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Coronavirus in N.Y.: Desperate for a Test, They Couldn’t Get One Coronavirus in N.Y.: Desperate for a Test, They Couldn’t Get One
(3 days later)
One woman in Harlem who wanted to be tested was told by health care workers not to worry about her coronavirus-like symptoms. In Brooklyn, a woman had to wait to get tested until her mother tested positive for the virus. One doctor at a hospital network has turned away patients who probably had the coronavirus because they did not meet the current testing criteria.One woman in Harlem who wanted to be tested was told by health care workers not to worry about her coronavirus-like symptoms. In Brooklyn, a woman had to wait to get tested until her mother tested positive for the virus. One doctor at a hospital network has turned away patients who probably had the coronavirus because they did not meet the current testing criteria.
President Trump has proclaimed that anyone who wants to get a coronavirus test can. Gov. Andrew M. Cuomo has declared that the state should be testing 1,000 people a day.President Trump has proclaimed that anyone who wants to get a coronavirus test can. Gov. Andrew M. Cuomo has declared that the state should be testing 1,000 people a day.
In New York, at least, the reality seems far more complicated.In New York, at least, the reality seems far more complicated.
Numerous interviews with doctors, hospital administrators and health officials this week revealed a confused and often troubled testing system in New York that has left many people who believe that they have been exposed to the coronavirus deeply frustrated.Numerous interviews with doctors, hospital administrators and health officials this week revealed a confused and often troubled testing system in New York that has left many people who believe that they have been exposed to the coronavirus deeply frustrated.
The accounts suggest that the state and local governments have at times struggled to roll out one of the most effective means for responding to the epidemic: widespread testing.The accounts suggest that the state and local governments have at times struggled to roll out one of the most effective means for responding to the epidemic: widespread testing.
Fewer than 2,000 people in total have been tested since New York was approved to test in-state in late February, even with an escalation in testing in the last several days, according to officials.Fewer than 2,000 people in total have been tested since New York was approved to test in-state in late February, even with an escalation in testing in the last several days, according to officials.
For now it appears that a large majority of New Yorkers who end up having the coronavirus are likely to not know it during the duration of their illness because testing is so limited.For now it appears that a large majority of New Yorkers who end up having the coronavirus are likely to not know it during the duration of their illness because testing is so limited.
And without much ability to detect cases or track their spread, it is difficult to know what mitigation strategies are working, or when it is time to try more aggressive measures.And without much ability to detect cases or track their spread, it is difficult to know what mitigation strategies are working, or when it is time to try more aggressive measures.
On Wednesday, Mr. Cuomo acknowledged that the testing shortage was having significant impact on the state’s effort to curb the outbreak. He said he had asked 28 private labs in the state to “get up, get running and start moving forward with testing” in order to “greatly increase our testing capacity.”On Wednesday, Mr. Cuomo acknowledged that the testing shortage was having significant impact on the state’s effort to curb the outbreak. He said he had asked 28 private labs in the state to “get up, get running and start moving forward with testing” in order to “greatly increase our testing capacity.”
Administration officials said the federal government had authorized New York’s request to allow the labs to perform testing. The labs have begun to prepare, officials said, and final approval is expected in the coming days after the state files the necessary paperwork.Administration officials said the federal government had authorized New York’s request to allow the labs to perform testing. The labs have begun to prepare, officials said, and final approval is expected in the coming days after the state files the necessary paperwork.
“We can’t just wait anymore,” Mr. Cuomo said. “It’s compounding the problem.”“We can’t just wait anymore,” Mr. Cuomo said. “It’s compounding the problem.”
Mr. Cuomo had said last week that he wanted to test 1,000 people per day within a week.Mr. Cuomo had said last week that he wanted to test 1,000 people per day within a week.
Other states have experienced difficulties getting people tested quickly, but the issue appears to be especially pronounced in New York, which now has one of the largest clusters of coronavirus cases in the country.Other states have experienced difficulties getting people tested quickly, but the issue appears to be especially pronounced in New York, which now has one of the largest clusters of coronavirus cases in the country.
The frustration is compounded by a confusing morass of local, state and federal guidelines about when testing is appropriate — meant to help ration the available tests — and by differing interpretations of those rules on the part of hospitals, clinics, medical practices and individual doctors.The frustration is compounded by a confusing morass of local, state and federal guidelines about when testing is appropriate — meant to help ration the available tests — and by differing interpretations of those rules on the part of hospitals, clinics, medical practices and individual doctors.
Not everyone who wants to be tested needs to be tested if they aren’t exhibiting symptoms related to the illness. But for many, it’s an ordeal just finding out what the actual symptoms or guidelines are.Not everyone who wants to be tested needs to be tested if they aren’t exhibiting symptoms related to the illness. But for many, it’s an ordeal just finding out what the actual symptoms or guidelines are.
