(CNN) On the surface, West Virginia might have seemed immune to coronavirus.

While the other 49 states had reported more than 5,000 cases combined, West Virginia didn't report its first case until Tuesday afternoon, when Gov. Jim Justice announced an infection in the state's eastern panhandle.

But that doesn't mean the deadly virus hadn't earlier reached the state, where coal miners and elderly residents can be especially vulnerable.

West Viriginia's lag might be due to a lack of testing, said a federal lawmaker and a sick nurse who's been rejected repeatedly for testing.

"We've only had 84 tests in my state" as of Monday, said Joe Manchin, the state's senior US senator.

"I have over 720,000 elderly. I've got over 220,000 that are critically ill under 60 years of age," Manchin said. "If you put all this together, of the 1,800,000 people (living in West Virginia), I have over a million that could be absolutely, totally devastated by this virus if it hits."

He said he's extremely worried about those with respiratory illnesses.

"If we don't even have the tests to identify who is ill, who needs treatment ... what do we do?" he said. "I don't have the ventilators. I don't have the respirators. I don't have anything available to that many people that are that vulnerable."

Manchin said he's asked Vice President Mike Pence, who's leading the Trump administration's response to the outbreak , and others to increase testing capabilities in West Virginia.

In the meantime, some sick residents are left to worry and wait.

'We have been unable to get permission'

One nurse in West Virginia said she's been very sick for more than a week but has been unable to get a coronavirus test despite repeated requests by her and her doctors.

The nurse, who asked not to be identified for fear that she will lose her job, told CNN that she first developed a fever of between 100 and 103 degrees and an "unrelenting cough" that won't let up.

The nurse said she was tested for two strains of the flu, and both came back negative. But when she asked to be tested for the coronavirus she was declined repeatedly.

"I have had several doctors ask for me to be tested, but we have been unable to get permission for me to be tested," she said.

The nurse said she and her doctors have repeatedly contacted the Centers for Disease Control and Prevention as well as the West Virginia health department.

She said her requests were declined because she has not been in direct contact with someone who has tested positive.

Now, other members of her family have also fallen sick. When they tried to get tested for coronavirus, they were also declined, the nurse said.

"At this point I'm so angry and outraged at the way this is being handled," she said.

Why testing in West Virginia is scarce

The West Virginia Department of Health and Human Resources said testing supplies "are not unlimited."

"Currently, COVID-19 testing is used in accordance with guidelines from the U.S. Centers for Disease Control and Prevention (CDC)," the health department said in a statement Monday.

It said two groups of people have been prioritized for testing since early March. They include:

-- Seriously ill people who are hospitalized or otherwise are at high risk of complications -- for example, people with coronavirus symptoms who are elderly or have serious underlying chronic illnesses. "No history of potential exposure is needed for these patients," the health department said.

-- People who are at medium to high risk of having been infected. "This includes any individual with symptoms of lower respiratory illness (fever, cough, shortness of breath) AND a history of likely exposure to COVID-19 within 14 days of symptom onset (e.g., close contact with an individual confirmed to have COVID-19 or recent travel history from or living in areas with widespread community transmission) AND do not have another identified cause for their illness (e.g., flu, or other respiratory viruses)," the health department's statement said.

"These are slight modifications of CDC Guidelines, focusing on those most ill in criteria one above, given that supplies are limited, and some products remain on backorder in West Virginia and nationally. They are subject to change."

What West Virginia did proactively

Even before its first confirmed case, the state rolled out a series of precautions aimed at staving off coronavirus.

On Tuesday, Justice ordered the closure of bars, casinos, and restaurants to seating customers.

But even the governor knew coronavirus in West Virginia was inevitable.

"Even though we still don't have a confirmed case at this time, in talking to our great medical professionals we know that eventually that will no longer be the case," Justice said last week.

"So we're continuing to do everything in our power to be prepared, but we also have to be proactive to make sure all West Virginians are as safe as possible."