In recent months, Dr. Denise Hooks-Anderson has grown accustomed to saying “no.”
That’s the answer she always gives when her patients in Richmond Heights, Mo., ask whether she can test them for the coronavirus.
“At our practice, we’ve never been able to do testing,” said Dr. Hooks-Anderson, a family medicine doctor whose patients are largely African-American, a group disproportionately burdened by the coronavirus. In her office and many others, there simply is not enough protective equipment, like masks and gloves, to keep staff members safe while they collect potentially infectious samples.
Dr. Hooks-Anderson worries about her patients, whom she encourages to look elsewhere for a test if they suspect an infection. Still, the dangers are too great for her practice to become directly involved, she said: “Are we willing to take that risk? To essentially take out the entire staff if someone were to get infected? In the midst of a pandemic, that becomes a big issue.”
Back in March, after President Trump declared the coronavirus a national emergency, doctors felt ill-equipped to diagnose their patients or counsel them on treatment and prevention. Three months later, testing numbers are up. But primary care physicians — the doctors that many turn to first when their health declines — are not always equipped to check their patients for the pathogen. And community testing sites have not been evenly distributed, snubbing some populations most vulnerable to the ill effects of the virus. Many Americans hoping to get tested are not even sure where to start looking.
Physicians like Dr. Hooks-Anderson are concerned that these issues will not be any closer to being resolved in the coming weeks and months, even while demand increases as states reopen, employees resume in-person work and parents seek care and schooling for their children. The situation may grow especially dire by autumn, when health officials expect to see a rise in infections, above and beyond the ongoing outbreaks that will likely last through the summer.
“Things are going to get ugly in the fall,” said Dr. Gabriela Maradiaga Panayotti, a pediatrician at Duke University Medical Center in Durham, N. C. “I don’t know if anybody knows how that’s going to be handled.”
Since the virus made landfall in the United States, more than 30 million diagnostic tests have been administered to patients across the country, according to the Covid Tracking Project. These tests, which hunt for bits of coronavirus genetic material, can help a person figure out if they are currently infected, even in the absence of symptoms. (Antibody tests, on the other hand, indicate whether someone had the virus in the past.)
But testing rates still fall short of where experts say they should be. And because the coronavirus can infect and spread from individuals who don’t show signs of illness, the strength of its grip on the nation remains unknown.
Concerns surrounding the nation’s stock of coronavirus tests aren’t new. Sputtering supply chains have been an ongoing problem, caused by delays in F.D.A. approvals and flaws in an early C.D.C. test. The result was a lost month during which the virus spread undetected. Even after independent manufacturers were finally allowed into the fray, they struggled to keep pace.
In the months since, the government has granted emergency use authorization to dozens of diagnostic tests, which are now widely available in many locations, including community health centers, urgent care centers and pharmacies like CVS and Walgreens. But “we’re still catching up,” said Dr. Alexander McAdam, director of the Infectious Diseases Diagnostic Laboratory at Boston Children’s Hospital. That means a significant proportion of Americans who want a test still cannot get one.
Eligibility and convenience vary widely between sites, even within neighborhoods. Some sites have only enough capacity to swab people with symptoms and who are at highest risk of falling ill; others won’t swab patients before they have been screened by a doctor. Logistical hiccups at the laboratories that process the samples can also keep test results out of patients’ hands for days.
A few of these hurdles could be cleared by ramping up production of point-of-care tests that do not need to be sent away to a laboratory. Patients could be tested and counseled by the same provider, perhaps without even leaving the room. Such tests could even be distributed to common points of congregation, including schools and workplaces. “A point-of-care test would be a game changer,” Dr. Maradiaga Panayotti said.
But only a small handful of the diagnostic tests that have been given the F.D.A. green light meet point-of-care criteria, and their manufacturers already strain to churn them out at maximum speed.
Even health networks that have developed their own coronavirus tests, like Nebraska Medicine, cannot offer assessments to all of their own patients, said Dr. Nada Fadul, who directs the network’s H.I.V. clinic in Omaha.
“Many researchers are advocating for testing contacts” of people with confirmed infections, Dr. Fadul said. “We’re still at the point where we’re just barely able to test the symptomatic patients.”
Frequently Asked Questions and Advice
Updated June 24, 2020
What’s the best material for a mask?
Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.
Is it harder to exercise while wearing a mask?
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
I’ve heard about a treatment called dexamethasone. Does it work?
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
What is pandemic paid leave?
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
Does asymptomatic transmission of Covid-19 happen?
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
What’s the risk of catching coronavirus from a surface?
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
How does blood type influence coronavirus?
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
How many people have lost their jobs due to coronavirus in the U.S.?
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
What are the symptoms of coronavirus?
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
How can I protect myself while flying?
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
What should I do if I feel sick?
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
Tests are also especially scarce among primary care physicians. Many smaller doctors’ offices are not set up to grapple with the logistics of collecting samples of a highly contagious and dangerous pathogen.
“We don’t have the luxury of space to do separate sick areas or swabbing areas,” said Dr. Hai Cao, a pediatrician at South Slope Pediatrics in Brooklyn. “It would be nice if we did. But in our limited space, I don’t see that as being a prudent move.”
To complicate matters further, not all Americans have a doctor to consult, said Dr. Utibe Essien, a physician and health services researcher at the University of Pittsburgh’s School of Medicine. Coronavirus testing is covered under insurance in the United States, but about 28 million people in the country remain uninsured. The federal government has set aside money to foot the bill for these patients, but some could still be saddled with unanticipated costs. Fear of an enormous medical bill can be enough to drive someone away from a testing site altogether, said Dr. Maradiaga Panayotti.
On the whole, testing still is not reaching some communities that need it most.
Dr. Brittani James, a family medicine doctor at Mile Square Health Center in Chicago, said the testing center in the parking lot outside her practice is not even close to testing at capacity. In her community, where many residents are African-American, rates of employment and housing security are low; people often cannot afford the car or bus fare that would ferry them to a testing site. Some of Dr. James’s patients, disillusioned by decades of institutional racism, are also hesitant to visit testing sites with ties to the government, she said.
The barriers to getting a test are so high that “we can’t even get to the point of, ‘Are there enough tests?’” Dr. James said.
Existing disparities may only be exacerbated by the approach of the fall season, when other respiratory illnesses that share symptoms with Covid-19, such as the flu, reappear, and schools invite students back to campus.
While coronavirus case numbers continue to balloon, many American cities are reopening — among them, St. Louis, where Dr. Hooks-Anderson is dreading what’s to come.
“I think it’s only going to get worse,” she said. “I would love to be wrong.”