Searching for a COVID-19 Test in America
Most people were now wearing masks, and a few were obviously nervous about inadvertently drifting too close.
Anybody that wants a test gets a test. They’re all there. And the tests are beautiful.
~President Donald J. Trump to reporters, March 6th, 2020
Back in early March, my brother, a pharmacist, developed nausea and a terrible headache. His doctor thought it was a sinus infection, and prescribed him an antibiotic, and the symptoms seemed to go away. My brother had made plans to go with his partner to a resort in Mexico, and off they went. The COVID-19 timeline has moved so rapidly, that although this was only a month ago, this now seems like a fictional tale about a land in which air travel to another country is harmless, and symptoms of illness are merely that.
When my brother told friends of his plans to go to Mexico, the objections were not that he might contract COVID-19, but that the government might change plans abruptly and he’d be stuck out there. “What’s the downside?” he’d respond. “That I’m trapped in a resort hotel?” And we all laughed. To be extra safe—and we thought he was overdoing it—he and his partner, a nurse, wore face masks on the flight and brought bottles of hand sanitizer.
On his return, my brother fell ill again with the same symptoms. He had no fever—one day, for four hours, he had a 99.5, but that was all—but he was suffering from nausea, lightheadedness, and a migraine on one side of his head; he said he thought the sinus infection had flared-up again. He didn’t want to take another round of antibiotics and hoped it would go away by itself. But it didn’t go away, so he called his doctor again. This was mid-March. By this time, doctors weren’t taking visits; the school where I teach had just shut down, abruptly, from one day to the next; two of my adult kids had been laid off as baristas when the city started shutting down services. In short, no one quite knew what was happening and with each new day it seemed like hurtling further into the unknown, like a herky-jerky wooden roller coaster in pitch dark. My brother set up a video appointment, and the doctor again diagnosed a sinus infection, this time prescribing not only an antibiotic, but also prednisone, for the swelling.
Jonathan Kay
Then my brother’s partner started to show the same symptoms. By this time in the nightmarish roller coaster ride, people were recognizing that perhaps there were odder symptoms of COVID-19; since his partner is a nurse, she was required to test for COVID-19 just in case, and couldn’t go to work for a week. She encouraged my brother to get tested with her; there was a drive-in site that was offering free testing to those over 50 with symptoms, as well as healthcare professionals. The problem was my brother had no fever, which was a requirement for testing; he’d hardly had any fever this whole time. But just to be on the safe side, he decided it would be wise to screen out the possibility of COVID-19, so he lied and said he had a fever of 100, and they tested him. The results would come in about a week, they said.
We were all so certain he had a sinus infection or something of that kind, that we went over to his house for a small family dinner—my 20-year-old son who had had to come home early from his study abroad in Paris; my 21-year-old nephew who likewise had had to come home from college; my brother, and his ex-wife and her new husband. And we all passed a rather wonderful evening, eating, laughing, and playing cards.
I shopped for the Passover seder, and invited my adult children over, as well as my brother and nephew. This was only last week, but now I can’t imagine thinking of having my children over. Such has been the speed of the ride. The very next day, I went to Home Depot to pick up toilet paper—there’d been multiple six-foot-high pyramid-stacks of it when I’d gone there a week earlier. When I arrived, I found I had to wait in a long line just to get into the store while greeters in blue gloves and masks let us in one at a time, wiping down our carts and spraying us. A couple tried exiting where we were entering, and the greeter literally screamed at them to go another way. When the couple hesitated, probably shocked at getting screamed at, the greeter screamed louder and madly gestured to his left: “NOT THIS WAY!” People got meek and obedient, no doubt just wanting to get their supplies.
Most people were now wearing masks, and a few were obviously nervous about inadvertently drifting too close. We’re an adaptable species, but this behavior seemed to be on another level; with each plunge into the unknown, we were acting as though we’d always done it this way. “Social distancing” had always been a phrase. Zoom was always used for conferences. Like everyone else, though, I accommodated myself to the situation, and also acted just as though we’d always done it this way. When I finally got into the store, I discovered that the toilet paper stacks were gone, like snow piles melting in sudden spring heat, and nothing was left. I went to four other stores in my quest, and eventually settled for napkins.
