Name: Presumed COVID-19 patients often sent home from Houston hospital ERs without testing, doctors report
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Presumed COVID-19 patients often sent home from Houston hospital ERs without testing, doctors report

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This is a carousel. Use Next and Previous buttons to navigateBy the time Andrea Seboyon arrived at United Memorial Medical Center on June 6, she could no longer draw a full breath or speak in sentences. Her body had become so starved of oxygen her fingernails had turned purple.An X-ray showed the 34-year-old fast-food worker had less than 20 percent function left between two lungs. Dr. Joseph Varon, chief medical officer, quickly ordered two COVID-19 tests although he already knew the answer. “Everything lit up like a Christmas tree,” he said of the results.What troubled him, he said, was that Seboyon said she had gone to Memorial Hermann Greater Heights emergency room two days before with a fever, cough and shortness of breath — all telltale signs of the virus that was just starting to spike in Houston again. Her blood was drawn, her chest X-rayed, and she said she was sent home with a pneumonia diagnosis and packet of antibiotics. What she said she didn’t get was a test for COVID-19.“How can you not test someone like her in the middle of a pandemic?” Varon asked. “It’s dangerous.”More for youAs the nation’s fourth-largest city shudders under the virus’ renewed fury, “hundreds” of emergency room patients at two of Houston’s major health systems are often not tested even if they appear sick with COVID-19, according to multiple doctors at those hospitals, some speaking on the condition of anonymity for fear of retribution from their institutions.Instead, at Memorial Hermann Health System and Harris Health System, COVID-19 tests are typically reserved for the small percentage of emergency patients who meet the criteria to be immediately hospitalized, such as unstable vital signs or needing oxygen, the doctors said. The exception is health care workers and first responders who are usually tested even if not admitted, the doctors said.Doctors at other health systems in the city told the Houston Chronicle that emergency patients with symptoms are generally tested whether hospitalized or not.Memorial Hermann disputed a lack of testing in its emergency rooms, while Harris Health acknowledged it limits emergency room testing to those who require hospitalization.Some health officials worry that such restrictions — especially in emergency rooms that are often the default health care provider for the poor — could leave an unknown swath of contagious patients who could infect others or, as in the case of Seboyon, may already be sick and quickly become critically ill.It also ultimately skews public health data and thwarts contact tracing efforts, setting up a potentially serious undercount as Texas becomes a national hot zone and the Houston medical community scrambles to keep up with an escalation that shows little signs of slowing, health officials warn.Across Texas, the number of new confirmed cases is shattering records daily. On Wednesday the statewide number shot up to more than 8,000 cases in a single day. Thursday was only slightly lower at 7,692. Friday saw 7,919. The new rolling statewide average is now more than 6,750 new cases per day, according to a Chronicle analysis of statewide data.The Houston region saw nearly 2,000 new cases on Thursday, bringing the total to 47,531, the analysis showed. That means more than 1 in 4 cases in the state are now in the Houston region.The numbers are now so high some local health experts are beginning to ask if testing is even necessaryBut what if the true toll was even higher?A senior-level Memorial Hermann emergency physician estimated that “hundreds” of likely positive cases may be untested each day across the system’s 17 hospitals’ emergency rooms.The doctor, who spoke on the condition of anonymity for fear of losing his job, said about 50 to 70 people now arrive every day at some Memorial Hermann emergency rooms with signs of COVID-19. Of those, maybe 10 meet the criteria for admission, which is consistent with the national average. Those who are hospitalized are most often tested. The others, typically, are not, he said.Many are, in fact, presumed to be positive. But if they don’t meet the threshold to be admitted, they are sent home with instructions to self-isolate and self-monitor, the doctor said.During a private online discussion between Memorial Hermann emergency physicians shared with the Chronicle, one doctor lamented the lack of clear emergency room testing guidance and another senior-level emergency physician said testing of nonadmitted patients was “rare.”While there is no specific rule prohibiting such testing, and any Memorial Hermann emergency room physician could insist on a test, most don’t push it as hospital culture remains focused on preserving supplies, one of the doctors in the group told the Chronicle.At smaller United Memorial, which sits in the middle of the Acres Homes neighborhood, one of the city’s hardest-hit areas, Varon said he has treated several patients in his COVID-19 unit who first went to a Memorial Hermann emergency room and said they were not tested.Memorial Hermann leadership has pushed back against the reports, denying that presumed positive patients are not tested in its emergency rooms.“There are no supply issues or policies preventing emergency room physicians from ordering COVID-19 tests when they believe it is medically necessary,” the hospital said in a statement earlier in the week.The statement added, however, the health system encourages patients who suspect they have the virus and do not need immediate treatment to “visit one of the many available testing locations across Greater Houston” rather than come to the emergency room.The spokeswoman said she could not comment about Seboyon’s case due to patient privacy laws and because the woman did not give Memorial Hermann permission to discuss her medical records.At Harris Health, Dr. Esmaeil Porsa, CEO, confirmed that only those with serious respiratory conditions who are already hospitalized or need to be admitted get tests.“While wanting to test broadly, testing capacity really drove most of our testing strategies. We were initially constrained by the number of swab kits and then by the amount of reagent for processing tests,” Porsa said in a statement. “We have prioritized hospitalized patients for the rapid testing because it is critical to helping us anticipate care needs and to appropriately isolate those patients.”He added that Harris Health is “now having ongoing conversation about expanded testing. We continue to have to balance supply chain realities in this decision making.”