Though federal officials have directed the nation’s physicians to order coronavirus testing for anyone they think needs it, some Pennsylvania residents say they have been denied tests deemed vital to containing the spread of the respiratory illness.

The U.S. Centers for Disease Control and Prevention on Sunday updated guidance for evaluating and testing possible cases. The earlier instructions essentially limited testing to symptomatic people who had traveled to an outbreak hot spot or were exposed to a confirmed case. Now, the CDC is advising physicians to “use their judgment” to order testing for anyone with symptoms — regardless of travel — especially older adults who are at greatest risk of serious complications and death.

Pennsylvania Department of Health officials insist they are following the new guidance, at the same time noting that they have the final say about who gets tested at the state lab.

“We follow CDC guidance. We’ve loosened up” testing criteria, said Sharon Watkins, the state Health Department’s epidemiologist. “We consult with doctors whenever they call us. If a doctor feels a test is warranted and we don’t think so, they can use a commercial lab.”

Yet at a news conference Thursday afternoon, Philadelphia Health Commissioner Thomas Farley said limited testing availability has made it difficult to identify cases and take action to slow the spread of the virus.

Philadelphians who were in contact with known patients in Philadelphia and Montgomery County were showing symptoms of the virus, he said, but the city had not received any test results Wednesday or by 4 p.m. Thursday.

“Our ability to contain this infection rests right off the bat on our ability to identify cases as quickly as possible," he said.

Until this week, the state lab was the sole point of access to testing in this state. LabCorp and Quest are now offering testing, although doctors may be unaware of the new services.

Anecdotal cases — and state Health Department data showing only 138 tests in a state with more than 13 million people had been completed as of Thursday afternoon — suggest Pennsylvania retains stringent rules, even as outbreaks worsen. Gov. Tom Wolf on Thursday ordered mass closings of schools and businesses in Montgomery County, where 13 people have tested positive.

Claudia Bahorik, 69, a retired family physician in Bernville, Berks County, was appalled to discover the state deemed her ineligible for a test.

Bahorik has been hospitalized for pneumonia three times in the past. About two weeks after she spent a Saturday in Manhattan and Nassau County, Long Island — where dozens of cases have been confirmed — she developed a cough, mild fever, and shortness of breath. On Tuesday, a flu test was negative and X-rays and blood tests were normal, so her doctor called the state Health Department to get approval to send respiratory specimens for coronavirus testing.

“He said they told him they wouldn’t test because I ‘didn’t meet the criteria,' " Bahorik said by phone Wednesday after she, too, called the Health Department and was rebuffed. “I asked how would we ever know the extent of the epidemic if we can’t test all persons with symptoms.”

In the guidance issued Sunday, the CDC said it was expanding testing to do just that — “to quickly detect and respond to community spread of the virus in the United States.”

Pennsylvania state health officials have taken the position that community spread — transmission of an illness with no known source of infection — is not yet occurring because most of the state’s 22 positive tests have each been traced to a source.

But state officials also have stressed that they are prepared to meet growing testing needs. Pennsylvania’s physician general, Rachel Levine, has repeatedly said the state lab has no testing backlog and can do up to 125 cases a day.

There are no data on how many doctors, like Barhorik’s, have been refused a test — or how many doctors don’t realize they are supposed to help expand testing.

On Monday, for example, Francesca D’Angelo’s doctor told her he wouldn’t request a coronavirus test from the state because she didn’t meet testing criteria.

D’Angelo, 39, had respiratory symptoms, tested negative for the flu, lives just minutes from Bucks County schools closed because of the coronavirus, and works in a health-care facility.

She tried to get the Bucks County Health Department to intercede with the state on her behalf, but a county worker echoed her doctor’s conclusion that she didn’t need a test. The worker “basically said there’s no point in me calling the state Health Department,” D’Angelo added.

Another resident, Sara Simon, ran into a similarly dismissive attitude when she called the state Health Department on Thursday to ask about testing, prompted by Gov. Wolf’s tweet that people possibly exposed during travel should do so.

Simon, a reporter with the Spotlight PA investigative newsroom in Harrisburg, was at a journalism conference last week in New Orleans with her boyfriend, a ProPublica reporter. One other attendees at the conference have been diagnosed with coronavirus.

The Pennsylvania couple are now self-isolating at home in Mechanicsburg for two weeks in case they were exposed. (Spotlight PA, focused on Pennsylvania government, is an independent unit led by The Inquirer in partnership with the Pittsburgh Post-Gazette and PennLive/the Patriot-News.)

“I said my lungs feel a little heavy and my boyfriend’s throat feels scratchy, but we’ve been taking our temperatures and have no fevers," Simon recalled telling a state nurse during the call. "The registered nurse laughed at me and said: ‘Yeah, you definitely don’t have the coronavirus. Turn off the TV. You would know if you had it.’ ”

Despite the nurse’s comment, health experts have found cases of people without symptoms transmitting the virus.

For Bahorik, whose career taught her the importance of using medical judgment, the situation is surreal.

“I heard Vice President Pence in a news briefing telling us that there were sufficient test kits and everyone with symptoms could be tested,” she said. “So on live TV, the government says one thing to reporters, but in reality testing is not being done.”

Staff writer Laura McCrystal contributed to this report. Are you a Pennsylvania physician or patient who has sought testing and been turned away? Please email Marie McCullough at mmccullough@inquirer.com.