Dennis Magnasco, a 32-year-old Harvard University graduate student from Somerville, was tested for COVID-19 on March 18 as he battled a hacking cough, high fever, and shortness of breath. Eleven days later, he was still waiting for the results.
Meantime, he watched others, including Harvard’s president, Lawrence S. Bacow, US Congresswoman Ayanna Pressley, Boston Celtics guard Marcus Smart, and state health commissioner Dr. Monica Bharel receive tests and results in a mere fraction of the time. Smart had no symptoms, Pressley was feverish, Bacow and his wife had fevers and chills, and Bharel described her illness as mild.
The alarming rise in the number of deaths and positive cases of COVID-19 has prompted a veritable race to get tested. Some celebrities, politicians, and top athletes, many with mild infections or no symptoms at all, have seemingly received tests and results in hours, while others have coughed and stressed for over a week. Discussion of this divide has bounced around virtual meeting rooms and burned across social media: Just how does a person qualify for a test and how long should they have to wait for results?
The answer: It depends.
Power and prestige certainly help: Witness the Boston Celtics enlisting a private company to conduct testing in mid-March when tests were hard to come by for just about any other Massachusetts resident.
But differing interpretations by health care providers of federal and state testing guidelines also play an outsized role. So, too, does the availability of testing supplies and a patient’s past medical history.
“Most people would argue that in a time of pandemic, the most important thing is for people to trust the advice their government and their doctors are giving them,” said George Annas, director of the Center for Health Law, Ethics and Human Rights at Boston University’s School of Public Health.
But, Annas said, federal government recommendations have shifted, state rules have changed, and a general confusion about testing has undermined public confidence about fairness.
“There doesn’t seem to be a uniform rule,” Annas said. “The system can’t be seen as unfair, as privileging people who have connections or money or something the average American doesn’t have.”
On March 13, Massachusetts health officials relaxed rules and gave health care providers more discretion on which patients should be tested. But by then, many health care providers were running out of nasal swabs to test patients.
For weeks, nurses, physicians, and sick patients have raised alarm about a severe shortage of tests and long waits for results. Beth Israel Lahey Health, for example, halted outpatient screening for the coronavirus, reserving tests for health care workers and the most severe cases at its network of 12 hospitals. Medical workers have reported patients with fevers and other symptoms of COVID-19 being refused tests.
As testing has increased across Massachusetts in recent days, Governor Charlie Baker suggested that the days of rationing coronavirus tests were done.
“Because we’ve ramped up our testing capacity and dramatically expanded the number of outlets that are available to conduct these tests, people should be able to get tested,” Baker said Wednesday.
But across the state, there remains wide disparities in who gets tested and how fast they get results.
A 60-year-old emergency room nurse at a hospital in Greater Boston said on Friday he couldn’t get a test, despite having had a sore throat, cough, and headache for days, in addition to his diabetes and related nerve damage. The nurse, who asked that his name not be used for fear of angering his employer, said the hospital he works for in the Beth Israel Lahey Health network requires a temperature of 100.4 to qualify for a COVID-19 test. His is 99.1.
Complicating things further, he said doctors in his own ER told him to stay home because they fear he will infect others. But, he said, hospital administrators advised him he could continue to work if his fever remains under the testing threshold.
“I am on the front line and I can’t get a straight story,” the nurse said. “No wonder,” he added, “so many people are confused.”
In a statement to the Globe, a spokeswoman for Beth Israel Lahey Health said their policy is to “test any symptomatic employee, which we define as having a fever (temperature 100.4 F or higher) or feverishness and/or respiratory symptoms, which may be mild, such as a sore throat.”
Even among the nation’s top politicians, there’s a disparity in testing.
Congressman Seth Moulton, a 41-year-old Salem Democrat, has been in quarantine with his wife and 18-month-old daughter for more than a week.
Moulton said he and his wife — with mild fevers, sore throats, and “incredible chest tightness,” the likes of which he’s never felt before — didn’t qualify for tests, according to the attending physician for the US House of Representatives that Moulton consulted.
The doctor told him there isn’t a treatment for the disease. Moulton said he and his wife didn’t push it further because they didn’t want to use up a test that someone else might need more.
“It just highlights how bad the situation is,” Moulton said. “Everyone has a different criteria for when to test.”
On the flip side, Congresswoman Ayanna Pressley obtained a test Wednesday and received results on Friday showing she was negative for COVID-19, according to her staff. Pressley had flu-like symptoms that included a mild fever.
Pressley called her primary care physician, who consulted with the attending physician for the US House of Representatives. They arranged for a test through Massachusetts General Hospital, according to Pressley’s staff.
The 46-year-old Democrat has two preexisting conditions that put her at risk for respiratory illnesses. She has had asthma since childhood, her staff said. And recently, Pressley went public with her alopecia diagnosis, an autoimmune disease that causes hair loss.
Perhaps most significant, Pressley was in close proximity to a colleague who has tested positive for COVID-19. Representative Ben McAdams, a Democrat from Utah, recently released a statement after being hospitalized with “severe shortness of breath” from COVID-19. Pressley attended a Financial Services Committee hearing with McAdams the week before he was hospitalized.
On Friday, Governor Baker unveiled a new partnership with a company to provide an online health tool that people can use if they suspect they have been sickened with coronavirus. The website is buoy.com/mass.
”This is not to be used in place of emergency medical care,” Baker said, calling it a tool to “get the best guidance and advice about what to do next.”
Hours later, Baker’s health commissioner, Dr. Monica Bharel, announced she had tested positive for COVID-19. She said in a statement she was tested Thursday night and received her results on Friday from the State Public Health Lab.
Meanwhile Magnasco, the Harvard grad student, continues to wait for his results. Sunday marked 11 days since he was tested.
Magnasco, a former army medic, said staff at the West Roxbury VA Medical Center initially thought the results from the state’s lab would be back in three days.
“I realize it wouldn’t change my behavior; I would still self-quarantine,” Magnasco said. “But thinking in the long term, because of my background as a medic, if I could volunteer my time knowing I had been exposed and having immunity would be important.”
He’s still in quarantine.