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For people who missed out on coronavirus testing, what comes next?

A Hernando County woman said she was never tested but is certain she had COVID-19. Scientists are working on tests that could help people like her.
 
Health care workers test residents as dozens of vehicles lined up at a drive-thru COVID-19 testing site at Raymond James Stadium site on March 25 in Tampa.  Residents that wished to be tested had to be approved and registered online before arriving at the site.
Health care workers test residents as dozens of vehicles lined up at a drive-thru COVID-19 testing site at Raymond James Stadium site on March 25 in Tampa. Residents that wished to be tested had to be approved and registered online before arriving at the site. [ LUIS SANTANA | Times ]
Published March 30, 2020|Updated March 30, 2020

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To Robyn Sosna, the doctor couldn’t have been more clear.

The discharge paperwork from Oak Hill Hospital in Brooksville had a bolded line: “Coronavirus, COVID-19, Suspected." Below, it said, "You have symptoms related to COVID-19 and the diagnostic test results are not yet ready.”

Sosna, 58, had stepped off a cruise ship at Port Tampa Bay on March 7, coughing and fatigued. She has a chronic condition, lupus. The hospital didn’t have the capability to test her, she said, so the doctor told her to go to the health department in Hernando County.

But Sosna was never tested.

At the local office a few days later, she said, a worker told her she was not eligible because she did not have a fever, Tylenol having suppressed her temperature.

“I was a cross between crying and pissed off,” Sosna said. “I was just done.”

She stayed in her bedroom in Spring Hill for the next two weeks, barely able to lift a cup of water. Her husband left food and drinks on the back deck, where she had access through a private door. They were afraid to be close. Sosna’s breathing was shallow and sharp.

“It feels like there’s glass in my muscles and my joints,” she remembers thinking. She had vivid dreams where people talked about her dying. The days blurred. She slept all the time.

Robyn and Wesley Sosna, of Spring Hill. Robyn, 58, said she fell ill after a cruise but struggled to get tested for coronavirus. Without an official diagnosis, she worries about future care.
Robyn and Wesley Sosna, of Spring Hill. Robyn, 58, said she fell ill after a cruise but struggled to get tested for coronavirus. Without an official diagnosis, she worries about future care. [ WESLEY SOSNA | Wesley Sosna ]

Sosna was convinced she had coronavirus.

“Take the worst flu you’ve ever had and magnify it by about a thousand, and that’s what your body feels like,” she said.

Nearly three weeks after her attempt to get tested, her strength is starting to come back. But Sosna struggles with a new concern that she’ll miss out on future care because COVID-19 is not part of her medical record. What if former patients need a booster shot? What if there’s a long-term issue? Sosna’s brain feels sluggish, thoughts slow to become actions.

The worry places her at yet another precarious point of the United States’ lack of testing for the disease. Ailing people have reported being brushed aside as ineligible for tests, while elected leaders and top doctors admit they have no idea how widespread the pandemic is.

As the illness locks up American life, scientists are trying to develop a new test for people like Sosna — to help confirm or dispel diagnoses they largely made for themselves — and to retroactively measure just how much of the country has been sick this whole time.

• • •

The limited test kits used to-date allow doctors to check if the coronavirus is inside a person right now.

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What Sosna needs is something called a serological test, to look for the presence of antibodies, which the body amasses to fight an infection, and which linger as a sign of past sickness and defense against future disease.

Such tests are common for other viruses, including hepatitis, said Dr. Marissa Levine, director of the Center for Leadership in Public Health Practice at the University of South Florida.

The U.S. Centers for Disease Control and Prevention says it is “working to develop” a serological test for COVID-19 “to assist with efforts to determine how much of the U.S. population has been exposed.” The agency did not respond to questions. On its website, the CDC says “antibody test results are important in detecting infections with few or no symptoms.”

It could also help Sosna. “She’s not out of luck,” Levine said.

Antibody tests would improve understanding of the disease across the United States. For one, more people could be tested, experts say, allowing health professionals to better calculate key figures like mortality rates.

Much about this specific coronavirus remains unknown, including what happens to patients long term, said Dr. Gigi Kwik Gronvall, a senior scholar at the Johns Hopkins Center for Health Security. People who recover from more well-known viruses gain immunity for a couple of years in some cases and even longer in others. It’s not yet clear what immunity will look like for COVID-19 survivors, but a serological test could help doctors and policymakers identify who has resistance to the disease, and thus could potentially go back to work more easily and help with the response.

Roughly a couple dozen companies are trying to create antibody tests for the United States, Gronvall said. They could work like blood tests in yearly checkups. Dr. Deborah Birx, the coronavirus response coordinator for the White House, said in a recent briefing that officials hope to make a test that requires only a finger-prick. The Icahn School of Medicine at Mount Sinai earlier this month announced researchers had developed a potential antibody test.

“There’s a lot of things in this pandemic that have not gone the way they should,” Gronvall said, “but the science has been blazing fast.”

• • •

In Spring Hill last week Robyn Sosna cleaned the dishes. She found herself “huffing and puffing.”

She has wondered if any other passengers on her cruise to the Bahamas felt sick. She and her daughter wore gloves in the dining area and sanitized their room frequently. Her daughter has not fallen ill.

Testing has expanded, with private labs and hospitals supplementing the state. But capacity is still far short of demand.

Where Sosna lives, “if an individual suspects that he or she needs testing for COVID-19, they are urged to contact their health care provider or the Department of Health,” said Ashley Thomas, spokeswoman for the Florida Department of Health in Hernando County. A doctor can collect a sample or provide a written order for the person to be tested somewhere else.

At Oak Hill Hospital, doctors “follow the CDC and Florida Department of Health criteria for ordering COVID-19 tests,” said Debra McKell, marketing director for HCA West Florida Division. “Actual testing is done by FDOH and commercial labs.”

Under Florida’s guidelines as of March 15, someone with a fever, cough or shortness of breath and who recently returned from a cruise should be tested.

Sosna is following news updates as the state’s caseload shoots higher. She calls the numbers “BS.” Hernando County had reported 20 positive cases of coronavirus as of Monday morning, with 248 people tested.

None of them was her.

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