Patty Baker started feeling ill on March 23. Her symptoms started with a sore throat and nausea, then a fever. The next day, she stayed home from work as her temperature rose to 102.
Soon came the shortness of breath, the tightness in the chest, and coughing that made Baker fear she had contracted the coronavirus now spreading across the U.S. For more than a week, the 52-year-old remained shut in her bedroom, where she slowly recovered.
Baker, who didn’t have health insurance even before her March 24 layoff, tried three times to get tested for coronavirus. She never got a test, she said, even after going through channels that officials say should allow someone like her to get tested.
Baker’s experience illustrates the obstacles that many residents have faced in getting coronavirus testing, even as the number of those tested locally for the virus rises. So far, approximately 3,000 Bexar County residents have been tested, City officials say.
More testing could provide valuable insight into how quickly the virus is spreading in San Antonio. Across the United States, data disparities over testing have hindered efforts to prepare for and slow the spread of the contagion.
“We do know that we need to emphasize wider assessment, wider testing for our city,” San Antonio Mayor Ron Nirenberg said in a Friday briefing.
Health experts around the world have credited countries such as South Korea and Germany with using mass testing to track and impede the spread of the virus. In these countries, mass testing has helped save lives by getting more infected people into isolation and reducing the speed of the contagion being spread. The U.S., meanwhile, has struggled with making testing available to everyone who needs it.
In San Antonio, testing has been slow to ramp up, but that could be changing. On Friday, Colleen Bridger, an assistant city manager and former Metro Health director, announced in a Rivard Report live interview event that testing would be available at the mass testing site at Freeman Coliseum even for those who do not have a doctor’s order.
“The problem is the protocol for administering the test has been very strict and narrow,” Nirenberg said. “So we have loosened that up.”
Residents with coronavirus symptoms can call the City’s hotline at 210-207-5779 to see if they qualify for an appointment to get tested. Also, nearly 40,000 residents have also used the City’s online self-screening tool to see if they should call the hotline and ask for testing. Of those 40,000, more than 8,700 people have been recommended for testing.
The latest Metro Health figures show 384 confirmed coronavirus cases, with 11 deaths. For the first time, the number of cases tied to the spread of the virus from person to person within Bexar County has exceeded the number of travel-related cases, at 117 to 102.
As of Thursday morning, approximately 1,500 people had been tested at Freeman. Private laboratories and the San Antonio Metropolitan Health District also have been testing. As of Friday, Metro Health’s lab had tested 671 Bexar County residents.
Testing Gap May Reflect Economic Disparities
One possible clue about testing disparities within Bexar County is the map of positive test results by zip code. Bexar County’s more affluent zip codes tend to have the highest number of confirmed coronavirus cases, a difference that could reflect a gap in access to health care or information about testing.
For example, the 78209 zip code, which is in Alamo Heights, has until recently had the highest number of cases. The median household income in that area is more than $72,000, according to U.S. census data. Compare that to the Southwest San Antonio zip code of 78226, where the median income is about $30,000 and there are no confirmed cases.
Several City Council members raised questions about testing and where it’s taking place at their meeting Thursday.
“That’s the concern in the neighborhoods: Is the reason why we don’t have as many is because we’re not getting tested?” said Councilwoman Shirley Gonzales (D5), whose district includes several low-income zip codes with little or no positive tests reported.
City and Metro Health staff are trying to better understand that possible disparity, Bridger said.
“We are looking at some areas, for example, on the South Side that don’t seem to have as many positive tests and trying to figure out if it’s because they don’t have access to testing or they just don’t have as many positive tests,” Bridger said. “We’re doing a more in-depth analysis of that data to figure out what’s going on there.”
The City also is looking at setting up alternative testing sites in areas with low testing rates, Bridger said. She said that people who believe they might have the coronavirus and call Metro Health’s hotline will be able to get tested at Freeman Coliseum, as long as they make an appointment.
That’s not what happened for Baker, who shared her story with the Rivard Report in a phone interview Thursday.
Baker thought she could go without health insurance for a while. The doctor’s office where she worked offered an insurance plan, but it was all employee-paid, she said. It would have cost her $100 per month she couldn’t afford. She decided she would wait until open enrollment in the fall on HealthCare.gov, the Affordable Care Act’s insurance marketplace.
“And then this hit me,” said Baker, who was laid off within days of getting sick after the office where she worked closed and cut staff.
As her symptoms worsened in late March, Baker at first wondered whether it was seasonal allergies. Maybe she had caught the sinus infection her son had contracted a couple weeks earlier. She lives at home with her adult children.