As a result, people with symptoms or who fear they have been exposed report spending hours on the phone trying to figure out whether they should get tested and which facilities might be able to do the tests.As a result, people with symptoms or who fear they have been exposed report spending hours on the phone trying to figure out whether they should get tested and which facilities might be able to do the tests.
Some just give up.Some just give up.
“People with fever are tested, but not those with only respiratory symptoms,” one emergency room doctor in Brooklyn said. But people with no fever “aren’t being tested,” he added.“People with fever are tested, but not those with only respiratory symptoms,” one emergency room doctor in Brooklyn said. But people with no fever “aren’t being tested,” he added.
“There are just not enough testing supplies, so we’re basically rationing testing supplies,” the doctor said.“There are just not enough testing supplies, so we’re basically rationing testing supplies,” the doctor said.
The message from City Hall has compounded the confusion. Mayor Bill de Blasio has been urging people with symptoms to rush to their health care providers and seek testing.The message from City Hall has compounded the confusion. Mayor Bill de Blasio has been urging people with symptoms to rush to their health care providers and seek testing.
“So, we want to keep telling parents, keep telling school personnel — get tested immediately,” Mayor de Blasio has said. “That is the ballgame. So, we’re continuing to pump out that message.”“So, we want to keep telling parents, keep telling school personnel — get tested immediately,” Mayor de Blasio has said. “That is the ballgame. So, we’re continuing to pump out that message.”
But New Yorkers are often finding that when they seek testing, they are rebuffed by health care providers. Early on, some didn’t fit the C.D.C.’s guidelines, which started out being exceedingly narrow, then expanded.But New Yorkers are often finding that when they seek testing, they are rebuffed by health care providers. Early on, some didn’t fit the C.D.C.’s guidelines, which started out being exceedingly narrow, then expanded.
But at other times the bottleneck has been the city’s own Department of Health, which runs most of the testing in New York City. When doctors have called there to inquire about testing a patient, they have often been instructed not to send a sample to the health department lab for testing, according to interviews with doctors and other hospital employees.But at other times the bottleneck has been the city’s own Department of Health, which runs most of the testing in New York City. When doctors have called there to inquire about testing a patient, they have often been instructed not to send a sample to the health department lab for testing, according to interviews with doctors and other hospital employees.
In New York City, testing is still largely being done manually, by lab workers, limiting the number of tests that a laboratory can perform.In New York City, testing is still largely being done manually, by lab workers, limiting the number of tests that a laboratory can perform.
The city’s public health laboratory is only able right now to test “samples for 60 people” a day, the health commissioner, Dr. Oxiris Barbot, said on Tuesday, adding that she hoped to ramp up to roughly 100 people a day soon.The city’s public health laboratory is only able right now to test “samples for 60 people” a day, the health commissioner, Dr. Oxiris Barbot, said on Tuesday, adding that she hoped to ramp up to roughly 100 people a day soon.
On Long Island, the laboratory division of Northwell Health — which runs 23 hospitals in the state and on Sunday was given F.D.A. approval to start testing — said they had begun a semi-automated process that would expand capacity from the 60 or 70 tests it was doing manually each day at the start of the week.On Long Island, the laboratory division of Northwell Health — which runs 23 hospitals in the state and on Sunday was given F.D.A. approval to start testing — said they had begun a semi-automated process that would expand capacity from the 60 or 70 tests it was doing manually each day at the start of the week.
But those changes aren’t coming fast enough for people who want to be tested now.But those changes aren’t coming fast enough for people who want to be tested now.
Ludmila Janda, a 34-year-old data scientist who lives in Manhattan, said that last week she had developed coronavirus-like symptoms — a cough and 102 degree fever. But at Community Healthcare Network in Harlem, she was told to monitor her symptoms and to visit urgent care if she felt worse.Ludmila Janda, a 34-year-old data scientist who lives in Manhattan, said that last week she had developed coronavirus-like symptoms — a cough and 102 degree fever. But at Community Healthcare Network in Harlem, she was told to monitor her symptoms and to visit urgent care if she felt worse.
Ms. Janda said she asked the nurse if she should get tested for the coronavirus and was told no. Even as her symptoms began to alleviate, Ms. Janda said she was worried about being contagious and called the health center again over the weekend to see if she could get tested.Ms. Janda said she asked the nurse if she should get tested for the coronavirus and was told no. Even as her symptoms began to alleviate, Ms. Janda said she was worried about being contagious and called the health center again over the weekend to see if she could get tested.
“Every time I tried to reach a medical doctor I was told not to worry about it,” she said. “It seems, as a country, that we are being misinformed about how many people are being tested and how many may have the disease.”“Every time I tried to reach a medical doctor I was told not to worry about it,” she said. “It seems, as a country, that we are being misinformed about how many people are being tested and how many may have the disease.”