That evening, my brother called and told me he and his partner had tested positive for COVID-19. What’s more, my brother’s ex-wife, whose father had just died and who was upset both for her mother in her 90s and because they couldn’t even have a funeral, was now certain she had contracted it too. She’d developed my brother’s symptoms—the headache, the dizziness, the nausea. Despite my new-found skills in adjusting to the unexpected, my brain still had trouble processing the information and started out with the trivial. My first thought was that the $200 in Passover brisket, chicken, and turkey would go to waste because now I couldn’t invite anyone over. My second thought was the disappointment that we wouldn’t have a seder. Then I began to worry about my brother, his ex-wife, her elderly mother, and especially my brother’s partner, since she’d had cancer and a lung mass just the year before, plus she had a severely disabled adult daughter. Finally, it occurred to me that I’d been exposed to the virus too, and so had my 20-year-old son. For a few minutes, I was irrationally angry with my brother for not… for not… What? He’d been told repeatedly it was a sinus infection. His own son was furious with him, and told him he’d “ruined everything.” Such is our need for human agency and control over nature.
The next morning, I called my doctor to see if he had any advice, and found that his entire office—not a small family office, but part of large medical organization—was closed. Not closed simply for physical visits, but closed. I had no primary care doctor anymore. Not to be deterred, I called my health insurance. The poor man on the line was obviously trained to repeat everything I said. “I see,” he said after listening to my story. “That is very stressful that you cannot reach your doctor. Have you tried calling your primary?” Yes, he literally said this. I explained, again, that my primary was not open. “You are saying your primary care doctor is not open,” he echoed. “That is unfortunate and must be a stressful situation for you. Have you tried calling him up?” He finally connected me to a representative who told me that there was a telemedicine branch via the insurance, and he gave me the numbers. I dutifully wrote them down on the back of an envelope, which I then lost. But I wasn’t ready to call them anyway. It seemed a subpar way of reaching a doctor, and I just wanted to ask some questions anyway.
So, instead, I visited the next best thing: Google. Unfortunately, as is obvious to anyone with wifi, the information out there is contradictory, catastrophic, political, and generally not particularly useful. Don’t wear a mask, you fool—it’s not helpful at all and might even give you a false sense of security. Wear a mask, you fool—or get arrested. This is just like the flu. This is nothing like the flu. We can expect two million deaths. 100,000. 60,000. We will resume normal programming by April. May. June. September. Never. Use Zoom to enjoy time with your family. Zoom has security leaks to China and malicious hackers. Sunny posts from very wealthy, healthy, well-fed people exhorted me to be cheerful. Stern posts from nurses exhorted me to stop being selfish. Humorous memes filled my screen about the lack of toilet paper and the horrific strain of being around one’s own children full time, but nothing about the lack of thermometers and doctors or, oh, money to buy food and essentials from the thousands of people like my children who were laid off but whose unemployment hadn’t even been processed yet. Several people posted how the silver lining was that COVID-19 was making them appreciate long solo walks in nature, and working from home. (One positive—if ever one doubted the upper-class tilt of the media and the chattering classes on Twitter, COVID-19 has driven that nail in the coffin.)
I tried to find locations for testing, but a mishmash of results popped up, not websites of the testing places you’d think, but news articles announcing their openings, or possible openings, or changing rules. Links that were supposed to lead to appointments instead led to announcements about press coverage. It was all extremely confusing. A news article informed me that, “Testing criteria is changing daily.” Another site advertised a single testing day on March 26th (nearly a week earlier) for just four hours, between 1 and 5pm. They were all weirdly specific, like “For x county residents only and with a physician’s referral only, Mondays and Wednesdays from 3pm to 7pm.” “For x hospital patients only, with a doctor’s prescription and an appointment only.” Each site had a different set of labyrinthian rules. Nearly all the sites required a “physician referral.”
Only when I scrolled down, and clicked this or that link, and then another link, and another, did I finally find a website that listed the drive-in site a half hour away that didn’t require a doctor but did require a fever. I only knew to look for it because of my brother, who only knew about it because of his partner, who is a nurse. But I didn’t have any symptoms at all. I played around with calling the telemedicine numbers and going to the one local place I seemed to be permitted to go with a prescription and an appointment. That’s when I realized I couldn’t find the phone numbers my health insurance representative had given me. I was probably being a worrywart, I told myself, and decided to wait and see.
