UPDATE: Dr. Kelley Moon and her patient have both tested negative. The Nacogdoches family physician learned Monday and her patient was told Tuesday. Moon said she has no regrets for taking a stand to demand testing. "I would have done it all again."

On March 15, Dr. Kelley Moon arrived at the Nacogdoches Memorial Hospital emergency room to say her ailing patient, with all the tell-tale signs of the new coronavirus, would soon be arriving and needed testing.

But what instantly caught the nurses’ attention was Moon’s own condition.

A fixture in the small East Texas community, the 49-year-old family physician was pale, feverish and seemed to be struggling for breath behind her medical mask. “Maybe you need to be tested,” they told her.

“It probably wouldn’t hurt,” she agreed. Although she knew she was sick, she worried less for herself and more for the 150 patients who come to her clinic each week. How far could the potentially deadly virus spread in her city of 33,000 if she was infected?

And so it began, a harrowing eight-hour battle for testing for a doctor and patient in one regional hospital.

As day turned to night, Moon and her patient, a young woman in her 30s whose condition was deteriorating, were denied testing multiple times. Although both exhibited symptoms, they did not meet all of the strict Centers for Disease Control criteria, including traveling to known disease hotspots or having proven direct contact with someone who tested positive.

Moon insisted that the hospital keep calling the CDC hotline to ask again if they could be tested. As a doctor, she even called on her own. The agency, though, would not budge. She said one person even told her, “nothing is going to change my mind.”

Fed up, Moon released a chilling video to Facebook from inside the ER. “I can’t breathe,” she said, her voice a hoarse whisper, “God help us.”

The hospital declined to comment directly on the case, citing patient privacy, but offered a statement saying it has consistently followed recommendations from the CDC and the Texas Department of State Health Services.

“Memorial Hospital leadership and health care providers are adhering to the most up-to-the-minute recommendations on testing protocols and have been from the beginning of this ever-evolving situation,” the hospital said.

Doctors across Texas and across the nation say what happened to Moon is far from isolated and should serve as a testament to just how elusive testing remains, even for those on the front lines of the pandemic - the very people who may need it most.

It remains unknown how many health care workers in this country are already infected, but the daily risk–and fear–is real.

The American College of Emergency Physicians, the organization that represents about 31,000 emergency room doctors, said two physicians are in critical condition after contracting the virus. One is in his 40s in Washington, the other, 70, is in New Jersey. CNN reported at least nine health care workers had tested positive for the virus with 20 more presumed positive. It was not disclosed where those cases occurred. And on Friday a Houston doctor said a fellow emergency physician and friend had just tested positive.

The virus has afflicted thousands of health care workers globally. China’s National Health Commission last month said 3,300 health care workers were infected and at least 13 died. On Monday, the Italian Department of Infectious Disease said nearly one in 10, or 2,339, of the 25,000 cases in that country had struck health care workers.

Dr. Alison Haddock, assistant professor of emergency medicine at Houston’s Baylor College of Medicine and emergency room physician at Ben Taub Hospital is worried.

"If we lose our front line," she asked, "who will take care of us?”

Test kits scarce

CDC officials and the White House, under sharp criticism, have promised more robust testing with greater availability and loosened criteria, including latitude for doctors to ask for testing for their patients.

And in fact, testing has ticked up dramatically in recent days, mostly because of the introduction of private lab testing and the access of drive-throughs. At one such site in Houston the line of cars on Thursday stretched for miles.

On March 13, Gov. Greg Abbott said just 220 tests had been conducted in all of Texas. By Saturday that number had jumped nearly thirtyfold to 6,500 statewide.

But so, too, has the staggering march of the virus. As of Saturday, the number of cases in the U.S. had topped 25,000 with nearly 300 deaths. In Texas there were 608 known cases by Saturday night, rising by more than 188 in a matter of hours, according to a Houston Chronicle analysis.

On the same day Moon struggled to get tested, officials at a press briefing in Washington said testing priority will go to senior citizens and medical professionals with viral symptoms to avoid “paralyzing” the health care system.

But doctors say in the days since, it is simply not happening, or at least not consistently.

