Dennis Smith’s 66-year-old wife — released recently from nursing care, overweight and suffering from a lung infection — was told Tuesday that she didn’t need a coronavirus test.

Stacey Snyder’s son — a 23-year-old public school teacher in Mount Pleasant who was hospitalized last week for pneumonia — was also denied a test.

And Dr. Daryl Granner’s neighbor — who had coffee with an Iowa City traveler to Egypt who was shortly thereafter diagnosed with COVID-19 — has gone untested despite requesting it for more than a week.

They are among the Iowans frustrated with testing criteria they fear may be jeopardizing human life in the midst of a pandemic. Meanwhile, the state's public health department is releasing less information about test results than officials in some other states.

The Iowa Department of Public Health, the main agency tasked with overseeing the state's response to the coronavirus, did not immediately respond to a request for comment Wednesday regarding complaints about the lack of testing.

In recent days, the department has provided general information about Iowa's testing capabilities.

On Wednesday. Gov. Kim Reynolds released a short video underscoring the message that "not everyone needs to be tested."

Dr. Caitlin Pedati, the public health department's state medical director and epidemiologist, sat with the governor to answer questions about testing during the video.

Pedati said most people who get the virus will have mild symptoms and should just stay home. When people have more severe symptoms and need to be hospitalized, they should be tested so doctors know how to treat the illness and what kind of protective equipment to use.

They emphasized that tests and protective equipment are in limited supply.

Dennis Smith tried to follow the rules to get his wife, Molly, tested.

Molly Smith’s friends and family phoned211, a community information and referral service. An operator told the Des Moines family that she didn’t need to be tested because she didn’t have a fever, Dennis Smith said Tuesday.

“It’s hard for me to believe that a person with my wife’s profile of severe physical disabilities, a person just discharged from skilled nursing, is told she doesn’t need a test,” he said. “She has all of these red flags with her condition, but apparently the state has so few resources to test people that unless you meet every last criterion for coronavirus, they aren’t apparently going to test you.”

► Coronavirus in Iowa: The latest news on the spread and impact of COVID-19

Limited state testing

Iowa public health officials have gradually shifted their approach to coronavirus testing.

At first, the State Hygienic Laboratory at the University of Iowa was the sole facility testing Iowans for the virus, starting on Feb. 27 when it received the testing materials. The state-based testing meant the Iowa Department of Public Health shared how many people had been tested and the results of both positive and negative tests on its website.

In the days after Reynolds announced the first cases of coronavirus in the state, public health officials said the laboratory had materials to test 500 people.

On March 12, a spokeswoman for the laboratory said supplies had dwindled, and there remained only enough materials to test about 150 people. That same day, the public health department confirmed that several private, out-of-state companies were now collecting specimens from Iowa health care providers for testing.

The expansion of testing from national companies means delays before Iowans learn some coronavirus test results. The State Hygienic Laboratory released results within about 24 hours after testing. With private companies, specimens must be sent out of state for confirmation. That process can take several days.

Pedati, the public health department's state medical director, said March 13 that testing capacity had increased again, and the new estimate was that the state had testing materials for about 850 people.

Across the nation, despite federal officials saying the test is available to all, a lack of testing materials and differing procedures have been reported. President Donald Trump said Tuesday that the federal government was working to expand testing.

Reynolds on Monday announced the addition of a second shift to the hygienic lab to expand testing capabilities from 54 to 108 tests per day. The state is prepared to add a third shift to run tests around the clock, she said.

The state lab will perform coronavirus testing only when certain criteria are met, under guidelines that remained in place this week. Those criteria mostly apply to hospitalized patients with a fever or respiratory failure and people who have traveled to countries with travel health warnings.

Hospitals do not need approval from the Iowa Department of Public Health to administer a test, but the hygienic laboratory will not run the tests unless they meet the criteria, said Amy McCoy, a spokeswoman for the department.

Reynolds said Monday that she is exploring drive-thru testing, which is being set up in other states. Some health care systems in the state have begun offering mobile services aimed at quickly checking patients for COVID-19. But the services may be limited to certain patients.

"That's a priority of mine," Reynolds said about drive-thru testing. "We're working on it."

Jennifer Killion, an Ames doctor, is concerned that testing criteria used in Iowa are too narrow to properly detect the spread of coronavirus in the community. Proper detection will help identify those who are infected and prevent spread to vulnerable populations, she said.

Doctors in Iowa can order private tests on patients who are ill, but that takes additional steps and results take about five days, she noted. Testing is also constrained by limited supplies and personal protective equipment, Killion said.

“If we mostly only test hospitalized patients, my concern is at that point — because they usually need hospitalization a week into it and since only 10 to 20 percent need hospitalization — you could be looking at 100 cases in the community by the time you diagnose that one patient in the hospital,” Killion said.