It was when she became feverish that she suspected coronavirus. She has asthma, a chronic lung condition that puts her in a higher risk group for suffering the worst effects of the virus that leaves people gasping for air.
“I started to get really scared then,” she said.
As her symptoms worsened, she visited CentroMed’s Eling Medical Clinic on Walzem Road, not far from her home in the Windcrest area. CentroMed specializes in providing affordable medical care to low-income and uninsured patients. It’s where Baker would typically go to see a doctor.
When she got there, screeners at the front door stopped her from going inside. They told her they weren’t seeing possible coronavirus patients at that clinic and gave her a number to call instead.
Next, she called a childhood friend who had become a doctor. He came to her home and listened to her breathing. She talked to him about getting a referral for coronavirus testing, but he told her it wouldn’t have made a difference anyway, she said. By then, her fever had broken.
“Although I did have all of the symptoms, I probably would have been sent home [from the emergency room] anyway because they were only hospitalizing people who were basically near death,” Baker said. “He said just to stay home, quarantine yourself, and if you find that you can’t walk from the bedroom to the kitchen without your lips turning blue or running out of breath, then go to the emergency room.”
Dr. Norma Parra is chief medical officer for CentroMed, which operates 23 clinics in the area. During the past few weeks, CentroMed has offered coronavirus testing whenever possible, but it’s been a “fluid situation” depending on testing supplies and lab turnaround times, she said.
In mid-March, CentroMed staff took coronavirus samples for about two weeks, sending their samples to LabCorp, a national laboratory chain. Eventually, it started taking up to 12 days to get results, she said. As of Friday, that lag time has led CentroMed to stop doing coronavirus testing, instead sending patients through the public health department.
“We realized that the faster results were coming through the Metro [Health] line, so the doctors started calling Metro [Health] to get screening through that service to get faster results for our very anxious patients,” Parra said.
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Parra confirmed CentroMed at one point started turning possible coronavirus patients away at the clinic doors. They had staff stationed outside, diverting people away from the clinic to lessen the chances that other patients and staff would get the virus, Parra said.
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CentroMed gave patients cards to help them make appointments at an upper respiratory clinic near Brooks on the Southeast Side, Parra said. Doing so allowed the clinic network to make the most use of its limited personal protective equipment like masks, face shields, and gowns. They ramped up their staff of licensed vocational nurses to help with the influx of phone calls, she said.
Baker said she was eventually referred to Metro Health’s coronavirus hotline. She called the number but said the person on the other end told her she wouldn’t qualify for testing at Freeman.
“Metro Health basically told me the same thing – you need to see a doctor before you can do anything,” Baker said. “That’s when I went home and basically cried and laid in bed.”
Had she managed to get an appointment to be tested at Freeman, there would have been thousands of coronavirus test kits waiting for people like her, according to City officials.
No Shortage of Test Kits
At the City Council meeting Thursday, Bridger told Council members that San Antonio has been receiving regular shipments of coronavirus test kits from the federal government – 5,000 a week for the past three weeks.
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Of those tests, 1,500 a week have been sent to Austin and El Paso, which have not been getting the shipments, Bridger said.
“For the perspective of comparison to other places throughout the U.S., we are doing pretty well with testing,” she said.
With approximately 1,500 people tested so far at Freeman, that leaves about 9,000 tests that have yet to be used, a statistic Councilman John Courage (D9) pointed out at the meeting.
“Why aren’t we testing more people?” Courage asked.
“We’re testing all of the people who call us and ask for testing,” Bridger responded.
One reason more people haven’t made appointments at Freeman is because testing has become more widely available elswhere, she said. Bridger estimated that 35 different San Antonio organizations, including hospitals, urgent care clinics, and some private practices, have been testing for coronavirus.
After hitting dead ends at CentroMed and the City’s hotline, Baker gave up on getting tested. She decided her best bet was to ride out her illness at home.
Isolation and Bleach
For more than a week, Baker stayed in her bedroom, with the door closed. Her daughter had bought some masks online before a nationwide mask shortage began, and she wore them whenever she’d come in to give her mother food and water. Her daughter wiped down the door knob regularly with water and bleach.
Eventually, Baker started to feel better. A few days ago, she was able to take a full breath early in the morning and hold it for 10 seconds without coughing. She feels fine now, she said.
One news story that terrified her during her illness was of a 17-year-old in Los Angeles with no health insurance who died after being turned away from an urgent care clinic. She feared the same would happen to her.
“What’s really, really scary is it could have taken a different turn,” she said. “If I had gotten worse, what would I have done? I would have ended up going to the emergency room and possibly being turned away.”