A Lakeville massage therapist is glad to hear that Minnesota's public health lab has the capacity to test for the novel coronavirus. Now she hopes they will finally test her.
The woman, who asked not to be identified to protect her privacy, has bunkered herself at her home for nearly two weeks after getting sick on a trip to Singapore. And while she might be getting better, she said she is frustrated the state has denied her requests for testing and is nervous about returning to work until she knows if the virus made her ill.
Her story reflects what will likely be growing demand for testing in Minnesota, particularly now that the virus has spread globally and is being passed person-to-person in the western United States. "This is my job; this is my life. I don't want to infect others. I can't understand why ruling out with a test is such a wrong thing to ask," the woman said.
Minnesota health officials said they expect more requests after they announced Monday that they no longer have to send lab samples to the U.S. Centers for Disease Control and Prevention. The state's lab can now test up to 100 samples per day.
State health officials said clinical judgments would perhaps result in tests of people who don't meet current CDC guidance. Whether a person has visited a country that has cases of COVID-2019, the name for the illness caused by this virus, doesn't matter as much now that there are U.S. cases, said Jan Malcolm, state health commissioner.
"If you have the underlying clinical symptoms, the travel criterion is not the rule-out that it was before," said Malcolm, who appeared at a briefing Monday with Gov. Tim Walz and state legislative leaders. She noted that updated guidance on whom to test was sent to doctors Monday.
Even the CDC guidance on whom to test is expanding. The CDC initially recommended testing of people with fevers or lower-respiratory symptoms who had traveled to China, or who had been in close contact with such travelers. On Thursday it added sick people with recent travels to Iran, Italy, Japan and South Korea — countries that are seeing growing numbers of cases. The CDC also now recommends testing for people hospitalized with lower-respiratory problems that can't be explained by other common causes such as influenza.
Some public health experts have criticized the U.S. for being too restrictive in its testing guidelines, which might have allowed the virus to enter the country and circulate unnoticed.
That appears to be the case in Washington state, where health officials late last week reported cases of infection involving people with no relevant travel histories. Malcolm said it's possible based on that experience that cases already exist in Minnesota, though the silver lining is that they must be mild cases if they haven't reached her attention.
The Lakeville woman traveled to Singapore on Jan. 29 to meet her daughter, who had been studying there, despite concerns about the virus and its impact on her health after radiation treatments late last year that could have weakened her immune system.
Concern in Singapore escalated by the day, and she was repeatedly required to take her temperature at her resort and other locations. Taxi drivers weren't wearing masks at first but all were wearing them by the time she flew home Feb. 10 via Tokyo and Seattle. She returned to work for a week but felt sick Feb. 19 and stayed home after that.
Nurses met her outside of a Lakeville clinic Feb. 21, gave her a mask and whisked her into a room. But after she tested negative for flu and strep, her doctor was told by the state health department that she didn't fit testing criteria for coronavirus.
"So I just went home," said the woman, who lives with her husband and two of her children.
Testing every suspect case isn't critical for treatment, because no vaccine or specific medication exists for the new coronavirus, said Kris Ehresmann, infectious disease director for the Minnesota Department of Health. Regardless of the type of infection, people with fevers and respiratory symptoms should stay away from school, work and public gatherings until they have been symptom-free for a full day, she said.
"Tested or not tested, that's the right thing to do," she said. "And when she's recovered, hey, then she's good to go."
There is no evidence that people are infectious after their fevers and symptoms go away, Ehresmann said. On Friday, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, recommended that people take one day after healing before going out in public.
Testing will be critically important for Minnesota as an early warning system, Ehresmann said. Positive tests in communities can alert the local schools to cancel classes, employees to work from home, or churches to provide services online.
"All those things can help slow down the spread," she said. "That's partly why we want to track what's going on."
Minnesota had previously sent lab samples to the CDC from five patients in the state whose symptoms and travel histories suggested they were at risk for COVID-2019. All five cases proved negative. The state had been receiving 60 calls a day about coronavirus in the last couple of weeks, though not all calls involved requests for testing.
Research has found that 80% of people with the novel virus suffer mild symptoms. Estimates of the death rate from infection are between 1 and 2%, which would make the virus more severe than common seasonal influenza. People who are elderly or have other health problems are at greatest risk.
Walz and legislative leaders urged calm as they develop state response plans, including coordinating with businesses, hospitals and long-term care facilities. A House committee hearing was set for Wednesday to evaluate budgetary needs to respond to the outbreak.
"This will get to Minnesota at some point," Walz said. "Preparation is the way we are able to contain it, that we are able to keep the numbers lower."
The Lakeville woman said it is difficult to feel calm, even if she has only a slight chance of being infected: "I think it's within my right and my responsibility for those people around me to just get the test."