I didn’t have to wait long. A few days after my brother announced he’d tested positive, I came down with a terrible headache, nausea, and lightheadedness. My skin felt strange. I felt feverish, too hot or too cold, but I don’t have a working thermometer—I’m 57 and all my kids are grown; I simply have lost track of the need for one. And now there is nowhere to buy one. I eventually ordered one from Amazon which is due to arrive by April 27th. For now. Yes, it’s harder to get than toilet paper. But don’t worry! Online advice exhorted. It’s not necessary to take your temperature, apparently. Just “feel” if you have a fever. But state the exact fever you have when making an appointment.
In any event, maybe I had an unrelated stomach virus. But the symptoms went on too long for a generic virus, and the lightheadedness and strange sensitivity in my skin was new to me. My 20-year-old seemed untouched, thankfully (and remains so; we wonder if he had a mild case in Paris during his aborted study abroad). A few days ago, after nearly a week of feeling ill, I decided I really wanted to test myself to see whether I had COVID-19. I live in a small, one-bedroom apartment carved out of an old Victorian house; there are five tenants in the building. I wanted to know for their sakes, and I also wanted to know just to know.
I decided to go to the free drive-through testing facility my brother had used, since by now I had symptoms. The drive-through place had announced via the media (not their own website, which as far as I can tell does not exist) that they were closing on Friday at 7pm as they’d lost their government funding, so at around 2pm, I drove the 25 minutes there. It was odd to be driving; I felt a bit disoriented or maybe disconnected from myself but I forged on. When I got there, it was closed. The police officer in front of the entrance—I guess to collect other fools like me—told me it had closed early “because of the wind.” He told me there was another drive-through testing site in Center City, Philly, and gave me the address. I decided to just drive there and get this over with.
On my way, I called them twice to be sure they were open—I had to pull over and look up their information, which took me over five minutes of scrolling through Google even though the officer had told me its address—but both times, an automated voice told me I had reached a mail box that was full. Whoever has heard of a government testing site that has a full voicemail box? I began to worry that it wasn’t a real place, but when I finally got there, a half hour later, I found it did exist—and that it was closed too. The officer in front of the entrance waved me away, saying they “had to close early and next time, try calling.” I told him I had tried calling, but the mail box was full, but he’d already turned to the car behind me. After hesitating, I drove on and decided I’d try calling my insurance again and finding out if I could get a telemedicine appointment after all. This way I’d have a doctor’s referral for testing and could go to the site ostensibly available for my county. I managed to find the numbers I’d lost on Google.
I spent the next hour on hold, but by the time I arrived home, I finally got through. The representative was kind and upbeat, and brightly told me to download an app so I could do the video conferencing with the doctor. She emailed me the link, but it wouldn’t download. I tried several times, reset my phone, checked my phone’s memory, but no go. She acted puzzled, although when I looked through the app comments later, I found many people were experiencing problems with it. I then asked if I could do this on my computer, and she said yes. I was suddenly overcome with a wave of dizziness and nausea and heat and told her I’d do the rest myself. (The symptoms have been so strange that way—you feel almost completely better, then suddenly, in the abrupt way this disease seems to do everything else, everything changes at once and you feel completely awful.) She cheerfully wished me good health and safety.
I then spent then next hour or so tucked in bed with my laptop propped on my knees unsuccessfully trying to download the app onto my computer. It kept crashing. I restarted my computer and tried three different browsers, but nothing worked. This was now probably four or five hours of trying to find a testing site. I braved the telemedicine site again, was on hold for 43 minutes—then got disconnected. Not willing to admit defeat, I called them again, and after being on hold again for about an hour, I finally reached a human being! I told him the story and he commiserated, and said yes, the app was causing problems for everyone. I asked him how people without wifi contacted doctors and he said, “Good question!” After walking me through a few failed attempts at fixing the problem, I tentatively asked him if it was possible to simply have an old fashioned telephone consult. “Of course!” he said cheerfully. “I’ll connect you!” He looked up doctor wait times and said there was one with no wait and they’d call me within five minutes. To my amazement, I got a phone call in five minutes.
