact with the hospitalized patient, but she said not all of them are staying home — because the Health Department hasn’t told them to.
“If no one is telling you what to do, you just go about your business,” Rauchwater said. “I get that tests are limited, and I get that our understanding of asymptomatic transmission is incomplete. But this is why it happens. This is why we have a pandemic.”