On Friday Alabama became one of the last states in the nation to report a positive case of COVID-19 as state public health leaders struggled to explain why so few Alabamians have been tested.

“One of the reasons we hadn’t had a positive case is because we haven’t run enough tests,” said Dr. Paul Goepfert, a physician and researcher at the University of Alabama at Birmingham.

Alabama didn’t perform its first tests for the novel coronavirus until March 5, two days after the CDC approved widespread testing and more than a month after the first U.S. case of COVID-19 was reported.

By March 9 the state had only run about 20 tests; three days later, the state had tested another 30.

Meanwhile the number of U.S. coronavirus cases surged past 1,000 and the World Health Organization declared a worldwide pandemic.

The lack of testing has been an issue nationwide. Across the United States, very few patients received tests for COVID-19 in the early days of the outbreak.

Dr. Anthony Fauci of the National Institute for Allergy and Infectious Diseases said Wednesday testing had been a failure. “The system is not really geared to what we need right now,” Fauci said.

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The Alabama Department of Public Health received its first batch of kits from the CDC in February, but federal health officials recalled the tests because they were unreliable. At that point, only a handful of labs including the CDC could test for the virus.

Initially, one of the main reasons so few Alabamians were tested was that criteria for who could be tested was narrow: those who had traveled internationally to a small number of specific countries, had close contact with a diagnosed patient or an underlying medical condition. Nobody else.

Dr. Scott Harris, the state health officer for Alabama, said those guidelines simply reflected rules passed down from the U.S. Centers for Disease Control and Prevention.

“The U.S. as a whole has been slow to roll out testing,” Harris said. During several press conferences Harris told the public there were likely cases of COVID-19 in Alabama that weren’t being caught.

“In a perfect world with unlimited resources, we would test every person every day,” he said.

By Friday morning, a week after testing began in Alabama, the state had its first confirmed case, followed soon after by five more. The number of tests approved by the department jumped to 70.

Now the number of COVID-19 cases in Alabama are likely to climb higher because the health department relaxed its strict testing criteria as of Thursday night, allowing doctors to order a coronavirus test for any patient they think needs one.

Private labs also began offering services outside the tightly controlled state system.

That’s where Dr. Shane Lee turned on Monday when a patient with fever and cough walked into his waiting room in rural Perry County, after a trip to a coronavirus hotspot inside the United States.

Lee was able to take a specimen in his office and arrange for testing through LabCorp, rather than the state lab. The results came back negative.

“Three weeks ago, the coronavirus was someone else’s problem,” Lee said. “But now it’s here and we have to deal with it.”

For the past week, there’s been concern nationwide that there weren’t enough coronavirus tests to go around. Low testing numbers in many states have prompted medical leaders to warn that cases are going unnoticed and exacerbating community transmission of the coronavirus.

Readers have reached out to AL.com saying they were denied coronavirus tests despite having symptoms or coming into contact with people who’d traveled to infected areas.

Patients showed up at the emergency room at Huntsville Hospital last week with symptoms like fever and coughing, asking to be tested for coronavirus, said Jeff Samz, the chief operating officer for the Huntsville Hospital Health System. But many of those patients didn’t meet the CDC’s criteria and were not tested. By Friday the hospital had sent around 23 tests to the state lab for testing.

“I think the testing done in Alabama (so far) has been adequate,” he told a crowd of reporters at a press conference Friday. “I think the public health department has done a great job trying to use the resources they have to take care of the state.”

David Spillers, CEO at Huntsville Hospital Health System, said the hospital, like other hospitals around the state, was following CDC’s criteria for testing.

“I do think (the stringent testing criteria) was related to a limited number of test kits in the United States,” he said, “and you wanted to make sure you were testing appropriately.”

Samz said the hospital has enough testing kits to be able to test those who doctors say need a test.

Jeffery St. Clair, president and CEO of Springhill Medical Center in Mobile, said Friday that his hospital hadn’t had a patient yet that met the CDC criteria to be tested. Since criteria were relaxed, he said the medical staff has discussed new criteria.

“While our new testing requirements aren’t as stringent as what the department of public health and the CDC had us prior to (Thursday), we still go through a lot of ruling out before we’ll order a test,” he said. “Ordering a COVID-19 test is not our first line of defense.”

Alabama is on track to see a testing boom in the coming week, now that the state health department relaxed testing criteria.

Friday afternoon, a long line of cars wrapped around the block at a drive-thru coronavirus testing site in Vestavia Hills, operated by the private Assurance Scientific Labs. The lab, which says it can test 10,000 samples a week, opened a second location in Bessemer.

Huntsville Hospital plans to open a “fever clinic” in Huntsville next week, possibly with a drive-thru option, for coronavirus testing with or without a physician referral. Springhill Memorial Hospital in Mobile has also opened a separate triage area outside the ER in a climate-controlled tent.

Hospitals like Huntsville Hospital are also trying to get certified to be able to process tests in-house, rather than sending them out to private labs or the state, cutting wait times for results down to just a few hours.

The health department has set up a hotline for the public to call for information about coronavirus testing.

Martha Wise, executive director of the Jefferson County Medical Society, said she has been swamped with calls from doctors in the past week.

“Testing is more accessible than it was four days ago,” Wise said. “But realistically, not everyone with symptoms will get tested.”

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