Fourteen days. That’s how long Heather Campbell, of Davis, waited for an answer on whether her persistent fever, cough and shortness of breath were due to coronavirus.
It started with a dry cough on March 19. Without a diagnosis, her employer wanted her to continue working, so she did, clocking in regularly at a hardware store.
As the week wore on, the illness spread to three of her children and her husband. On the 22nd, she took the Centers for Disease Control and Prevention’s COVID-19 questionnaire, which told her to call the emergency room. The ER said she didn’t qualify for a test.
On the 25th, struggling to breathe, she went to her primary physician, who ruled out flu, strep, bronchitis and pneumonia. The doctor wanted to test her for COVID-19, but again, the ER said no.
Finally, 10 days after she first fell ill, she drove an hour to another clinic and received a test.
“If you feel sick, if you have symptoms, tests should be available to where you can have that peace of mind, and let the people you have been around know,” she said.
Oklahoma, like the rest of the U.S., is scrambling to catch up to the need to test people for COVID-19, the disease caused by the novel coronavirus. The state’s first case was reported March 17, but until this week, only vulnerable populations and critically ill patients were being tested, based on strict guidelines from the U.S. Centers for Disease Control.
Limited supplies was one reason. There have been relatively few sites where people can be tested. And the turnaround for results has been often a week to two weeks as the state ramped up testing and processing capabilities.
The lag has potentially deadly consequences, as people who are unaware they are infected unknowingly spread the disease. Health care workers rely on testing to protect themselves and noninfected patients and determine when to wear personal protective equipment.
Health experts say expanding testing is critical to rein in the virus and limit its spread by identifying people who should self-quarantine. It also provides data useful for determining where resources like medical personnel and equipment should be allocated and when social isolation measures can be relaxed.
Without more testing, social isolation will continue to be necessary to combat the spread.
Oklahoma isn’t ready to test wide swaths of its residents, including those not showing symptoms. But the state has boosted testing of the sick.
Drive-through testing sites have opened in communities across the state. At the sites, medical personnel can conduct a swab test while the patient remains in their car, limiting their contact with others.
The state Wednesday lifted restrictions on who can receive a test. Now, testing is available to any adult with symptoms, which include a fever of 100.4 or above, cough and shortness of breath.
Gov. Kevin Stitt, speaking publicly on Wednesday, urged county health departments to ramp up testing, adding that the state now has the capacity to process 13,000 tests.
“Anybody that has symptoms – test them,” Stitt said. “Do not turn people away that are showing symptoms.”
Oklahoma has significantly increased its available test kits, and had 19,903 on hand as of Friday. These numbers refer to the kits containing swabs that health-care providers use to obtain a sample from a patient’s nose or throat.
That’s enough for now, but it’s hard to predict how many tests the state might need as the virus’ infection rate grows.
“We are still using every avenue to make sure we have enough to meet demand today and in the coming weeks,” said Shelly Zumwalt, chief of innovation for the state Office of Management and Enterprise Services.
Expanding the number of people tested will also improve the state’s data, which will help inform more accurate projections of when the virus is likely to peak in the state, and how many hospital beds and other resources will be needed.
One model from the Institute for Health Metrics and Evaluation in Washington predicts 1,499 total coronavirus deaths in Oklahoma, peaking in late April at 41 to 62 per day. An estimated 5,000 Oklahomans would be hospitalized per day. This model and others change frequently as new data is gathered.
Several national media reports this week singled out Oklahoma as having one of the lowest rates of testing, but that may not be entirely accurate. The state is using private labs for some testing, and those labs have been reporting positive results but not negatives.
On Tuesday, state Health Department Commissioner Gary Cox sent a letter to private labs, instructing them to report both positive and negative tests. If not, they could be fined. Friday’s public report still did not include negative results from those labs.
The state is now working with 10 labs to process COVID-19 tests, including Oklahoma State University.
Another area of focus is getting results back quicker. Currently, labs used by the state are reporting turnaround times that vary from as little as five hours up to several days. Patients have reported waiting much longer – a week or more, in some cases.
Results are still taking about two to eight days, said LaWanna Halstead, vice president of quality at the Oklahoma Hospital Association. But she’s hearing fewer reports of eight-day waits.
A new rapid response test, which can deliver results in 5 to 13 minutes, began shipping to states this week, according to a Washington Post story. But the devices are in high demand and governors are competing to get the devices into their state.
Also, the White House was apparently debating strategy – whether to send the devices to hot spot areas, or deliver to rural and low density areas, to “figure out the spread.”
There’s really no way to know how many coronavirus tests Oklahoma would need at the virus’s peak. The state has just under 4 million residents.
“The reality is, you do want to test people on a large-scale basis so that you understand the prevalence of the disease in the population,” Halstead said. For now, Oklahoma has to focus on the sick population, she added.
She said as the state begins to accomplish adequate testing, Oklahoma will see numbers go way up but will also better understand it’s prevalence.
The approach in South Korea was to quickly scale up testing to be able to assess 10,000 people per day. The country also used cell phone data to make public the locations of people who tested positive, giving other citizens the opportunity to trace their own proximity and, if necessary, self-isolate or get themselves tested, according to a March 17 article in Science Magazine.
As of Friday, South Korea had reported 10,062 cases and 174 deaths; that’s 196 cases and 3 deaths per 1 million residents, according to Worldometer, a reference website run by an international team of developers, researchers and volunteers.
In comparison, the U.S. on Friday reached 273,777 cases and 7,028 deaths, or 827 cases and 21 deaths per 1 million residents.
For Campbell, the Davis mother, her answer came Wednesday: negative for COVID-19. But it was little solace. She’s still sick, and still quarantined.
“I should be happy I am negative but it left me wondering what is wrong with my daughter and me,” she said. She wonders if it’s really a false negative.
Researchers say false negatives are possible but don’t know how common. People who test negative “probably were not infected” at the time they were tested, but could get sick later, according to the Centers for Disease Control.
Test manufacturers try to be as accurate as possible, but false negatives do occur, said J.T. Harrison, vice president of sales and marketing at IMMY, a Norman laboratory working to analyze COVID-19 tests. Even if a patient tests negative, doctors can look for other signs that would indicate COVID-19.
A test that can detect coronavirus antibodies could help communities respond to the pandemic, and the Food and Drug Administration issued its first emergency use authorization for a coronavirus antibodies test this week. IMMY is working on being able to run an antibodies test.
“This is a test that really needs to be out there in the community to show true community spread,” he said.