Sun Sentinel Palm Beach Edition
Getting tested in Florida requires meeting criteria
With the nation facing a shortage of coronavirus test kits, South Floridians with coughs and fevers may have trouble learning whether they have something worse than a simple cold.
Symptoms alone are not enough to get tested for the new coronavirus, since Florida and other states lack the capacity to follow federal testing guidelines. The Florida Department of Health will only take specimens from people who fit narrow criteria, such as contact with an infected person, recent travel to
China or other high-risk country, or respiratory illness requiring hospitalization without an alternate diagnosis.
The low testing rate led to criticism Friday from Florida elected officials who said swift testing was the key to tracking and containing the disease. And medical professionals expressed frustration, saying the state’s narrow testing criteria made it difficult to treat patients and provide the most useful information to public health authorities.
“We are on the front lines,” said René Casanova, a family medicine physician with HELIX Medical Centers, who is trying to figure out how to handle possible cases. “I don’t think we’re getting a lot of support on this right now,”
Earlier this week, a female patient walked into Casanova’s urgent care office in Deerfield Beach and expressed concerns about being infected with COVID-19. The female patient had a dry cough, muscle aches and had been battling a fever. She recently traveled to the Dominican Republic, where at least one case of the virus has been confirmed.
“I called the Department of Health. I told them the whole story, and they said no tests,” he said.
Rifky Shpielman, a nurse practitioner at the same center, said she was frustrated in trying to obtain a test for a patient who reported respiratory symptoms, feeling feverish and extensive recent travel, although not to any of the countries known for many coronavirus cases. She called the state health department’s Broward office to obtain a test but was refused.
They recommended a flu test, she said, but no immediate coronavirus test. They told her her patient should quarantine himself until Monday, but he said he planned to fly to New York on Saturday.
“I said, ‘Hypothetically speaking, if this patient has coronavirus, I’m just letting him out there with the viral illness so he can spread it to everyone else?’ They said, ‘Well, he doesn’t fit the criteria,’” she said. “I was left extremely frustrated as a health care provider. Given the fact that the world is in such a crisis, I would have expected a better, tighter responsibility, for them trying to at least contain this or have immediate testing for the patients that are highrisk for the virus.”
The bottleneck appears to be at the federal level. But on Friday, President Trump signed an $8.3 billion federal spending bill to bolster the fight against the illness. Some of that money is slotted for more test kits that will be sent to states — eventually. Until Florida gets more test kits, health officials say they cannot follow the Centers for Disease Control and Prevention guidelines that leave testing for COVID-19 to a doctor’s discretion.
As of 4 p.m. Friday, there are nine confirmed Florida cases of COVID-19, although five of those are Floridians who had been traveling and are isolated outof-state and one of those is an out-of-state resident isolated in Florida. Fifty-one tests are pending. More than 1,200 have been or are currently being monitored, which means they have risk factors, such as contact with an infected person, but have not shown symptoms. In the United States, there are more than 230 confirmed cases, 14 deaths, and 20 states that have reported cases.
Broward Mayor Dale Holness said he hopes the state health department can increase its testing capacity quickly.
“I’m a bit disappointed that we might not have enough supplies to react quickly if we have a surge, but hopefully that can be fixed,” he said. “We need to be able to identify and isolate.”
At a public forum Friday in West Palm Beach, U.S. Rep. Ted Deutch pressed a state health official on why Florida isn’t testing more people.
“On testing, the CDC has eased the testing requirements, so my understanding is if you have the symptoms you’ll be eligible for a test, but at the state level in Florida that hasn’t changed yet,” said Deutch, a Boca Raton Democrat. “If not, why not? Doesn’t that mean more people won’t be tested who should be and they could be walking around infected without knowing?”
Dr. Alina Alonso, director of the Palm Beach County
Unit of the Florida Department of Health, didn’t answer Deutch directly. Instead, she launched into a lengthy discussion of testing, fatality rates and the need for people to get flu shots.
“We’re still have certain criteria, and that criteria got away from the travel but we’re still saving those tests for people who are severely ill,” she said. “And once this become commercial, and earlier today we heard some folks say it might be available as soon as the next few weeks. Then everybody to get tested will go to Quest or LabCorp and get your test and then everybody will be testing themselves and the majority of the people will be negative.”
Deutch pressed again: “There are people who have been calling our office, whose concern is that if someone has symptoms, shortness of breath and a fever, the things that we’ve all read about for coronavirus that at the national level that would be enough to get a test. In Florida, I guess what you’re telling me that’s only enough if it’s really, really severe.”
At a roundtable at the Palm Beach County Health Department, U.S. Sen. Marco Rubio also expressed concern at the lack of widespread testing.
“I wish things would have been done differently a month ago in terms of the creation of a rapid test that could provide us these results,” said Rubio, a Miami Republican. “And we’ll have to look into why that didn’t work the way it should have. But we cannot let the looking into that stop us from fixing the problem we now face.”
Of the new federal money, Florida will get about $25 million, according to the office of Gov. Ron fe. Florida also will get $500,000 from the U.S. Department of Health and Human Services for supplies and to hire more lab and epidemiological assistants, which will help expand testing.
“We know if there’s a surge we will need to get the labs to process more and speed up the testing process,” said Helen Ferre, a spokeswoman for the governor.
“We are keeping the narrower testing guidelines in place for now,” she said. Florida’s doctors will have commercial testing available soon, she said. “Doctors can use those, but they come at a cost.” The COVID-19 tests sent through the state’s three Department of Health labs are free.
Paula Thaqi, director of the Florida Department of Health in Broward County, said the county’s COVID-19 call center received 50 calls Wednesday.
She also said her health department is monitoring people in the county to make sure they don’t develop symptoms.
For now, Florida will only test people who have been to a country with an outbreak, come in contact with someone confirmed with the new coronavirus or been ruled out as having a respiratory illness. Everyone else is told to self-isolate or see a doctor.
DeSantis said he has pushed the CDC to get more test kits. “We certainly believe that would help things. Especially if we’re in a situation where we have a surge of people showing up with symptoms. Being able to do that local testing would make a big, big difference,” DeSantis said at a news conference Thursday.
“We are told they have tens of thousands that will eventually be in route, but we don’t have them yet.”
Information on the Department of Health websites directs people with cough, fever and shortness of breath — coronavirus symptoms — to call a local health department first, before going to a doctor or hospital.
Additional testing ability in Florida could come as early as next week from the private sector. Companies such as Quest and Labcorp have gained government approval to test for the new coronavirus in their labs.
Physicians would collect specimens and send them to the commercial labs. Quest spokesperson Wendy Bost said her company has relationships with half the country’s physicians and health systems. Initially doctors and hospitals in Florida will send samples to the lab in California for processing, and results could take 2-3 days.
“We’re in a position to supplement the public health response and provide testing to patients who can benefit from it,” Bost said.
“I’m a bit disappointed that we might not have enough supplies to react quickly if we have a surge, but hopefully that can be fixed. We need to be able to identify and isolate.”
Dale Holness, Broward mayor