By CELIA LLOPIS-JEPSEN, Kansas News Service
TOPEKA, Kansas — In many parts of Kansas, people not sick enough for hospitalization still can’t find out if they have COVID-19.
Doctor’s offices and hospitals say access to coronavirus testing has improved in Kansas, but still remains out of reach for many people.
A clinic runs out of swabs to collect patient samples. A vendor postpones delivery of testing equipment. A private lab becomes backlogged.
Ascension Via Christi Health in Wichita is among hospitals trying to buy new 5- to 15-minute tests that received a temporary emergency greenlight from the U.S. Food and Drug Administration. But the best the system of hospitals and clinics can do for now is get in line, so it has contacted its suppliers.
“We have the equipment,” chief nursing officer Carla Yost said in an email, “but we do not have the test kits.”
For now, she says, those kits are heading to areas where the outbreak is more acute. So Ascension Via Christi is sending samples to its lab in Tulsa. Getting results takes about a day and a half.
“We have couriers running routes to and from our Kansas hospitals multiple times a day,” Yost said. “Seven days a week.”
As of last week, more than 6,500 Kansans had been tested for SARS-CoV-2, the virus that causes COVID-19. More than 550 had tested positive. The state has a dashboard that lets you explore how many people have been tested in each county.
Some doctors are raising concerns about false negatives — tests that suggest someone doesn’t have the virus when they are infected — and encouraging people with coronavirus symptoms who test negative to stay home anyway.
Is testing free?
Congress passed a law requiring most health plans to cover COVID-19 testing for now without cost to the patient. But patients could get bills anyway, Kaiser Family Foundation says.
Americans often end up at an emergency room outside their insurance network, or sometimes go to an in-network hospital or clinic only to find out later that the facility used out-of-network labs or staff. Patients might also get charged for other services in conjunction with their COVID-19 tests, the New York Times reported.
Uninsured people and people with low-quality health insurance should get the tests for free, too, under the same federal law, but that will take some legwork on the state's part. The Kansas News Service is seeking more information from Gov. Laura Kelly's office about what uninsured Kansans should do if they receive a bill in the meantime.
As for coronavirus treatment, many insurers may cover it, but they don’t have to. On Friday, Blue Cross Blue Shield of Kansas announced it would waive copays and deductibles for COVID-19 treatment for the next 60 days for plans fully under its control. (In other cases, employers will have the final say.)
How much testing does Kansas do?
At the state lab in Topeka, coronavirus testing took several hours at first. Staff worked 16-hour shifts, health secretary Lee Norman has said, but still got through fewer than 200 samples a day.
Last weekend, the Kansas Department of Health and Environment received equipment to ramp up to between 700 and 1,000 samples a day. State officials hope to get as many as 64,000 test kits soon.
Kansas has also ordered equipment and supplies for 45-minute tests and expects to receive that in the next few weeks.
Yet the specialized nose and throat swabs needed for collecting patient samples are in short supply here and elsewhere.
Private labs, local health agencies and hospitals in Kansas
Some hospitals have purchased testing equipment and kits, too. St Luke’s Health System in the Kansas City area set up in-house testing that cut wait time from a few days to hours. The University of Kansas Health System has had similar success.
But vendors can’t move fast enough to meet demand. Stormont Vail Hospital in Topeka expected to receive testing equipment early this week — then its supplier pushed back the delivery date to later in the month.
“We find that vendors will say that we've been ‘reprioritized’” for various coronavirus-related supplies, Stormont CEO Robert Kenagy said. “It's very difficult to get vendors to commit.”
For now, many clinics and hospitals use external labs. At least four such labs are processing tests for Kansas clinics and hospitals.
Community Health Center of Southeast Kansas uses a company with lab sites in Lenexa and St. Louis. As of this week, the center had plenty of supplies to gather patient samples, but getting back results was taking five to seven days, vice president Christi Keating said.
Who gets tested through which lab?
As of April 1, private labs had identified about 75% of known COVID-19 cases in Kansas.
The state lab may sometimes be a faster option, but limited resources have forced Kansas to limit who it tests.
Clinics and hospitals can send samples to the state lab only for patients that fit certain criteria, such as health care workers or nursing home residents with coronavirus symptoms. Samples from other patients go to private labs.
What about those drive-through testing sites?
Sites such as this one in Wyandotte County where patients can pull up and give a sample to a waiting health worker are springing up across the state.
So far these are not places to show up unannounced. You’ll need approval and an appointment through a health care provider first. Criteria vary by provider, and some post them on their websites.
Who can get tested?
Whether to order the test in the first place remains up to your health care provider. Because of the testing bottleneck, the Centers for Disease Control and Prevention recommends prioritizing some patients over others, but its guidelines aren’t binding.
If your symptoms aren’t serious, your doctor or nurse practitioner may simply ask you to stay home, care for yourself and call if you get worse. Most people test negative for COVID-19, and most cases of it are mild. Research from other countries suggests about 1 in 5 patients get sick enough to need hospitalization.
“It would be nice if we had as many COVID-19 tests as we do influenza tests, but it’s not there,” said Jim Zauche, a doctor at Garden City’s St. Catherine Hospital.
His hospital is focusing on testing people sick enough for hospitalization. So for Finney County residents with milder symptoms, he recommends calling the public health department or your doctor before showing up at the ER in search of a test.
The CDC has a list of coronavirus symptoms and a self-check tool to help people decide when to seek medical care.
What about tests for people without symptoms?
The question of whether to push for broader testing remains a matter of debate, with some experts arguing the U.S. shouldn’t ignore people with few or no symptoms.
Kansas ultimately wants to launch population studies that include seemingly healthy people, to better understand how common the virus is in different areas, pinpoint hotspots and stop the spread. Johnson County has plans for a similar effort.
Officials were hopeful this week that enough test kits would come through to help the state achieve that.
“It will allow us to change our thinking,” Norman said. “Until that time, social distancing is the name of the game.”
What about false negatives?
A Yale University medical professor is among those urging caution among people told they don’t have the coronavirus, and warning of a potentially significant rate of people testing negative despite having the illness.
KU Health System has double-tested 34 patients so far to check accuracy, and got the same results in each round of testing.
But the problem of false negatives may have less to do with the actual test and more to do with sample collection, which often involves inserting an uncomfortable swab very deep into a person’s nose. That makes training medical workers vital, or all bets are off.
“You’re putting … the swab back to about where your ear is,” KU infectious disease specialist Dana Hawkinson said. “If you have a nice nurse who doesn’t want to hurt you, that could be a problem because the sampling may not be good.”
Celia Llopis-Jepsen reports on consumer health and education for the Kansas News Service. You can follow her on Twitter @celia_LJ or email her at [email protected]. The Kansas News Service is a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio focused on health, the social determinants of health and their connection to public policy.