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March 23, 2020

'The gray zone': Maybe you have the coronavirus. But maybe you don't. What next?

Daily Briefing

    Liz Lucas, a data editor for Kaiser Health News (KHN), learned she had close contact with someone who tested positive for the novel coronavirus. But without clear guidelines on how to move forward, Lucas fell into a "gray area for testing and … quarantine"—an issue that's affecting many other Americans and causing confusion among health officials, doctors, and the public, KHN's Laura Ungar writes.

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    Exposed to the new coronavirus—and unsure what to do

    Earlier this month, Lucas got a phone call from a friend she'd interacted with at NICAR20, a journalism conference in New Orleans. The friend told Lucas she had tested presumptively positive for COVID-19, the disease caused by the new coronavirus. The same day, the Investigative Reporters & Editors Group, the organization behind the conference, released a statement saying an attendee had tested positive for COVID-19, was quarantining at home for 14 days, and was "expected to make a full recovery."

    According to Lucas, during the conference she had spent hours in the same room as her friend who tested positive for COVID-19. Lucas went out to dinner with her friend and they even shared a hug, Ungar writes.

    Lucas, who had already returned home to St. Louis when she got the call, said she was unsure how she should move forward, so she quickly contacted the St. Louis Department of Health. The employee Lucas spoke with on the phone took her phone number and said she would call Lucas back. Lucas also called her primary care doctor, who told Lucas to wait to hear back from the health department. The primary care physician told Lucas she had no way to test her, but said that Lucas should go to the ED if she developed symptoms of COVID-19.

    Lucas said that after waiting a few hours and not hearing back from the health department, she "got antsy," so she then called the St. Louis County Health Department for guidance. However, the employee at the county health department suggested that Lucas call Missouri's health department, instead.

    Lucas then called the state's public health emergency hotline, and a person on the phone told her she didn't need to be tested for COVID-19. Lucas said that, when she asked if she should self-quarantine, the person "didn't have an answer." Instead, the person reiterated that Lucas didn't need testing.

    The next day, a St. Louis city employee called Lucas back and said she should alert the city's health department if she developed symptoms of COVID-19. "They told me that I don't have to self-quarantine, but obviously I could. It's kind of like my choice. It might be a good idea but not required," Lucas said.

    Lucas described her interactions with the local and state health departments as "very frustrating." She said, "I just wanted to make a plan. I just wanted clear guidelines, and I couldn't get them."

    Ultimately, Lucas decided to self-quarantine. Six days later, she still hadn't developed symptoms of COVID-19, Ungar writes.

    The COVID-19 'gray area'

    Randall Williams, director of the Missouri Department of Health and Senior Services, said Lucas made the right decision to self-quarantine. According to Williams, anyone who has had close contact with a patient that tested positive for COVID-19 should self-quarantine for 14 days.

    But Ungar writes that many people, like Lucas, who are unsure of their COVID-19 status "fall into the gray area for testing and deciding whether to quarantine themselves," with some receiving tests for the new coronavirus and being told to quarantine while others are not.

    The reason for the uncertainty, Ungar reports, is that testing and isolation and quarantine criteria currently vary by state, and in some cases even by city.

    For instance, Williams noted that local governments, not state governments, are responsible for regulating quarantine and isolation policies in Missouri. So, when Lucas reached out to the state health department, she should have been referred back to the city of St. Louis' health department, he said.

    According to KHN, St. Louis city officials did not return KHN's requests for comment.

    However, Williams said the state can refer people who don't have symptoms for testing, as long as patients meet state-specific criteria for the tests. According to Williams, being in close contact with a known patient would qualify someone like Lucas for testing in Missouri, though other states may have different guidelines.

    But that variation  ultimately can lead to patients getting delayed advice and "incorrect information," Ungar writes.

    "There are mixed messages and confusing messages from the top levels, and that's trickling down to the lower levels," said Jeremy Youde, dean of the College of Liberal Arts at the University of Minnesota-Duluth. "This speaks to why communication and trust are so vital to public health responses, and why it's all the more vital to get everyone on the same page as quickly as we can" (Ungar, Kaiser Health News, 3/13).

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