Joe Connolly and his family hadn’t been up for long when an email stopped them in their tracks.

Connolly’s mother-in-law, who was visiting them in San Antonio, had gotten word from her church in Houston that 10 days earlier, she had attended the same Mass as a person infected with novel coronavirus.

She’d sat in the same section at St. Cecilia’s Catholic Church, but not near enough to be considered at a high risk of having the virus. She also had no symptoms.

Still, the news set everyone in the house on edge. Connolly and his wife, Emily, have a 5-month-old girl whose immune system is fragile and untested. There were scant reports to suggest children were at risk of serious complications, but much about the virus remains a mystery.

After the visit ended sooner than planned, the couple spent the rest of the weekend weighing what to do next. Would they be putting others at risk if they went to church the next day, and work that upcoming week?

Eventually, they settled on what seemed like a reasonable course of action: They would self-quarantine and ask health officials for guidance.

More Information Local hotline Call the San Antonio Metropolitan Health District for information about the coronavirus: 210-207-5779 (Monday to Friday 8 a.m. to 5 p.m., and Saturday and Sunday, 10 a.m. to 3 p.m., English and Spanish)

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That’s when the trouble began.

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Over the past several weeks, Connolly and other San Antonians wanting to know whether they were infected with coronavirus have grown frustrated as they encountered local limits on testing and miscommunication between the Metropolitan Health District and doctors’ offices.

Connolly was baffled when he tried to find out how he and his wife could get tested. It was like he was stuck in a “cyclical phone tree” between his doctor’s office and Metro Health, each telling him to call the other.

In the end, after he was informed he was not a candidate for testing, he said he couldn’t help but worry whether the region was prepared for the continued spread of the virus.

“It did not instill any confidence. All I can really do is wash my hands and pray that this thing doesn’t get out of hand,” said Connolly, 30, who works in contract administration.

Metro Health said it has taken steps to improve early issues with its COVID-19 phone hotline that caused confusion for callers.

But mounting public dissatisfaction with testing has also been exacerbated by a mismatch in expectations. People who have been in proximity of someone with coronavirus may want to get tested to ease concerns that they may be a carrier of the virus. Testing became available in San Antonio only last week, and federal guidelines have dictated it largely be used to diagnose the sick, not for screening purposes, which indicates how widespread the infection is.

“As we’ve heard nationally and throughout the state, there are a finite number of tests,” said Jennifer Herriott, Metro Health’s assistant director of community health. “We do need to be using those for people who are most likely to be positive. We cannot test everyone.”

No responsibility

That weekend, Connolly emailed his boss to tell him he would work from home. He and his wife found Metro Health’s coronavirus hotline, but they were dismayed to learn its hours of operations only were from 8 a.m. to 5 p.m. on weekdays.

When Connolly called Monday, he was told he could wait it out at home until Wednesday, two weeks after his mother-in-law’s potential exposure, by which point she would have gotten sick if she had the virus. Connolly relayed the information to his employer. He heard back from a supervisor, who wanted either a negative test result or a doctor’s note before Connolly would be allowed to return.

This time, Connolly called the office of his primary care provider, who promptly referred him back to Metro Health as the area’s authority on testing. They gave him the wrong phone number to call, so he wound up at the hotline he’d called earlier. After a quick succession of transfers, he was told a doctor needed to do the testing. Bemused, he explained that his doctor had said the opposite.

Eventually, he heard back from a doctor at Metro Health, who explained he was at a very low risk of having the virus and could safely return to work. Connolly thought it was a “flimsy answer,” but it was the best he had gotten so far.

“What was frustrating was that nobody took responsibility, and it didn’t seem like they had any interest in calling the other office and sorting it out,” he said.

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Daniel Demers was similarly dissatisfied with his inability to get tested for the virus about a week earlier.

On the evening of Feb. 29, the 35-year-old software engineer went to meet his girlfriend on her break at North Star Mall, where they ate at the food court from 6 to 7 p.m.

It wasn’t until later that he learned he could have been there at the same time as a woman who had fallen ill with the virus earlier that month, during her quarantine at Joint Base San Antonio-Lackland.

The woman, who had been evacuated from Wuhan, China, had been released from a hospital earlier that day, having tested negative twice. But a third test that came back later that evening showed she still had low levels of the virus in her body. Since she appeared to have recovered, it’s not clear whether she was still infectious, but she was returned to the hospital within hours.

The mix-up angered local officials, who publicly shared a timeline of the woman’s movements that day, including the two hours she spent at the mall, much of it at the food court.

When Demers learned about the incident the following Monday, he rushed home from work. He called his doctor, who said his office didn’t have testing available and advised him to go to the hospital if he developed a high fever.

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Demers, whose two children are 5 and 6, thought that wasn’t good enough. He called his ex-wife and told her she’d need to take the kids because he’d potentially been exposed to coronavirus. When he called Metro Health, he was put through to the epidemiology department.

“I was pretty adamant that I was probably right next to this woman,” Demers said.

But the department only was facilitating testing for people with symptoms.

