In January, college freshman Kate Austin was on a dream trip teaching English in Tokyo.
“It was one of the most fulfilling experiences of my life,” she said.
But about two weeks in, things went sideways when Austin developed some now-familiar symptoms: a cough, body aches, fever and intense fatigue.
She initially assumed she had strep throat. News coming out of China about a novel virus was far from her mind.
But days into her illness, Austin crashed.
“Then there was this three-day period where I could not leave my bed,” she said, and made the decision to go see a doctor.
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There, she was diagnosed with an unspecified upper respiratory virus. She was sick enough that the doctor — and her parents — encouraged her to go back to Minnesota.
Austin’s arrival back in the United States marked the start of a chain reaction. In the coming weeks, Austin’s parents and friends would get sick — with one of them ultimately being diagnosed with COVID-19.
Her story underscores just how much understanding of coronavirus has changed in a short period of time, and suggests that the virus has been in Minnesota weeks, if not months, longer than tests initially detected.
Still not better after being home for a few days, Austin sought medical help on Jan. 28 over the phone, and was told by providers to head to the emergency room.
At first, Austin said ER doctors seemed poised to test her for COVID-19.
But guidance from the Centers for Disease Control and Prevention stopped that. Doctors told Austin that they couldn't test her because she had not traveled to China, where most of the cases were occurring in January.
Minnesota Health Department infectious disease director Kris Ehresmann said tests were limited at the time, so practitioners had to be discerning about who they tested. She said the situation also underscores how rapidly the state and national response has changed in less than three months.
“You can look back and say, ‘Oh yeah, that makes total sense.’ What we know now, she should have been tested,” said Ehresmann. “But at the time, the health care providers who evaluated her were absolutely following the guidance that had been put out by CDC.”
Looking back, Austin said her doctors’ advice prompted her to make some decisions that seemed reasonable at the time.
“They said, 'We promise you don’t have coronavirus, you’re good enough and healthy enough to go see your friends,’” Austin said. “So, I proceeded to see three of my friends who proceeded to get immediately sick.”
A positive result
Those friends were just the first in her circle to fall ill.
In February, her parents, David and Sue Austin, were each diagnosed with pneumonia, while others connected to the family developed COVID-19-like symptoms.
David Austin spent weeks at home, sick.
“From the time a tickle forms in my throat to ‘Boy, I think I’ve got pneumonia’ was three days,” he said, describing the speedy onset of his illness. “It reaches out and grabs you good and hard, right away.”
While David Austin steadily got better, Sue Austin’s recovery was up and down.
On March 11, the day Minnesota confirmed just its fifth case of COVID-19, Sue Austin again sought medical care.
"The health care provider said, 'Wow. I think you might have corona[virus],’” she said.
Her timing was fortuitous. She was able to secure a diagnostic test just days before the state tightened guidance around who could get one.
Three days later, she was contacted by the state Health Department.
“We got notified from the Minnesota Department of Health: 'Yes, Sue is positive,” she said.
Sue Austin said the state Health Department quizzed her about interactions in the days before her test result.
But what was baffling to her was that the state was only concerned with contacts she’d made after March 2 — even though she may have exposed others in February when she first became sick.
“I had had a several-hour-long brunch with two really close friends, but because it was the day before, March 1, they were not considered.” Sue Austin said.
And the Health Department seemed unconcerned that her daughter may have carried the virus back from Japan in January.
Ehresmann said that when public health experts investigate cases, they are looking for who could be currently infectious.
‘All this goofiness’
Meanwhile, those in close contact with Sue Austin — including David and Kate, who presumed they’d already had the virus — went into quarantine as advised by the Health Department.
“I think the Austins’ story is a microcosm for all this goofiness,” said one of Sue Austin’s friends, who was in isolation after being in close contact with her in the days before her diagnosis.
The friend didn’t want to be named for fear she may have transmitted the virus unknowingly at work.
She never developed symptoms and couldn't get tested. But as someone who has been living with the uncertainty of whether she was an asymptomatic carrier, she's frustrated with the state's testing strategy because she said it stands to miss a lot of potential cases.
"There should be some system of going back through the people who were identified, at least as potential carriers, to at least rule in or rule out whether we had COVID[-19],” said the friend.
David Austin and his daughter Kate live with that same uncertainty. They don’t know if they had COVID-19, but they strongly suspect it.
The family's story suggests coronavirus was in Minnesota long before it was detected by testing, said Ehresmann.
A growing body of evidence suggests the virus was spreading in the United States in early February.
"It's very likely that we had more virus circulating in the community than we were aware of,” Ehresmann said.
David Austin wants to donate plasma at Mayo Clinic for a potential treatment for COVID-19, but he has been rejected because he never got a positive diagnostic test. He hopes to eventually get an antibody test to settle the question.
A statewide strategy announced earlier this month to test more people isn't at full capacity yet. Public officials see testing as a key to determining when and how to reopen the economy, and to identify people who may be candidates for plasma donation.
Until then, David Austin is left to wonder whether his family exposed others to COVID-19 and that's been hard, he said.
"We have to figure out how to make sure this doesn't happen again as a society — because it's just too painful,” he said.