SUPPORT OUR JOURNALISM: Help our journalists uncover the big stories like this one. Subscribe today.

“The ER reality on testing is (that) it has not been adequate and does not match the rhetoric,” said Haddock, who added she was not speaking of her hospital's handling of the crisis, but rather basing her assessment on conversations she has had with colleagues across the nation who are frustrated with the mixed messages coming from the White House and public health officials.

Others say the lack of available testing is compounded by a lack of adequate protective clothing and equipment for front-line doctors. Across the nation doctors are reporting rationing and reusing equipment.

The CDC changed its guidance to doctors, saying that regular surgical masks are an “acceptable alternative” to the more expensive, custom-fitted N95 masks because supply of the latter was running out. The N95 respirators filter out about 95 percent of airborne particles while looser-fitting surgical masks only limit exposure, health officials say.

Some doctors interviewed by the Chronicle said they worry they carry the virus and do not yet know. They talked of colleagues who now sleep and eat in separate spaces from their families. Others have sent children away to live with relatives.

Haddock changes out of her scrubs before getting into her car and then strips down again once home, throwing everything into the laundry before heading straight for the shower.

“Our country knew this was coming,” she said, “why were we so slow to respond?”

Kelley Moon admits she was a skeptic, thinking the predictions of a looming health crisis were overwrought. “I had been on the side of, Ok, guys. We need to chill.”

It all changed just over a week ago.

On March 11, she was diagnosed with strep throat and prescribed antibiotics. The next day a woman with the symptoms similar to COVID-19 came into her two-doctor clinic but was diagnosed with the flu. Moon was home sick at the time and did not treat the patient.

On March 13 Moon met with a colleague who was worried he had been exposed to the virus at a conference and asked about testing. It suddenly hit her: she was unprepared if this thing was spreading. She called the hospital to find out what to do if she suspected a patient had contracted the virus.

She was told that a series of other ailments must be ruled out first. If all tests are negative, the hospital could still only test for the virus if the patient met all other CDC criteria, such as specific symptoms, recent travel or direct exposure to someone who had tested positive.

By March 14 her staff was worried. The patient diagnosed with the flu had come back and seemed sicker. Was it the virus? Were they all at risk? The next morning Moon called the patient and told her to meet her at the emergency room.

Moon also was still sick. After five days, the antibiotics had not blunted her fever or cough. If she also had the virus she had no idea how or when she was exposed. Soon both doctor and patient were in separate hospital isolation rooms. Both underwent a battery of tests. Moon still tested positive for strep throat and the other woman’s chest x-ray showed pneumonia. That knocked them out of eligibility for coronavirus testing, she said she was told.

