As COVID-19 cases spike, the test kits needed to help stem the spread of the disease remain in short supply, with healthcare workers across the state reporting widespread failings in the federal government's response to the growing crisis.

Federal officials said nearly 1 million tests were expected to be available by the end of this week. But in California, one of the country's hardest-hit regions with 60 cases, the total testing capacity is limited to only 7,400 through the weekend, according to the California Department of Public Health.

The inability to test widely and swiftly for the novel coronavirus has impeded the country's ability to beat back the spread of the virus, experts say.

Without testing, public health officials don't know where the virus is spreading and where to target efforts to contain it. Twelve Americans have been killed so far by the disease.

The shortage of test kits is creating chaos for doctors and nurses as their triage efforts are complicated by testing restrictions and shortfalls.

"Last night I had a patient with clear coronavirus symptoms, but the health department didn't think he should be tested," said an emergency room doctor in Downey who spoke on condition of anonymity. "I went from that patient into the next room, where I had an 80-year-old, immune-compromised, diabetic patient. If I'm taking coronavirus in there, it's mild for me, but it's deadly for her."

California has only tested 516 people for COVID-19 to date, far below what is probably needed in a state where Gov. Gavin Newsom declared a state of emergency this week due to the outbreak. Though there are no known instances of community spread of the virus in California, the number of people who have been exposed to the virus appears to be growing daily.

About 1,250 Californians who were possibly exposed to COVID-19 on a cruise ship need to be tested for the virus. There are more than 9,000 people in California who have recently returned from countries experiencing severe outbreaks. Then there are others who may have been exposed within the community, and are now worried about infecting their families.

Renee Schwartz, a 60-year-old North Hills resident, said she was told by her doctors that her sinus infection and breathing problems could probably be COVID-19. But staff at multiple Los Angeles-area hospitals this week told her they don't test for the virus.

"I said 'Who does testing? And they said, 'No idea,'" Schwartz said.

Though the Centers for Disease Control and Prevention on Wednesday lifted some guidelines so anyone with symptoms can be tested by their physician, local officials can't take advantage of the looser restrictions because of the lack of test kits. In an advisory to physicians later that day, L.A. public health officials said that they would only be testing people with severe symptoms or with milder illness and a travel history to impacted areas.

In a letter sent to medical staff at one Downey hospital and viewed by The Times, an infection control coordinator instructed doctors to discharge patients with mild coronavirus symptoms, asking them to self-isolate at home. In the long run, that tactic will make the total number of coronavirus cases virtually unknowable — at least until retrospective testing is available.

"Myself and my colleagues have been working in the trenches in the ER, and we can't get people tested," said another doctor who works at a hospital in Downey. Both declined to be identified because they are not authorized to speak to the media.

The doctor said another suspected coronavirus patient was a transplant nurse, whose job is to work with immune-deficient patients. "I said, 'Come on! Please! We need to test her!'"

Amid the shortage, some healthcare workers also cast doubt on federal officials' stringent approach to testing. One California nurse who was exposed to a confirmed coronavirus patient has symptoms and is in quarantine, but has not yet been tested for the virus by the CDC.

"They said they would not test me because, if I were wearing the recommended protective equipment, then I wouldn't have the coronavirus. What kind of science-based answer is that?" the nurse, who asked to remain anonymous, said in a statement read by the National Nurses United's union president Deborah Burger in a news conference in Oakland on Thursday.

"I'm a registered nurse and I need to know if I'm positive before going back to care for patients," the nurse added. "Delaying this test puts the whole community at risk."

The CDC has not released information on how many Americans have been tested for COVID-19. The data was updated regularly on the agency's website until this week when the figures were removed.

In a call with reporters on Tuesday, Dr. Nancy Messonnier evaded a question about whether the narrow testing criteria early in the outbreak was linked to the limited availability in tests and potentially hindered the nation's response to the outbreak. She also would not name the cause of flaws in the early test kits, saying the investigation is ongoing.

"What we really need to focus on is where we are today," she said. " We need to be focused on what we're doing today to identify patients who are ill, make sure that they're getting appropriately treated and tested and make sure that we're protecting our communities."

It is unclear if those steps are being taken quickly enough as local health departments strain to keep up as the outbreak swells.

In Los Angeles County, a 34-year-old woman has been self-quarantining for two days after her doctor told her he suspected her high fever and pneumonia were caused by the novel virus. She has been waiting to hear from the public health department for next steps.

"I haven't been contacted, I haven't been tested," she said. "I'm not being treated and I'm still exposing people by staying here at home. I live with family — they have jobs, they have schools."

"I'm sick with something obviously," she said.

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