Some Alaskans are still struggling to access coronavirus testing, even if providers think they might have it

Originally published by Alaska Public Media

The World Health Organization’s top official earlier this week urged countries to “test every suspected case” of coronavirus. But as the United States lags in its testing ability, that still doesn’t appear to be happening yet, including in Alaska.

Mitchel Howell lives in Mat-Su, and a couple weeks ago, he started having a tough time breathing, he said in an interview.

Earlier this week, he woke up with a sore throat, too, and then he came down with a fever. So he called a nurse’s hotline at Mat-Su Regional Medical Center, and they told him to come in, he said.

“They did X-rays to check for pneumonia, did a few other tests to rule everything out,” he said. “And they came back and said I’m ‘suspected confirmed.’”

But Howell said he was told the medical center is only testing people in high-risk groups, or if they’re quarantined at the hospital.

“They gave me a note with quarantine procedures on it and told me to go home and come back if it gets worse,” he said.

Howell is not the only person with a story like this.

In Fairbanks, a woman named Sarah Seifert said she called Fairbanks Memorial Hospital’s hotline and was told by a doctor that based on her symptoms, she most likely had COVID-19 and should stay home.

She said she subsequently went to the emergency room when her symptoms worsened and was ultimately tested; the results are pending.

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In Southeast Alaska, Courtenay Kinkade went to her health care provider in Ketchikan with a respiratory illness and was given a note saying that she could be sick with the flu or a common cold, but added that “the novel coronavirus is also a concern.”

“Please understand that testing is limited and we will not be able to test everyone for the coronavirus to rule out this as a cause of symptoms,” her doctor wrote in a note.

Experts say testing is crucial in fighting the coronavirus because it helps health officials understand where to focus their efforts.

“You cannot fight a fire blindfolded. And we cannot stop this pandemic if we don’t know who is infected,” Tedros Adhanom, the WHO’s top official, said at a virtual news conference this week. “We have a simple message for all countries: test, test, test.”

When it comes to the Alaskans who weren’t tested, providers are still telling them to isolate themselves as if they have COVID-19.

But Howell works at a grocery store. And if he does have the coronavirus, he could have spread it to other people before he isolated himself.

Those people, if they’re showing symptoms, would also need to be quarantined to prevent further spread.

State health officials say they’re not tracking cases like Howell’s — when a provider makes the decision not to test someone that they think could be infected with COVID-19. But they also say they’re in constant conversations with providers about what they’re seeing from patients, beyond just the basic testing numbers.

“We are getting a lot of information from providers who are really paying attention to what they’re seeing in front of them, as far as the symptoms and the exposures, and asking really good questions about travel and contact,” said Louisa Castrodale, a state epidemiologist. “I think that’s really coming from across the state.”

Health officials point out that they’ve loosened restrictions on testing that were in place earlier in the pandemic. At this point, public and private labs will conduct tests on samples from any patient that, in a provider’s judgment, needs one, they said.

“We have opened it up. We are not limiting the providers,” Adam Crum, the state health commissioner, said at a news conference Wednesday. “If the provider wants to provide a sample and send that in, we will run that test.”

That said, health officials acknowledge that they’d still like to be doing more testing, and they say it’s possible some of the limitations might be at the provider level. One problem right now is that there aren’t enough of the swabs providers use to collect samples, Anne Zink, Alaska’s chief medical officer, said at Wednesday’s news conference. A day later, she asked communities to look in their clinics to see if they had extra swabs that could be used.

In the cases in the Mat-Su and Fairbanks, it’s hard to know exactly why the patients weren’t tested because the hospitals wouldn’t say. The Fairbanks hospital didn’t respond to requests for comment, and the Mat-Su hospital, in a prepared statement, said it can’t speak about specific cases and is following state guidelines.

“Our medical staff is working in collaboration with the State of Alaska Department of Health, closely following their recommendations and the U.S. Centers for Disease Control and Prevention’s screening guidelines for patients with upper-respiratory ailments that could potentially be identified as a COVID-19 case,” spokesman Alan Craft said. “If the physician determines a patient meets the appropriate risk criteria for COVID-19, the patient is tested.”

Two dynamics likely affecting testing are the infrequency of pandemics, and a response by providers and agencies that’s evolving daily, said Castrodale, the state epidemiologist.

“Things aren’t going by the book, because the book was just theoretical,” she said. “And so there are quite a few things that I think everybody learns every day.”

The state has so far prioritized tests for people who’ve been traveling, and health officials acknowledged that could make it more difficult to detect a big problem: When the coronavirus starts spreading among people in Alaska who haven’t been traveling.

But Castrodale said that the focus on travel-related transmission does not mean that the state is ignoring other possible COVID-19 cases. She noted that more than 500 tests have been run in Alaska on people whose results were negative — including dozens at out-of-state private labs, which are used for sick people who don’t have an obvious potential link to the disease.

“We’re still actively looking for COVID-19 and trying to really chase down the cases that we have and make sure we’re not going to allow this virus to take hold in our community,” Castrodale said.

While Alaskans may be tempted to blame providers or state officials for the lack of more widespread testing, they should really be focused on the federal government, said Kevin Berry, an economics professor at University of Alaska Anchorage who has studied pandemic disease.

“Most of the testing elsewhere is run, basically, by national governments,” he said. “This is something that should have been stockpiled by the federal government beforehand.”

But developing ways to test more people more quickly is more important than assigning blame, Berry said. For now, he added, Alaskans should follow public health officials’ advice: Isolate yourself if you’re sick and keep your social distance from other people.