Stateside's conversation with Sarah Cwiek

Michigan is dangerously short of COVID-19 test kits. And the tests themselves present all kinds of logistical problems for clinics and hospitals.

As medical teams try to test the highest-risk, most urgent cases, drive-thru testing is popping up throughout the state. Doctors hope drive-thru tests for the new coronavirus might address multiple problems at once. But deciding who should be tested, and what that process looks like, varies from place-to-place and at times, from person-to-person.

What’s the advantage of drive-thru testing?

Because the novel coronavirus is so contagious, medical officials are urging people not to come to hospitals unless their symptoms are serious enough to warrant immediate medical care. Drive-thrus offer the advantage of much more limited contact, greatly reducing the chances of infecting others.

In theory, a drive-thru test can also be a quicker option. But as we’ll see in a minute, that hasn’t necessarily been the case for many who have tried to do it.

What makes a person with coronavirus symptoms a candidate for this kind of test?

Some health systems, such as Henry Ford Allegiance in Jackson, require you to be showing symptoms and have had contact with a confirmed COVID-19 case, or a history of recent travel.

Spectrum Health in West Michigan requires a referral and appointment for a specific day and time, which you can get either from your physician or through their COVID-19 hotline.

University of Michigan/Michigan Medicine requires a thorough assessment through its hotline or a doctor’s referral, which could include a video visit with a doctor and eventual referral for testing. Their testing services are limited to Michigan Medicine patients and employees only.

Beaumont hospitals appear to be offering the most widespread testing. But they pre-screen patients curbside before sending them on to the testing site, as well as through their hotline.

“Right now, we don’t really have the bandwidth or the ability to test everyone,” said Nick Gilpin, assistant medical director for infection prevention at Beaumont. “Frankly, the state doesn’t have the bandwidth to test everyone. The [private] reference labs don’t have the ability to test everyone. So we have to make some pretty difficult clinical decisions on the front lines sometimes."

James Ziadeh, chief of emergency medicine at Beaumont-Royal Oak, said the focus is on the “highest-risk individuals.”

“Our elderly patient population, patients with immunocompromised conditions, hypertension, [or] coronary disease,” Ziadeh said. “Or [people who are] significantly symptomatic.”

But Beaumont officials also described the testing criteria as “fluid,” and it turns out being “significantly symptomatic” will not necessarily get you a test.

Two different experiences: Hal and Tina

Hal Newnan, 63, and Tina Louise, 43, both have symptoms of coronavirus. Both sought testing at Beaumont-Royal Oak. They had entirely different experiences.

Newnan said his symptoms started in early March with “a little sniffle.” That progressed to a sore throat,

fatigue, and shortness of breath.

“A feeling that my lungs aren’t right,” Newnan said. “It’s a feeling I’ve never had before and I’m 63 years old.”

Newnan never had more than a low-grade fever, but his doctor’s office told him to get tested. So he went to Beaumont, and after waiting in line for more than six hours, he was able to get the nasal swab test.

“During the course of this they explained that this will be tested for the flu and [then] for the coronavirus, if the flu test is negative,” Newnan said.

Newnan said his flu test came back negative, so he’s waiting on the COVID-19 results. He should know by the end of the week.

Meanwhile, Tina Louise has been sick since late February. She did test positive for strep throat, but after taking a full round of antibiotics, she still didn’t feel better. Her symptoms include a cough, fever, chest pain, and shortness of breath.

After receiving lots of messages from friends about Beaumont’s new drive-thru tests, she called the Beaumont hotline, then drove to the hospital. Her fever at that point was over 101 degrees. After going through the initial assessment, she was put in line to wait for the actual test. That took two hours.

But when she got up the next checkpoint, Louise said a nurse told her, “I’m really sorry, but you don’t really qualify for testing.”

Louise said she got upset. And she got even more upset when the nurse told her that if she really wanted to get a test, she could go to the emergency room.

“I don’t understand, because the messaging that we’re getting is don’t go to the ER unless you absolutely have to, because of how contagious this is,” Louise said. “Instead, go to these drive-in places and get tested, or triaged with urgent care or primary care. But try to avoid the hospital.”

The next day, Louise had a tele-medicine appointment with a primary care doctor. After hearing her symptoms, the doctor suggested a COVID-19 test, and told her Beaumont had drive-thru testing.

“And I kind of laughed a little, and was like well, I did that already and I got turned away,” Louise said.

Louise did call the Beaumont hotline again, but the nurse told her she still wasn’t likely to be tested—there just aren’t enough tests. She still hasn’t been tested.

The reality: even some who are “significantly symptomatic” won’t get tested

It’s not clear exactly why Hal Newnan got tested, and Tina Louise didn’t, even though her symptoms were more significant. It’s plausible that Newnan’s age played a role. But the reality is that so long as testing resources remain scarce, frontline clinicians have to make some difficult calls based on fluctuating criteria. Sometimes, those calls may not seem to make much sense.

The bottom line: if you have COVID-19 symptoms that are more than mild, call testing providers ahead of time to determine their screening criteria, and get assessed to maximize your chance of getting tested.

Health systems in Michigan currently offering drive-thru testing:

Beaumont Hospitals (Metro Detroit, 8 locations). COVID-19 hotline: 800-592-4784

Spectrum Health (West Michigan, 2 locations). COVID-19 hotline: 616-391-2380

Henry Ford Allegiance (Jackson). COVID-19 hotline: 313-874-7500

University of Michigan/Michigan Medicine (Southeast Michigan, 3 locations). COVID-19 hotline: 734-763-6336

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