As cases mount, Texans tackle the reality of the pandemic
Ill physician DOCTORS AT RISK: faces 8-hour fight for testing
On March 15, Dr. Kelley Moon arrived at the Nacogdoches Memorial Hospital emergency room to say her ailing patient, with all the telltale signs of the new coronavirus, would soon be arriving and needed testing.
But what instantly caught the nurses’ attention was Moon’s own condition.
A fixture in the small East Texas community, the 49-year-old family physician was pale, feverish and seemed to be struggling for breath behind her medical mask.
“Maybe you need to be tested,” they told her.
“It probably wouldn’t hurt,” she agreed. Although she knew she was sick, she worried less for herself and more for the 150 patients who come to her clinic each week. How far could the potentially deadly virus spread in her city of 33,000 if she were infected?
And so it began, a harrowing eight-hour battle for testing for a doctor and patient in one regional hospital.
As day turned to night, Moon and her patient, a young woman in her 30s whose condition was deteriorating, were denied testing multiple times. Al
though both exhibited symptoms, they did not meet all of the strict criteria from the Centers for Disease Control and Prevention, including traveling to known disease hot spots or having proven direct contact with someone who tested positive.
Moon insisted that the hospital keep calling the CDC hotline to ask again if they could be tested. As a doctor, she even called on her own. The agency, though, would not budge. She said one person even told her, “Nothing is going to change my mind.”
Fed up, Moon released a chilling video to Facebook from inside the ER. “I can’t breathe,” she said, her voice a hoarse whisper. “God help us.”
The hospital declined to comment directly on the case, citing patient privacy, but offered a statement saying it has consistently followed recommendations from the CDC and the Texas Department of State Health Services.
“Memorial Hospital leadership and health care providers are adhering to the most up-to-the-minute recommendations on testing protocols and have been from the beginning of this ever-evolving situation,” the hospital said.
Doctors across Texas and across the nation say what happened to Moon is far from isolated and should serve as a testament to just how elusive testing remains, even for those on the front lines of the pandemic — the very people who may need it most.
It remains unknown how many health care workers in this country are already infected, but the daily risk — and fear — is real.
The American College of Emergency Physicians, the organization that represents about 31,000 emergency room doctors, said two physicians are in critical condition after contracting the virus. One is in his 40s in Washington state; the other, 70, is in New Jersey. CNN reported at least nine health care workers had tested positive for the virus with 20 more presumed positive. It was not disclosed where those cases occurred. A Houston doctor said Friday a fellow emergency physician and friend in New York City has just tested positive.
The virus has afflicted thousands of health care workers globally. China’s National Health Commission last month said 3,300 health care workers were infected and at least 13 died. On Monday, the Italian Department of Infectious Disease said nearly 1 in 10, or 2,339, of the 25,000 cases in that country had struck health care workers.
Dr. Alison Haddock, assistant professor of emergency medicine at Houston’s Baylor College of Medicine and emergency room physician at Ben Taub Hospital, is worried.
“If we lose our front line,” she asked, “who will take care of us?”
Test kits scarce
CDC officials and the White House, under sharp criticism, have promised more robust testing with greater availability and loosened criteria, including latitude for doctors to ask for testing for their patients.
And in fact, testing has ticked up dramatically in recent days, mostly because of the introduction of private lab testing and the access of drive-thrus. At one such site in Houston, the line of cars on Thursday stretched for miles.
On March 13, Gov. Greg Abbott said just 220 tests had been conducted in all of Texas. By Saturday, that number had jumped nearly thirtyfold to 6,500.
But so, too, has the staggering march of the virus. As of Saturday afternoon the number of cases in the U.S. topped 25,000 with more than 300 deaths. In Texas there were 608 known cases, rising by more than 120 in a matter of hours, according to a Houston Chronicle analysis. Five people in Texas have died from COVID-19, the disease caused by the new coronavirus.