Worried, he decided to work from home as he self-quarantined. From there, he heard the mall had temporarily shut down for extra cleaning, which only increased his desire to get tested.

“It’s been a little disheartening that I can’t even get confirmation; they can’t even tell me if I have it,” said Demers, who hopes to see his kids again Monday. “I felt like I had to disrupt my own life because of a lack of knowledge and a lack of available testing.”

Those with symptoms, such as Carolyn Wilson, appear to have much better luck in getting quick access to a test. On Thursday, the 67-year-old interior designer went to her doctor’s office for a routine physical,

Days before, she’d returned from a trip to California, where she’d taken her grandson to Disneyland. Upon returning to San Antonio, she developed a sore throat, coughing and a severe headache.

When she relayed her symptoms and details about her recent trip, the physician’s assistant quickly left the room. Office staff talked with her through the door as they donned protective gear and located a test kit.

Her test results were negative but her doctor wants her to self-quarantine for another week.

Confusion

Herriott, of Metro Health, acknowledges there were some early bumps in the road with the hotline that contributed to the public’s confusion about who could get tested, and how.

When the hotline went live March 5, three people were taking calls, about 60 a day. Many of the questions were about the availability of testing. The hotline also started getting calls from people like Connolly, whose employers wanted them medically cleared before returning to work.

Herriott said such a requirement is not helpful for people who have never tested positive.

Local doctors kept directing worried patients to the hotline. Meanwhile, Metro Health staff were telling callers that physicians were the ones who would have to order a test and collect nose and throat swabs for it.

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As a result, the department updated its script to give the public and local health care providers clearer guidance on the testing process. Metro Health is also exploring opening a drive-through testing site, where it could collect specimens for coronavirus testing directly, Herriott said.

On Wednesday, the department expanded the number of available lines to eight. Even so, the hotline was flooded with more than 300 calls Friday, after the city’s first travel-related case of coronavirus was announced by local officials. The hotline now has limited hours on weekends, and it could further expand hours, Herriott said.

The department also revised its testing criteria Saturday to allow more people to get tested. Previously, testing was recommended only for those with recent travel to China and Iran, two countries with large outbreaks. The new guidelines have removed travel history and now focus largely on symptoms like fever, coughing and shortness of breath.

Testing capacity

Like elsewhere in the U.S., delays in widespread coronavirus testing in San Antonio and Texas were fueled by early problems with test kits distributed by the CDC.

In February, the labs at the state health department and Metro Health initially received test kits from the agency. But both labs ran into issues with some components that interfered with accurate results.

It took several weeks for the problems to be resolved. As a result, testing did not become available at the state health lab until March 5 and through Metro Health until Monday.

The state’s network of public health labs, which use the same test as CDC, hopes to automate part of the testing this week so that the labs can process 500 specimens per day, according to the Texas Department of State Health Services. That includes about 70 a day at the Metro Health lab.

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Still, it appears public health labs’ capability will soon be dwarfed by that of commercial laboratories, which may end up conducting the bulk of testing moving forward. Private labs like Quest Diagnostics have developed their own test and have estimated that the commercial lab industry as a whole could conduct 280,000 tests a week across the country by the end of the month.

In addition to kit scarcity, testing has been limited by strict guidelines issued by the Centers for Disease Control and Prevention, which at first restricted testing to people who had relevant symptoms and a travel history to certain foreign countries. Earlier this week, the health agency disclosed it had conducted just over 11,000 tests since the outbreak began.

That number is in sharp contrast to the level of testing done in South Korea, where tens of thousands of people were swabbed to learn how widespread the virus was in communities, an approach known as surveillance testing. No such effort has been undertaken in the U.S., where testing has largely been used to confirm cases in those who already appear to be sick.

It’s a figure that has alarmed some federal officials, including U.S. Rep. Lloyd Doggett, a San Antonio Democrat, who last week questioned CDC officials about the scarce availability of testing. Doggett said he is also worried that components in the kits, some of which come from China, could run out.

“We need to build to a system where we have the capacity to do 10,000 or 11,000 tests a day, not 11,000 over weeks,” Doggett said. “This virus will spread and hurt and kill more people because we haven’t identified where it is already.”

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As limited testing became a major sticking point in the federal government’s response to the coronavirus epidemic, officials in Texas have vowed to ramp up testing soon. On Friday, Gov. Greg Abbott said the state and the CDC have tested 220 Texans so far. The state is looking to expand its capability through drive-through test sites, the first of which opened last week in San Antonio for first responders and health care personnel.

Mark Wade, who has served as Metro Health’s laboratory services director since 2008, said testing is important for showing the level of disease in a community. But once the virus becomes truly widespread, he said, it may not be practical for health care providers to test every single person.

If a patient has symptoms but tests negative for the flu and other respiratory illnesses, doctors may treat it as coronavirus without conducting further testing.

Lauren Caruba covers health care and medicine in the San Antonio and Bexar County area. Read her on our free site, mySA.com, and on our subscriber site, ExpressNews.com. | lcaruba@express-news.net | Twitter: @LaurenCaruba