The doctor sounded exhausted and, when I told her I simply wanted a prescription for COVID-19 testing, she tried to dissuade me. “Based on your symptoms,” she said, “you almost certainly have it.” I told her I wanted to be tested anyway. “Well,” she replied, “there is a 30 percent false negative rate, so you might test negative but really have it and think you don’t.” I told her I just wanted to get tested and I’d deal with that when the time came. “You know, it’s very likely that you have COVID-19,” she repeated. “A test won’t change anything. Quarantine yourself until you stop having a fever and are symptom-free for three days.” I told her I just wanted to know, and also, the symptoms came and went, so it was hard to tell when the three days were over. She ignored me and just said, “I’ll give you a prescription, but I want you to know that we’re getting reports that most places won’t accept phone prescriptions. I keep getting calls from irate patients and I just want you to know I can’t guarantee the doctors will accept my prescription.” I asked her why not and she simply repeated she’d send me the prescription. I was pleased with myself. At last all my effort and stubbornness would pay off and I’d get the test! I triple checked the email address she had for me, and she assured me she’d send it. It never arrived.
The problem with following the doctor’s advice of simply assuming I have COVID-19 is that the symptoms can last for a month—at least, my brother’s and his partner’s symptoms have. And they come and go. My brother’s partner lost her fever and thought she had recovered. After six days, the fever and nausea returned with a vengeance. My brother had the same experience. My symptoms also come and go. I don’t know if I have a fever because I don’t have a thermometer and can’t buy one—am I supposed to just “feel” that I have one? So am I supposed to quarantine myself for a month? Or do I listen to the doctor’s advice and the CDC and “just” quarantine myself for two weeks? And afterwards? Based on my brother’s symptoms, I’d still be infectious. And on the other end of the spectrum, what if I turn out not to have COVID-19 and after quarantining myself all that time, I go out to the store, and then get the disease? What if I’m risking the safety of the other tenants? Do I tell them I might have COVID-19? What are the guidelines? I have no idea.
Matt Johnson
After the doctor failed to send me the promised referral, I waited two days, and intermittently tried calling the Center City public health number and kept coming up with a full voicemail message. This morning, I looked up options again, and saw the sites had already changed criteria and information (with the predictable caveat that they’d change at any time, and also their testing kits were limited), but most still seemed to require a physician’s referral. I steeled myself to once again try the telemedical route. But first I tried calling the public health number for probably the 20th time—and miracle of miracles, someone answered. I’m scheduled to test tomorrow afternoon. So I suppose I shall know in about a week. Or not. As the doctor said, there seems to be a 30 percent false negative rate.
What I do know is that there is no way the government and universities can possibly be taking accurate estimates of infection or mortality rates, and therefore, there is no way they can accurately predict anything. They don’t know the denominator or the numerator. Let’s say we calculated the flu mortality rates by including only those who tested positive and who were hospitalized. The mortality rate would certainly then be far higher than it is now, for we’d be excluding all the mild cases and all the untested cases unless a post-mortem test were ordered.
I cannot possibly be the only person who has found it supernaturally difficult to even get tested, who has been urged not to even bother testing, and who doesn’t have a primary doctor to consult. From the government’s viewpoint, I don’t exist as a COVID-19 case. Many people are being advised to simply assume they have it and stay home. How many? Of these people, how many actually have the disease? Of these, how many have mild symptoms or, like my son, symptoms so slight it’s unclear whether or not they even had the virus? Does my son get to go out in a mask now, since he’s symptom free and probably already had the virus? Or does he quarantine with me since we can’t possibly know for sure? He tried calling his own doctor, who likewise was closed. Meanwhile, people presumably still get cancer and heart attacks and diabetes, and a vast array of other illnesses. How many will die of these diseases because there aren’t doctors available or they were exhorted not to go to the emergency room unless symptoms were very severe?
My own symptoms aren’t too terrible so far. Pity the person, though, who’s been fired from his or her job, doesn’t have money for food because unemployment benefits are being processed so slowly, who doesn’t have a means of testing. Perhaps they live in a small apartment like I do, but not in a decent neighborhood where they can walk around safely. They infect others, and who knows if they get to the hospital in time. Throwing up our international hands and hoping for the best against all evidence—is this a way to treat a crisis?
