SALT LAKE CITY — Tiffany Mathison is terrified that everyone in her family has contracted the new coronavirus, but until Monday night, she was afraid she might never know for sure.
That’s because despite the fact that her family has exposure and symptoms, they were denied testing multiple times — a reality that, according to the Utah State Health Department’s epidemiologist, is one that may persist for the foreseeable future.
Mathison’s husband is an airline pilot who began experiencing symptoms — including a mild fever, dry cough and shortness of breath — about 11 days ago. Because he flies to places like Seattle and San Francisco where COVID-19 outbreaks are much worse, he felt like he should call in sick to work and get tested.
He called and talked to a doctor about his situation and symptoms but was told that because he hadn’t come in contact with a confirmed case or traveled outside the country, he needed to just monitor his symptoms and stay home.
“On Friday, my son woke up with a scratchy throat,” she said. “But I had one too, and I thought maybe it was allergies.”
Her 12-year-old son called her around lunchtime and said he felt like he had a fever, and she immediately went to the school and picked him up. They went to an urgent care, where they said he had a temperature of 103. After explaining their family situation, Mathison said her son was denied testing.
“My son has been super sick all weekend, and then last night, I started having this cough and fever,” she said. “I thought, ‘This is crazy. This morning (Monday), I called the COVID hotline ... and went over our symptoms. They said, ‘One of you needs to get tested.’ I said, ‘Can’t we all get tested?’ And she said, ‘There aren’t a whole lot of tests, so if you can just send one of you, that would be best.’ We sent my husband.”
They told the Mathisons to go to Alta View Hospital’s emergency room, but to call from the parking lot as they were setting up a mobile testing facility Monday morning. Mathison said her husband waited on hold for 2 1⁄2 hours before he talked to someone, and he was again denied testing because he wasn’t running a fever at that moment.
“He’s been running a fever on and off, and he’s been sick for 11 days,” she said. “It’s so frustrating to me because I’m listening to this press conference where they’re saying, ‘We have 19 cases in (Salt Lake County)’ and I’m saying, ‘No, no, no, no, you have more than that. People are sick, but they have been denied testing.”
Finally, Monday night, after a four-hour wait and another denial, a doctor agreed to let him talk to a doctor. Mathison said the doctor agreed to test him because he was a pilot and had traveled to high outbreak areas. They expect to know for sure in 24 hours.
A few hours earlier, the state’s epidemiologist Dr. Angela Dunn said more than 700 people had been tested in Utah, with 41 positive tests. But those numbers may not now — or ever — reflect the actual number of people who contract the virus because of two things: many people never exhibit symptoms and an inability to test everyone who suspects they have the virus.
Mathison said her family has tried to abide by the self-quarantine rules, and she even asked her son’s school to let his teachers know that he might have COVID-19. That, Dunn said, is what anyone with symptoms should do.
The state’s epidemiologist also outlined some of the issues with testing everyone who suspects they have contracted the virus, and acknowledged that some may never be tested.
“We are still limited by the supplies needed to test, and that comes from our federal partners,” said Dunn. “Each specimen collected requires a provider to be full PPE (personal protective equipment) and so we need to conserve our PPE for providers who need to care for patients with severe disease. We need to be very judicious in who we test.”
While private health care providers like ARUP and Intermountain Healthcare are either able to or soon will be able to test patients, the issue with personal protective equipment and the reagent (chemical) needed to process the tests will be an issue for the foreseeable future.
“The test kits are increasing in their capacity, but the reagents are part of that test kit,” she said. “Currently we have the ability to test everyone who needs it in Utah. ... Our limitations are going to be PPE and reagent.”
Dunn told reporters Saturday, it didn’t look like there were solutions to the limited amount of reagent or protective gear, but that they were trying to come up with ways to work around or solve those issues as best they could.
On Monday, Dunn said the reality is that not everyone needs to be tested.
“(Testing) is not going to change your care,” Dunn said. “There is no current specific treatment, meaning it’s all symptom management.”
The best course of action may be doing just what the Mathisons have done — act like you have it, even if you don’t know for sure.
“If you have symptoms that are mild and can be managed at home, and you don’t need excess care, just self-isolate at home,” Dunn said. “Not everybody is going to be get tested and we want to ensure that those who need a high level of care are going to be able to get it.”
Some of what’s confusing to people like Mathison is the messages they receive from world and national leaders. Last week President Donald Trump repeatedly said anyone who wants to get tested can get tested. On Monday, he said private companies either have created or were creating more tests and that it would assist local health departments in testing to have more options.
Also on Monday, the World Health Organization’s director general Dr. Tedros Adhanom Ghebreyesus said testing and isolation, including social distancing, are the “backbone of the response.”
Tedros praised the increases in governmental calls like Trump’s offered in Monday’s press conference, which asked people to limit gatherings to less than 10 people, as well as measures like those instituted by Summit and Salt Lake counties, closing dine-in, bars and event gatherings. But he reiterated that without testing, a community cannot win the battle to eradicate a virus like COVID-19.
“As I keep saying, all countries must take a comprehensive approach,” he said. “But the most effective way to prevent infections and save lives is breaking the chains of transmission. And to do that, you must test and isolate. You cannot fight a fire blindfolded. And we cannot stop this pandemic if we don’t know who is infected.”
He continued, “We have a simple message for all countries: Test, test, test. Test every suspected case.”
But the country’s top infectious disease expert, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told lawmakers in a hearing about coronavirus test kids that the U.S. does not have the system it needs to deal with the outbreak.
“The system is not really geared to what we need right now, what you are asking for,” he said, when asked who was in charge of making sure anyone who needs to get tested can get tested. “That is a failing. Let’s admit it.”
He said that the idea of anyone getting the test who wants or needs it as is happening in countries like South Korea, is not a capability of the U.S. system right now.
“Do I think it should be?” he asked himself. “Yes.”
That leaves local officials trying to find the best way to manage Utah’s outbreak, and that’s why Dunn’s suggestion is that people practice good hygiene, social distancing and self-quarantine if they have any symptoms. Getting a test, she said, will not change treatment for the vast majority of people.
Of those 41 positive tests, she said only a few have required hospitalization.
Maybe the best example of why testing may not be the magic bullet that it seems to be came from Utah Jazz all-star Donovan Mitchell. He tested positive last Thursday, the day after his teammate Rudy Gobert was tested after coming down with flu-like symptoms. Gobert’s positive test came just before the Jazz were to play in Oklahoma City, and it led to a suspension of the NBA season, followed by almost all major, minor and college athletic leagues.
“If it wasn’t public knowledge that I was sick, you wouldn’t know it,” Mitchell said. “And that’s the scariest part of this virus.”