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Doctors Getting More Latitude to Test Patients for COVID-19

WASHINGTON — Physicians are beginning to get more latitude regarding testing patients for suspected COVID-19, a public health official said Friday.

“The guidance for testing really just shifted this week; in our market, if we had a suspect case, we had to talk with our Department of State Health Services of Texas as well as the CDC to determine if they’re good for testing, and now it’s my understanding that that testing has gone more into the providers’ hands,” George Roberts Jr., president of the National Association of County and City Health Officials (NACCHO) and CEO of the Northeast Texas Public Health District, said at a press briefing here.

“If they believe this person needs to be tested for coronavirus, if there’s some type of travel history or other type of way they may have contracted the disease, the providers now have the ability to start doing that.”

“NACCHO members are working with their healthcare providers to make sure they know what to look for, answering questions, and in some cases, making sure they have the CDC test kits to be able to test for the virus,” he added. Until recently, all COVID-19 tests had to be sent to the CDC in Atlanta, which was very time-consuming, but in Texas, for example, “test kits are out in public laboratories … Hopefully that will reduce the time. Confirmatory testing will still have to go to the CDC, but at least you can have a preliminary diagnosis in a shorter amount of time.”

In addition, “we’ve inventoried preparedness supplies,” Roberts continued. “In our market, since we do public health emergency preparedness in seven counties, we have a warehouse that has a cache of preparedness supplies and we’ve inventoried our N95 masks, and we encouraged our local healthcare providers to do the same type of work to make sure they have the personal protective equipment they need.”

That’s important because the supplies can go fast. “Anecdotally, I understand in the state of Washington, where they’ve had a lot of cases, that they really burned through a lot of their PPE [personal protective equipment] dealing with people,” Roberts said during a question-and-answer session. “When you’re dealing with respiratory isolation and you’re wearing the respiratory isolation material and taking it on and off pretty frequently … I’m concerned that we’re going to have shortages of that,” he said, noting that part of the $8.3 billion in supplemental coronavirus funding approved this week by Congress will be for replenishing such supplies.

When doctors are dealing with patients in respiratory isolation, their personal protective equipment can get used up pretty quickly, said George Roberts Jr., president of the National Association of County and City Health Officials. (Photo by Joyce Frieden)

“Our public health emergency preparedness team is meeting with hospitals, schools, and government officials to update them and discuss preparations,” Roberts said. “And just this week, in my locality, we had a large meeting with our county government, several municipalities, police chiefs, and fire chiefs, and gave them talking points. We also met with emergency management officials.”

Local officials also talked about mass gatherings, he continued. “If this thing gets large, and you have to maybe close your schools, how are you going to make those decisions? The answer in Tyler, Texas might be different than Washington D.C. or the state of Washington,” said Roberts. “Each community is going to have to make those decisions about when to close the school or when to cancel it.”

“One of my school superintendents in our area said, ‘You don’t close the schools if you have the flu, do you?’ No, we close it when we have an attendance rate of 84%,” he added. “That’s when we probably make the decision to shut down the school for a couple of days and do major cleaning. That will be up to communities to have those conversations inside the community and talk about that.”

Decisions about whether to cancel large social events also must be made case by case, he said. In Harris County, Texas, where Houston is located, they’ve had no cases of COVID-19 in the community, and officials had to decide whether to cancel the Houston Rodeo and Stock Show — “which is a major, major, event in that community, and they were saying, ‘No, there’s not a reason to do that.'”

When considering these issues, “you have to look at what is the case on the ground? How many cases of CV [coronavirus] do you have in this community? Local officials and community leaders, and schools would come together and have a conference about it … and what is the public saying about it?” said Roberts. “In Austin, there was a large petition to try to cancel SXSW [the South by Southwest festival], and Austin said, ‘We’ve got no confirmed cases in our market right now; it’s on.'” (Austin city officials canceled the festival Friday; SXSW issued a statement noting that “As recently as Wednesday, Austin Public Health stated that ‘there’s no evidence that closing SXSW or any other gatherings will make the community safer.’ However, this situation evolved rapidly, and we honor and respect the City of Austin’s decision.”)

“There has to be a fine balance between protecting the community, understanding the risk, and mitigating fear,” Roberts said. “What can we do today? An infectious disease doctor in our area who I have a great deal of respect for, I asked him, ‘What do you think this is all about?’ He said, ‘George, I think this may be a bad flu season with no vaccines and no antivirals.’ That’s probably what we’re potentially facing.”

“How do we handle that? Good public health measures,” he said. “I’ve been in this job 13 years; I lived through H1N1 and lived through the Ebola scare,” which took place in Roberts’ home state of Texas. “I guarantee you there was a lot of fear about that, but we lived through that, and how did we do that? We didn’t have an Ebola vaccine, and when we started H1N1, we didn’t have an H1N1 vaccine, so we did that with public health measures — washing your hands, covering your cough, staying home when you’re sick, cleaning surfaces — just taking some commonsense solutions to this whole thing.”