By Haley Gehring
Junior, English Education, IUPUI
In a country that boasts the promise of life, liberty and the pursuit of happiness, and whose politicians often cite its healthcare system as the best in the world, America leads the world in cases of and deaths by COVID-19, the disease caused by the novel coronavirus. While many factors play into this tragic reality, the lack of equitable and widespread access to quick, accurate testing undeniably accounts for a large portion of the number of American lives the silent killer among us has affected.
The first steps a country takes in any pandemic are the most crucial, and unfortunately America started the battle with two left feet. Starting with faulty tests provided to states by the Center for Disease Control and Prevention (CDC) at the beginning of the outbreak, insufficient federal funding followed and led to a slew of issues: the need for (new) authorized tests, not enough authorized tests, and states and doctors rationing tests, all of which made contact tracing unviable.
Without a federal strategy, guidelines for testing were ultimately up to each state to figure out. For Indiana, where I live, the Indiana State Department of Health initially described those who needed a test as “high-risk Hoosiers,” which included those with severe respiratory illnesses, those over the age of 60, individuals with underlying health issues, and healthcare workers. When I received a test on March 14, 2020, I was determined to be high-risk, as I presented symptoms aligning with COVID-19 symptoms, on top of having asthma.
My symptoms were mild for a few days leading up to my decision to go to the emergency room. Starting on Tuesday of that week, I began to notice a mild sore throat followed by fever two days later. By Friday I had developed a dry cough. I had been in conversation with my primary care physician on Thursday and Friday, but was told I had nothing to worry about unless I developed difficulty breathing. Lo and behold, I woke up Saturday noticeably short of breath and with a significantly increased fever. As my symptoms aligned with the symptoms of COVID-19 the CDC has posted to its website, I made the decision to go to the emergency room that day.
When I arrived at the hospital, I was given a mask, had my temperature taken immediately, and was taken to a room in the COVID hall by a nurse covered in personal protective equipment. The nurse took my vitals, hooked me up to an EKG machine, and asked me a lot of questions: Had I traveled outside of the country? Had I been around a confirmed case of COVID-19? What were my symptoms? Did I have any underlying health conditions? After answering her questions, I was swabbed for the flu. When my flu swab came back negative, a physician’s assistant wanted to discuss my health history, focusing on my asthma. She listened to my lungs, which sounded clear to her, and decided I could be tested for COVID-19. The CDC states online that not everyone needs to be tested for COVID-19, as “most people have mild illness and are able to recover at home without medical care,” also noting that “there is no treatment specifically approved for people who have COVID-19.” However, they also provide guidance concerning the priorities for testing, giving priority to those with underlying health conditions, which includes moderate to severe asthma. Having asthma puts me at greater risk for severe outcomes (pneumonia, acute respiratory distress syndrome, or ARDS, and death) should I contract COVID-19. Ergo, I was swabbed for COVID-19.
My symptoms were determined to be mild enough to self-isolate at home. I was told to return should it become more difficult for me to breathe, but to otherwise stay home until my results were available, which was anticipated to be in five-to-seven days. I was directed to treat my fever, use my Albuterol inhaler as needed, and follow a print-off provided by the CDC to patients released after testing for COVID-19.
The next few days were the worst of them. Sunday through Tuesday, my fever spiked and consistently hung out between 101 and 102.4 degrees, despite using ibuprofen. I experienced extreme fatigue, body aches and chills. By Tuesday morning, I could not take a deep breath and I had sharp pain throughout the right side of my chest and back. When my inhaler did not grant my lungs any relief, I decided to head back to the emergency room.
Upon my arrival, I was placed in a room in the COVID hallway, as my test results were still undetermined, and the doctor immediately listened to my lungs and heard a bubbling sound. He ordered an X-ray of my chest and confirmed pneumonia in my lower right lung so a CT scan was ordered to rule out the pneumonia being fungal. I was given antibiotics and a steroid through IV while I waited on the respiratory department to determine if I was to be admitted or if I was to go back into self-isolation at home. Thankfully, I was sent home with two prescriptions of antibiotics and a steroid, and a referral to see a pulmonologist the following Monday.