Iowa releases less information

Iowa’s criteria for coronavirus testing and the information its state health officials publicly report about the tests are far narrower than in other states reviewed by the Des Moines Register.

In California, the state provides information on about two-dozen laboratories that are testing for the disease in a process the state says has made 24 million applicants eligible for testing. And in Florida, health officials are recommending tests for virtually anyone who is experiencing symptoms or is in an area where there is a confirmed community spread.

Florida, unlike Iowa, is also publicly reporting more specific demographics about the tests, including the total number of people tested, whether they are a resident of the state, age ranges and whether they were tested by a state or private laboratory. The state also lists whether those infected have traveled, have had contact with a confirmed case or are still "under investigation" on those criteria.

National labs that have begun running tests for Iowa are to report all positive tests results to the state, Reynolds said. However, state officials no longer have a count of pending tests or negative tests, she said.

“We will continue to report our positive cases and the county of residence, but we will no longer be able to provide information regarding any known risk factors or contact information related to the positive cases,” Reynolds said Monday.

On Tuesday, the state released information that six more people had tested positive for the virus, and on Wednesday announced nine additional positive tests, for a total of 38. Both were single-day highs.

► More:Here's a map of the coronavirus cases in Iowa

The state's news releases did not specify the individuals' ages or genders. They did not say whether the individuals had traveled to high-risk countries or had been in contact with other people identified as infected with coronavirus or whether their cases were considered instances of community transmission, the term used when no easily identifiable point of origin has been determined.

But others in Iowa are filling in some of the gaps.

Don Morrison, an Iowa City-based DJ who performed at about 10 events in Iowa City and Cedar Rapids since Feb. 28, tested positive for COVID-19 on Sunday, according to a statement from Star Entertainment, the company he runs. The company said he was self-quarantined at home Tuesday after being treated at University of Iowa Hospitals & Clinics over the weekend.

A local official in Pottawattamie County, where one of the first cases of coronavirus was identified, shared that a local Panera Bread was being cleaned to ensure that patrons who may have come in contact with the infected individual were not impacted.

The Urbandale Community School District announced Monday that one of its employees had tested positive. The diagnosed individual works at Karen Acres Elementary, the school district said, but it withheld other identification out of concern for the person's confidentiality, according to the announcement.

'Information is power'

Snyder,the mother of the Mount Pleasant teacher, said her son tested negative for the flu but remained ill last week. Doctors declined to administer the coronavirus test since he had not traveled out of the country or been in known contact with another person who tested positive for the virus, she said.

Snyder said she attempted to bypass the criteria used by the State Hygienic Laboratory by contacting her state legislators and the governor’s office, to no avail.

Her son improved this week and was released from the hospital on Sunday. Snyder no longer believes he has coronavirus, but said the situation underscores a serious public health crisis in needing to better identify cases and isolate people who are sick with the virus.

“Information is power, and we don’t have the right pieces of information to make sense of that,” Snyder said. “I think that would calm a lot of people’s fears and uncertainties if we had proper testing. Just to know you don’t have it changes how you can prepare the rest of your days in this quarantined time.”

Benjamin Gabriel, an Iowa City resident, had been seeking a coronavirus test for more than a week after an illness that included a persistent cough, occasional fever and nausea. After several online chats with health care workers over several days, he was sent to an ER on Monday with chest pain, where he was finally tested.

The next day, he learned his results were negative for the virus. He was back home by then and sat on the floor when he heard the news. He began to cry in relief.

"If it took somebody as sick as me that long to get the test, there's got to be a lot of sick, scared people out there," he said.

Correction: An earlier version of this story had the incorrect day for Benjamin ​​​​​​​Gabriel's ER visit and test results. He visited the ER and received results on Tuesday.

The state lab's testing criteria

The State Hygienic Laboratory will only perform coronavirus testing when certain criteria are met:

Hospitalized patients with fever and respiratory failure and no alternate diagnosis.

Hospitalized older adults (those older than 60) with fever and respiratory symptoms and chronic medical conditions.

Any person with household contact with a laboratory-confirmed case of COVID-19 in the 14 days before becoming ill with fever or respiratory symptoms.

Any person with a history of international travel to a country with a level 3 CDC travel health warning or who has taken an international cruise in the 14 days prior to becoming ill with fever and respiratory symptoms and no alternate diagnosis.

Source: Iowa Department of Public Health

Jason Clayworth is an investigative reporter at the Des Moines Register. He can be reached at 515-699-7058 or jclayworth@dmreg.com.

Barbara Rodriguez covers health care and politics for the Register. She can be reached by email at bcrodriguez@registermedia.com or by phone at 515-284-8011. Follow her on Twitter @bcrodriguez.

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