On the same day Moon struggled to get tested, officials at a press briefing in Washington said testing priority will go to senior citizens and medical professionals with viral symptoms to avoid “paralyzing” the health care system.
But doctors say in the days since it is simply not happening, or at least not consistently.
“The ER reality on testing is (that) it has not been adequate and does not match the rhetoric,” said Haddock, who added she was not speaking of her hospital’s handling of the crisis but rather basing her assessment on conversations she has had with medical colleagues across the nation who are frustrated with the mixed messages coming from the White House and public health officials.
Others say the lack of available testing is compounded by a lack of adequate protective clothing and equipment for front-line doctors. Across the nation, doctors are reporting rationing and resuing equipment.
Last week the CDC changed its guidance to doctors, saying that regular surgical masks are an “acceptable alternative” to the more expensive, custom-fitted N95 masks because supply of the latter was running out. The N95 respirators filter out about 95 percent of airborne particles while looser-fitting surgical masks only limit exposure, health officials say.
Some doctors interviewed by the Chronicle said they worry they carry the virus and do not yet know.
They talked of colleagues who now sleep and eat in separate spaces from their families. Others have sent children away to live with relatives.
Haddock changes out of her scrubs before getting into her car and then strips down again once home, throwing everything into the laundry before heading straight for the shower.
“Our country knew this was coming,” she said. “Why were we so slow to respond?”
Doubts erased
Moon admits she was a skeptic, thinking the predictions of a looming health crisis were overwrought. “I had been on the side of, ‘OK, guys. We need to chill.’ ”
It all changed just over a week ago.
On March 11, she was diagnosed with strep throat and prescribed antibiotics. The next day, a woman with the symptoms similar to COVID-19 came into her two-doctor clinic but was diagnosed with the flu. Moon was home sick at the time and did not treat the patient.
On March 13, Moon met with a colleague who was worried he had been exposed to the virus at a conference and asked about testing. It suddenly hit her: She was unprepared if this thing was spreading. She called the hospital to find out what to do if she suspected a patient had contracted the virus.
She was told that a series of other ailments must be ruled out first. If all tests are negative, the hospital could test for the virus only if the patient met all other CDC criteria, such as specific symptoms, recent travel or direct exposure to someone who had tested positive.
By March 14, her staff was worried. The patient diagnosed with the flu had come back and seemed sicker. Was it the virus? Were they all at risk? The next morning, Moon called the patient and told her to to meet her at the emergency room.
Moon also was still sick. After five days, the antibiotics had not blunted her fever or cough. If she did have the new coronavirus, she had no idea how or when she was exposed. Soon both doctor and patient were in separate hospital isolation rooms. Both underwent a battery of tests for other conditions. Moon still tested positive for strep throat and the other woman’s chest X-ray showed pneumonia. That knocked them out of eligibility for coronavirus testing, she said she was told.
By 7 p.m., she took a stand. She announced she was not leaving without both women getting tested. She texted her patient down the hall and asked if she was in for a fight. She was.
Finally, the hospital found a solution. The testing could be conducted by LabCorp, a private company, which allowed the hospital to circumvent CDC rules. A week later, the women still have no results. Moon was first told it would take a few days, then by Friday, and now sometime in the coming week.
The two women remain in their homes under self-quarantine. Moon’s son, her boyfriend and her boyfriend’s daughter are all living mostly in separate rooms. If the test is positive, at least she will know — not knowing is worse, she said.
She said she feels helpless away from her medical practice. She has been advising patients through social media. The other doctor at her clinic is still seeing patients in person because he has no symptoms. But he is taking his temperature regularly.
She knows she ruffled some feathers in her community but has no regrets. She is at turns angry, frustrated and frightened for her patients and her profession. “Maybe at the end of the day,” she said, “someone will hear my voice and protect us.”
“If we lose our front line, who will take care of us?”
Dr. Alison Haddock, assistant professor of emergency medicine at Houston’s Baylor College of Medicine