Within a few days and a lot of rest, my health finally started to improve. I stayed on top of my medications and took Tylenol for fever, rather than ibuprofen, as I was informed that the ibuprofen I had been taking may have contributed to the high fever I was experiencing. I was on the mend. But seven days after being swabbed for COVID-19, I still did not have my results. The doctor who saw me in the emergency room made it clear that I needed to see the pulmonologist as soon as possible, but the pulmonologist’s office would not schedule me until I had my results or 14 days had passed since I was tested.
The testing process is quite complex. When I was tested on March 14, testing capacity was much lower than it is now (early May). Due to issues related to CDC’s initial test kits, public health labs and the CDC possessing minimal tests, there were major delays in getting the general public tested, further causing an overwhelming number of swabs to backlog. After a patient is swabbed, the DNA is sent to a laboratory. Most hospitals in America are unable to do testing in-house, as most hospitals do not have molecular test labs on site, which are needed for COVID-19 testing.
Moreover, there are a limited number of labs that are able to automatically extract the RNA from the DNA. I was tested at St. Francis Hospital in Indianapolis and (at the time) all COVID-19 swabs had to be sent to a lab for processing. I finally received my results nine days after I was swabbed.
My COVID-19 test results were negative. When I received my results, I was just finishing up what would be my first of three rounds of medications. After a few days of being off of medications, my symptoms started resurfacing. I became skeptical of my negative results, especially when I discovered that many tests are inaccurate, producing false-negatives. In their article, “Coronavirus Tests Are Being Fast-Tracked by the FDA, but It’s Unclear How Accurate They Are” ProPublica journalists Lydia DePillis and Caroline Chen found, “Without much data on how COVID-19 tests are performing in the real world, concerns are mounting that a lack of accurate testing will make it more difficult for America to relax social distancing, as the ability to track and trace new infections will be critical for any strategy to reopen the country.” I was also given a nasal swab, which may be a faulty procedure because, “as the disease progresses, scientists think the virus tends to move down into a patient’s lungs, so the window of time when a nose swab will return a positive result may be limited.” Since the time I was swabbed, it has become a more common practice to swab the back of the throat for COVID-19.
In the end, the test results have had no effect on my recovery from pneumonia. I just finished my second round of antibiotics and am currently finishing a third round of Prednisone, and will continue to use a steroid inhaler for three months; all of which I would have had to do no matter what the test results were. The main concern for accurate and timely testing is to mitigate the spread of the disease through contact tracing.
Contact tracing, in its simplest sense, is the identification of the recent close contacts of an infected person. Contact tracing is important because those who come into contact with someone who are infected with a virus, such as COVID-19, “are at higher risk of becoming infected themselves, and of potentially further infecting others,” according to the World Health Organization. Contact tracing has been proven to aid in the containment of viruses, including COVID-19 in other countries around the world. This method relies heavily on accurate and timely testing practices to be effective.
Since the day I was swabbed, there has been an expansion in availability of testing. Various hospital locations in Indianapolis have started offering drive-thru options for testing. Eli Lilly in Indianapolis is offering drive-thru testing options to people who qualify. IU Health invites people to utilize their free online coronavirus screenings to avoid going to doctor offices and urgent/emergency care facilities. There has also been an increase in the speed of which results are available, now taking around 48 hours on average rather than five-to-seven days.
While my negative results are more likely to be true than false, the fact that there is question as to how accurate the COVID-19 tests are is an obvious issue. As someone who is at high-risk for developing severe respiratory issues from COVID-19, I worry about those who could pass the disease to me unintentionally as a result of inaccurate testing. As someone who is a college student, was in contact with multiple people every day of the week before my university went to online classes, I worry about the potential people I may have infected. Because of possible testing issues, they would never know to stay home or to get tested themselves.
Yet at this point in early May, Indiana, like a majority of other states, has begun to reopen despite still not having adequate testing or meeting White House guidelines to reopen.
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