Lack of COVid-19 testing in East Tennessee

The stories below are being collected in and around Knoxville, Tennessee. They have been edited for length and clarity, but not content.
 
“A few weeks ago, my partner came down with flu like symptoms, but tested negative for the flu. The doctor wanted to test for COVID-19 but my partner did not meet the requirements, even though they work at a credit union with hundreds of customers and international travelers daily. My partner went back to the doctor because they were still super sick, and they tested negative for the flu, strep, mono, and had clear sinuses and no pneumonia. The doctor still would not test my partner because they haven’t been in contact with a confirmed case.  
 
A week later, I became sick with a dry cough and fever, which progressed into shortness of breath. I have no health insurance, so I went to a clinic to ask about a test. This was before there was any real info about the test shortage and the administration was still trying to say that anyone could just walk into a doctor and get a test. The doctor was so rude that I left in tears before he even took vitals. He had horrible bedside manner and actually rolled his eyes at me when I asked him to please speak to me with a different tone. He had a nurse lead me out a back door because I was so upset and crying and he was still yelling at me down the hall "If you are sick enough to be tested you need to be at a hospital." They still charged me $125.
 
I called the health department and they said I couldn’t get tested until I needed to be hospitalized. Also, they said that I couldn’t have COVID-19 because I haven’t traveled and it isn’t in Knox County. Now, I am pretty sure that I have pneumonia and I am monitoring my oxygen levels. A friend who is an ER doctor said it is highly likely at this point that I have COVID-19, but he still cannot get me a test. I cannot afford an ER visit either. The message that was communicated from the Health Department to me was very much go to the ER if you are sick enough to be tested or go to your doctor. I think that in addition to being an irresponsible way to contain an outbreak, only testing the very sick, it also ignores the fact that a significant portion of our community can't just go to the ER and/or do not have a doctor because we have no health insurance. We especially cannot go if they will still not test us. 
 
The school has been closed for over a week now but several of my students now have a mild cough. This is a complete fail. This has been an extremely frustrating and at time infuriating situation.
 
We need free and accessible testing in our community. I worry constantly about the families that may be at risk because I cannot get a test. We have self-quarantined, but there were days I could have passed it at school. I know that my students, even those who are now showing signs of illness, will most likely be ok. But what about their families?”
 
— Preschool teacher, Knox County, Tennessee


“On Sunday, March 8th, I returned home from a weeklong trip to a major US city.  I flew there to attend a conference and stayed at the conference hotel for the majority of the trip, which was located approximately a block from multiple conferences that made news for people testing positive for COVID 19. I took precautions throughout the trip and washed my hands often, but unfortunately by the time I returned home, I was experiencing a myriad of symptoms including a fever, sore throat, congestion, and cough. I stayed home from work, assuming that it was likely just a cold, but not wanting to put anyone at risk. Although the fever was short-lived, my cough continued to worsen, leading to long coughing spells that left me breathless. 
 
At the encouragement of my coworkers and my partner, I called the local health department’s COVID 19 hotline. When I reached someone, I shared my symptoms, and the person asked where it was I had flown. After disclosing the city, they stated that it “wasn’t a priority location” and asked if I had been in direct contact with anyone who had tested positive for the virus. I shared that I had not been around anyone who had received a test for COVID 19, and she told me I wasn’t eligible for a test, encouraging me to call my primary care provider (PCP). It did not feel like the appropriate time to express my frustration with the idea that in order for someone to receive a test, they must know that they were exposed to someone else who had received a test that very few people have been able to meet the eligibility requirements for. 
 
I called my PCP. My PCP shared that they wanted me to stay home and treat my symptoms. I was told if the fever returned, shortness of breath worsened, or I felt generally worse, I was to call the office back prior to going to the emergency room. Fortunately my symptoms didn’t worsen to the point that I felt like I needed to go to the ER, but it was simultaneously validating of my concerns and alarming to me that the doctor was so concerned when the health department had been forced to turn me away. 
 
The worst part of this is that as my symptoms begin to lessen, I still don’t feel comfortable returning to work. I don’t (and will never) know definitively if my illness was a particularly bad cold, COVID 19, or something else altogether, and I don’t know when I will cease to be contagious. Had I received the test, I would have been able to make informed decisions in order to protect my loved ones, colleagues, and fellow community members, while also creating a plan for returning to work and/or volunteering to help others in our community who could be most negatively impacted by this virus. 
 
It is good public health practice to enable people to have access to testing for a myriad of illnesses, because knowing one’s status is one of the best ways to protect themselves and others. I am frustrated by my personal experiences, but I am also increasingly concerned about those among us who are older and/or immunocompromised who may be unable to receive testing and may realize they are sick when it is too late as well as those whose symptoms are so mild that they unknowingly have exposed others to the virus. The response to COVID 19 has left me feeling exasperated with the US public health system, and I am concerned about the wellbeing of our communities in the days, weeks, and months to come.”
 
— Public health worker, Knox County, Tennessee