Even before Hawaii’s stay-at-home mandate took place, 19-year-old Siena Swift decided to keep to her room after returning home from Pomona College in California, just in case she was carrying the coronavirus.
It turned out to be the right decision — she started to feel feverish about one week after she arrived home. With a doctor’s order, she was able to go to Adventist Health Castle Hospital for a COVID-19 test. They said to expect test results within three to five days. It’s been eight.
“I have been stir crazy,” she said. “To be honest waiting has been worse than any of the symptoms I’ve experienced so far.”
The bulk of Hawaii’s 5,747 tests to date have been conducted by private laboratories — Clinical Labs Hawaii and Diagnostic Laboratory Services.
But wait times for a COVID-19 result are now exceeding two weeks. The private laboratories have had to rely on sister facilities on the mainland to test specimens sent from Hawaii. Collection, shipment and testing resource shortages likely contribute to the wait times.
State health officials said Friday that the laboratories gained the ability on Wednesday to test COVID-19 samples in-house and on-island, and Hawaii patients should see their wait times decrease as a result.
But there’s still a number of patients that will have to wait. And in the meantime, they are expected to keep a distance from their family members.
Swift uses a ladder outside her window to escape for walks or bike rides when she feels well enough.
“I’m only in my room and the hallway to my bathroom,” she said. “I haven’t hugged or interacted with my parents since I’ve been home. It would be nice to go to the rest of my house and interact with my parents, but I don’t want to potentially expose my parents or my grandparents.”
On Friday, during the Senate Special Committee on COVID-19 meeting, lawmakers expressed frustration about still not knowing the results of their colleagues’ COVID-19 tests, which were conducted 10 days ago.
The tests were conducted after Sen. Clarence Nishihara was diagnosed with the coronavirus.
The Senate Special Committee on COVID-19 asked officials from the Hawaii Department of Health for the number of pending tests, but officials said they did not know — they only had the positive results that were reported to them.
The local private laboratories did not provide the number of tests that have results pending. A spokesperson for Clinical Labs Hawaii said its corporate headquarters would not be able to respond until Monday.
Mark Wasielewski, president of Diagnostic Laboratory Services, did send a statement by email, noting DLS has processed COVID-19 tests on island since March 13 and has the capacity to conduct as many as 180 tests per day on island.
“Results are ready the same or the next day for patients run locally at DLS,” he said. “We are following a nationally accepted prioritization process that puts hospital patients first, and then we fill the rest of our capacity continuing to follow the defined prioritization criteria.”
Any “overflow” test orders are shipped to two mainland lab partners, and those may take three to 10 days, he said.
“They are dealing with the national surge of requested tests,” he said. “The two mainland labs continue to show improvement and will hopefully reach their goal of three to four days turnaround time.”
Dr. Edward Desmond, director of the State Laboratories Division, said earlier this week that all clinical labs in the state have the collective capability to test just under 1,000 people per day. The private laboratories, with mainland partners, have conducted 5,379 of the 5,747 to date.
Each day for the past week, about eight to 14 new cases of COVID-19 have been confirmed in Hawaii, with most of them on Oahu. On Friday, there were 14 new cases, taking the state total to 120. Only seven have required hospitalization, according to DOH.
Sen. Jarrett Keohokalole, who joined the meeting by webcam as he awaited his own results, asked if the 1,000 tests per day capacity was sufficient. He, along with senators Donovan Dela Cruz and Kurt Fevella also await COVID-19 results.
State epidemiologist Dr. Sarah Park said demand “seems to be met as far as we can tell.”
“As far as we’re aware, they (private laboratories) are ready,” she added. “I’m sorry your tests got sent to the mainland before they were ready. We have testing capacity now in the state. But there’s still issues with supplies. Dr. Desmond has been communicating with laboratories and they’ve said they are experiencing continued intermittent supply issues.”
Nationally, testing has been hard to come by, and in places where the outbreak has worsened, some public health systems have advised doctors to not bother testing.
Some Hawaii doctors have called on the health department to broaden its capacity and criteria for testing.
An intensive care unit nurse who works on Oahu and requested that her name not be used out of concerns about losing her job, said she has seen seven patients who classify as highly probable COVID-19 cases. They’ve all resulted in negative test results, but one case seems so suspect that the doctor just re-ordered another test.
Even in the cases where patients are severely ill, rapid test requests are coming back in 20 to 30 hours. That’s not fast enough, she said. In the ICU, every hour counts, especially because the hospital workers must don full protective gear each time they enter the room.
“We wasted seven hours. We’re using all the PPE going in and out of that room,” she said.
In another case, ICU doctors ordered a rapid test for a very sick patient on a ventilator.
“I’m constantly looking to see if (the lab) had results. I noticed that (the lab) said it was discontinued. We called the lab and I guess they said they had a glitch in the system that day,” she said.
Because of the virus’ 14-day incubation period, which means symptoms can take days before they surface, doctors and the state advise not to administer COVID-19 tests until someone is showing symptoms.
Dr. Elizabeth Char, an emergency medicine doctor who testified at the state Senate committee meeting Friday, likened it to a pregnancy test:
“If you think day zero was Friday night, if I test you on Saturday, you know what the results are going to be — it’s going to be negative. Does that mean they’re not pregnant? Not necessarily, but that’s what the test says,” she said.
“If we just tested everybody indiscriminately we’re going to tell people you’re negative, you’re negative, and you’re negative, but that’s not what the results are saying. They’re saying right now you have not tested positive.”
Char said that despite the fact that asymptomatic people may transmit the virus, those who are symptomatic are more likely to yield accurate positive testing results.
Dela Cruz, also in quarantine and waiting for COVID-19 test results, asked whether or not asymptomatic people who have been exposed to positive people within the same household or workplace are being tested.
“Not exactly,” Char said. “If I’m symptomatic and I test positive, those who are in close contact with me should separate themselves from everybody and worry that they may test positive, but I wouldn’t necessarily test them unless they’re showing symptoms.”
Dela Cruz countered with another question — how do health officials reconcile that with the fact that many COVID-19 cases have been found in family clusters?
“The vast majority of transmission is from people who are symptomatic,” Char said. “Knowing we have a limited amount of reagents and ability to test, I don’t support — at this point — testing people with no symptoms, because I’d rather use that test on somebody who has a much higher likelihood that they’re actually sick.”
That decision is in line with CDC and DOH guidelines, she said.
“We don’t want to just test everybody and give them a false reassurance that their test is negative,” she said, noting that things like reagents — the compounds used in chemical reactions — are running short in supply.
Still, Char said she’d be in favor of more widespread testing.
As for Swift, she’s still not feeling well, but is eager to confirm whether or not she has the coronavirus. A flu test came back negative.
Her college classes will shift to online courses on Monday.
“It’s just been a waiting game,” she said. “The anxiety of not knowing makes me overanalyze the symptoms I’m having.”
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