Updated June 5, 2020 Updated June 12, 2020
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.
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.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.
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.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.
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.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.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
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.
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.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.
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.)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.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
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.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.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
Northwell said they will only test the very sick and the people most vulnerable to complications. The rest they’ll send home: Patients who want to be tested are turned down every day.Northwell said they will only test the very sick and the people most vulnerable to complications. The rest they’ll send home: Patients who want to be tested are turned down every day.
When turning people away, Dr. John D’Angelo, who oversees Northwell’s emergency departments and urgent care centers, said that doctors try to explain the reasons to patients who are upset.When turning people away, Dr. John D’Angelo, who oversees Northwell’s emergency departments and urgent care centers, said that doctors try to explain the reasons to patients who are upset.
“Some folks are more persistent than others, but you just try to be able to have people understand that in the big picture — and to be providing the right care to the sickest and most vulnerable patients — it’s a necessity right now,” he said.“Some folks are more persistent than others, but you just try to be able to have people understand that in the big picture — and to be providing the right care to the sickest and most vulnerable patients — it’s a necessity right now,” he said.
He said that some of the patients turned away probably had the new coronavirus. “The reality is it’s out there in the community,” Dr. D’Angelo said.He said that some of the patients turned away probably had the new coronavirus. “The reality is it’s out there in the community,” Dr. D’Angelo said.
Last week, a husband and wife, who live in Brooklyn and spoke on the condition of anonymity, had to jump through complicated hoops and complex hurdles — from heated phone calls to multiple hospital visits — to be tested for the coronavirus after the wife’s mother tested positive.Last week, a husband and wife, who live in Brooklyn and spoke on the condition of anonymity, had to jump through complicated hoops and complex hurdles — from heated phone calls to multiple hospital visits — to be tested for the coronavirus after the wife’s mother tested positive.
The mother had been on a cruise ship in Egypt in February when she fell ill, showing most of the coronavirus’s symptoms, those similar to pneumonia.The mother had been on a cruise ship in Egypt in February when she fell ill, showing most of the coronavirus’s symptoms, those similar to pneumonia.
Initially, the mother was refused testing because she had not traveled to one of the countries with an outbreak. But after another passenger tested positive, and following a long and highly charged call with a city health official, the daughter said she persuaded the city to have her mother tested on March 4.Initially, the mother was refused testing because she had not traveled to one of the countries with an outbreak. But after another passenger tested positive, and following a long and highly charged call with a city health official, the daughter said she persuaded the city to have her mother tested on March 4.
Two days later, they received a call informing them she had tested positive.Two days later, they received a call informing them she had tested positive.
“On TV basically everybody is saying, ‘We have the kits, come on down. Everyone who wants a test can get a test,’” the husband said. “Even down to the president saying it.” But the reality is different, he said.“On TV basically everybody is saying, ‘We have the kits, come on down. Everyone who wants a test can get a test,’” the husband said. “Even down to the president saying it.” But the reality is different, he said.
The following day, the couple made arrangements with the city to be tested at Mount Sinai Queens. The husband’s test came back negative. The wife is still awaiting results.The following day, the couple made arrangements with the city to be tested at Mount Sinai Queens. The husband’s test came back negative. The wife is still awaiting results.
With so little testing, doctors said, patients suspected of having mild cases of the coronavirus were sent home — as they would have been if they had the flu — and told to isolate themselves.With so little testing, doctors said, patients suspected of having mild cases of the coronavirus were sent home — as they would have been if they had the flu — and told to isolate themselves.
“From a medical standpoint, the testing in the lower-acuity, moderate patient is not going to make much of a difference in our medical management,” Dr. D’Angelo said.“From a medical standpoint, the testing in the lower-acuity, moderate patient is not going to make much of a difference in our medical management,” Dr. D’Angelo said.
But the lack of testing, even if it might not matter much for the treatment of an individual case, has hampered the broader public health campaign. Without a vaccine or proven treatments against the coronavirus, diagnostic testing was to be a key component of the public health response.But the lack of testing, even if it might not matter much for the treatment of an individual case, has hampered the broader public health campaign. Without a vaccine or proven treatments against the coronavirus, diagnostic testing was to be a key component of the public health response.
Now some city officials are beginning to conclude that it’s time to shift to new strategies.Now some city officials are beginning to conclude that it’s time to shift to new strategies.
“Given that we have now crossed into community spread, it’s not a good use of scarce testing resources to test thousands of people who are asymptomatic just because they were in the same room of someone who tested positive,” Mark Levine, a city councilman who heads the City Council’s Committee on Health, said in an interview.“Given that we have now crossed into community spread, it’s not a good use of scarce testing resources to test thousands of people who are asymptomatic just because they were in the same room of someone who tested positive,” Mark Levine, a city councilman who heads the City Council’s Committee on Health, said in an interview.