Back to Gallery Texas doctor on pandemic's 'front line' wages harrowing,... 66 1 of 66 Photo: Brett Coomer, Staff photographer 2 of 66 Photo: Jon Shapley, Staff photographer 3 of 66 Photo: Brett Coomer, Staff photographer 4 of 66 Photo: Karen Warren, Staff photographer 5 of 66 Photo: Karen Warren, Staff photographer 6 of 66 Photo: Karen Warren, Staff photographer 7 of 66 Photo: Melissa Phillip, Staff photographer 8 of 66 Photo: Jason Fochtman, Staff photographer 9 of 66 Photo: Yi-Chin Lee, Staff photographer 10 of 66 Photo: Yi-Chin Lee, Staff photographer 11 of 66 Photo: Mark Mulligan, Houston Chronicle / Staff photographer 12 of 66 Photo: Yi-Chin Lee/Staff photographer 13 of 66 Photo: Yi-Chin Lee, Staff photographer 14 of 66 Photo: Brett Coomer, Staff photographer 15 of 66 Photo: Brett Coomer, Staff photographer 16 of 66 Photo: Marie D. De Jesús, Staff photographer 17 of 66 Photo: Karen Warren, Staff photographer 18 of 66 Photo: Karen Warren, Staff photographer 19 of 66 Photo: Mark Mulligan, Staff photographer 20 of 66 Photo: Mark Mulligan, Staff photographer 21 of 66 Photo: Jon Shapley, Staff photographer 22 of 66 Photo: Melissa Phillip, Houston Chronicle / Staff photographer 23 of 66 Photo: Melissa Phillip, Staff photographer 24 of 66 Photo: Melissa Phillip, Staff photographer 25 of 66 Photo: Melissa Phillip, Staff photographer 26 of 66 Photo: Elizabeth Conley, Houston Chronicle / Staff photographer 27 of 66 Photo: Yi-Chin Lee, Staff photographer 28 of 66 Photo: Yi-Chin Lee, Staff photographer 29 of 66 Photo: Brett Coomer, Houston Chronicle / Staff photographer 30 of 66 Photo: Brett Coomer, Houston Chronicle / Staff photographer 31 of 66 Photo: Brett Coomer, Houston Chronicle / Staff photographer 32 of 66 Photo: Marie D. De Jesús, Staff photographer 33 of 66 Photo: Elizabeth Conley, Houston Chronicle / Staff photographer 34 of 66 Photo: Karen Warren, Houston Chronicle / Staff photographer 35 of 66 Photo: Jason Fochtman, Staff photographer 36 of 66 Photo: Jason Fochtman, Staff photographer 37 of 66 Photo: Jason Fochtman, Staff photographer 38 of 66 Photo: Mark Mulligan, Staff photographer 39 of 66 Photo: Michael Wyke, Contributor 40 of 66 Photo: Michael Wyke, Contributor 41 of 66 Photo: Jason Fochtman, Staff photographer 42 of 66 Photo: Jason Fochtman, Staff photographer 43 of 66 Photo: Jason Fochtman, Staff photographer 44 of 66 Photo: Jason Fochtman, Staff photographer 45 of 66 Photo: Jason Fochtman, Staff photographer 46 of 66 Photo: Brett Coomer, Staff photographer 47 of 66 Photo: Brett Coomer, Staff photographer 48 of 66 Photo: Elizabeth Conley, Staff photographer 49 of 66 Photo: Elizabeth Conley, Staff photographer 50 of 66 Photo: Elizabeth Conley, Staff photographer 51 of 66 Photo: Elizabeth Conley, Staff photographer 52 of 66 Photo: Karen Warren, Staff photographer 53 of 66 Photo: Brett Coomer, Staff photographer 54 of 66 Photo: Brett Coomer, Staff photographer 55 of 66 Photo: Karen Warren, Staff photographer 56 of 66 Photo: Marie D. De Jesús, Staff photographer 57 of 66 Photo: Jason Fochtman, Staff photographer 58 of 66 Photo: Jason Fochtman, Staff photographer 59 of 66 Photo: Mark Mulligan, Staff photographer 60 of 66 Photo: Yi-Chin Lee, Houston Chronicle / Staff photographer 61 of 66 Photo: Steve Gonzales, Houston Chronicle / Staff photographer 62 of 66 Photo: Marie D. De Jesús, Staff photographer 63 of 66 Photo: Mark Mulligan, Staff photographer 64 of 66 Photo: Steve Gonzales, Staff photographer 65 of 66 Photo: Melissa Phillip, Staff photographer 66 of 66 Photo: Brett Coomer, Staff photographer



































































































































By 7 p.m. she took a stand. She announced she was not leaving without getting tested. She texted her patient down the hall and asked if she was in for a fight. She was.

Finally, the hospital found a solution. The testing for both women could be conducted by LabCorp, a private company, which allowed the hospital to circumvent CDC rules.

Finally on March 24, Moon learned she was negative for the virus. Her patient, whose results were released the following day, was also negative.

Moon and her patient lived for more than a week in their homes under self-quarantine. The doctor's son, her boyfriend, and his daughter are all living mostly in separate rooms.

The doctor said she felt helpless away from her medical practice. She advised patients through social media. The other doctor at her clinic continued to see patients in person because he had no symptoms. But he took his temperature regularly.

Moon knows she ruffled some feathers in her community but has no regrets. She is at turns angry, frustrated and frightened for her patients and her profession. “Maybe at the end of the day,” she said, “ someone will hear my voice and protect us.”

jenny.deam@chron.com

@jenny_deam