“It bothers me that we can’t test everyone that wants to get tested,” said Dr. Cedric Dark, a professor of emergency medicine at Baylor College of Medicine. “If people don’t know they are positive, they might not be convinced to self-quarantine. They might still go to work. I fear the pandemic will just keep spreading.”From the very beginnings of the health crisis, testing has been fraught with confusion and spin as politics collided with public health.President Donald Trump has famously said both that anyone who needs a test can get one and, more recently, that testing needed to be slowed down because so many cases were being found. The latter remark was later characterized as sarcasm.Gov. Greg Abbott previously downplayed the sharp increase in cases following his order to begin reopening the state May 1, saying it was to be expected as a result of more robust testing. More recently, though, he has voiced alarm about the quickly filling hospital beds in Houston and elsewhere in Texas and hit pause on the state’s reopening, as well as required masks for most people in the state.There is little doubt that testing in Texas has substantially increased from the early days when critics said the state was slow out of the gate. The latest rolling daily average of tests given in the state is 38,597, according to the Texas Department of State Health Services. But the state still dwells near the bottom of the nation in its rate of testing, ranking 43rd in tests per 100,000 people, based on a Chronicle analysis of data from by the COVID Tracking Project, which collects information nationwide on testing primarily from state health departments.“How is this still happening? Emergency room doctors need access to testing for all patients with any symptoms of possible COVID-19,” said Dr. Alison Haddock, a Houston-based board member for the American College of Emergency Physicians. She said her organization has been calling for increased testing since March.Currently in Harris County, the testing criteria have broadened significantly from the early days to now include anyone with COVID-19 symptoms, those over 60, people with underlying medical conditions and those who have been in contact with someone who has tested positive. Testing locations in Harris County have also greatly expanded to more than 50 overall sites, including government-run locations, schools, community clinics and about two dozen retail locations, although many are often packed and results can take days.But even with more testing, some health experts argue it is still inadequate to protect cities and understand the full scope of the crisis. They are especially concerned about a lack of testing in hospital emergency rooms.“If that is truly what is going on, it is totally wrong,” said Dr. Carlos del Rio, a professor at Emory School of Medicine in Atlanta and one of the nation’s leading epidemiologists.“You’re violating every single principle of how you control an epidemic.”He cites what he calls the three “I’s” of a health crisis: information, identification, isolation. Without one there can be no two and three.Other experts, though, such as Dr. David Persse, health authority for the city of Houston, have concluded that such protocols may be unrealistic this far into the pandemic, especially given the high rate of false negatives that some types of test return. He conceded an undercount of actual cases should probably just be assumed.“I think we are at the point where doctors can make the call of whether someone has COVID without a test,” he said. He suggested that a better step now for emergency physicians to take is to make sure a presumed positive patient who is otherwise healthy knows to self-isolate, monitor their condition and make sure family and friends who may have been exposed also take needed precautions.But that is assuming compliance, said Jen Kates, director of global health and HIV health policy at Kaiser Family Foundation. She worries that if a patient is sick or frightened, they may have gone to the emergency room expecting to get a diagnosis.“If a health care worker doesn’t test them, they could take that as a sign they are not infected,” she said.Or that the virus is not that bad.Seboyon, a mother of three, said she started getting sick in late May with a persistent cough and a tiredness that sleep did not heal. She has no idea how or when she became infected.When she arrived at Memorial Hermann, she said she asked for a COVID-19 test during her exam but never got one.“I told them to do one because I couldn’t breathe. It was very obvious,” she said.Forty-eight hours later, her condition was quickly deteriorating. She first went to a walk-in clinic and she said the staff there became so alarmed they told her she must go to a hospital.When she arrived at United Memorial Medical Center, she was admitted and quickly given supplemental oxygen.She lay on her stomach so gravity would help push blood into her lungs. A healthy level of oxygen in the blood is above 95 percent. Prolonged levels under 80 are potentially fatal. Hers was 50.Varon started her on a mixture of steroids, vitamin C, thiamin and a blood thinner to combat the clots that had formed in her veins. He also began a course of an experimental antiviral medication.“It’s like having a constant pressure on your chest and at the same time you can’t catch air,” she said from her hospital bed on June 11 through an interpreter. She does not speak English.“I’m surprised she is still alive,” Varon said after her release last week.Today she is home. Her chest still hurts and she feels weak. Even a few steps wear her out. “My life has changed completely,” she said, as she sat outside her small apartment .“I know I was close to dying.”But how could she leave her children, ages 16, 14 and 10, without a mother? “They told me to keep going,” she said.So she did.Matt Dempsey and Godofredo Vásquez contributed to this report.jenny.deam@chron.comtwitter.com/jenny_deam

This is a carousel. Use Next and Previous buttons to navigateBy the time Andrea Seboyon arrived at United Memorial Medical Center on June 6, she could no longer draw a full breath or speak in sentences. Her body had become so starved of oxygen her fingernails had turned purple.An X-ray showed the 34-year-old fast-food worker had less than 20 percent function left between two lungs. Dr. Joseph Varon, chief medical officer, quickly ordered two COVID-19 tests although he already knew the answer. “Everything lit up like a Christmas tree,” he said of the results.What troubled him, he said, was...

Presumed COVID-19 patients often sent home from Houston hospital ERs without testing, doctors report

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