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March 26, 2020

Amid a surge in COVID-19 cases, officials prioritize testing for health care workers, critically ill

Daily Briefing

    In preparation for a spike in cases of COVID-19, the disease caused by the new coronavirus, health officials across the United States are beginning to restrict testing for the disease to critically ill patients and health care workers in an effort to preserve resources for people with the highest need.

    Our take: Is drive-thru testing the answer to coronavirus screening?

    US grapples with shortage of coronavirus tests

    In recent weeks, the federal government has come under scrutiny for its response to the United States' coronavirus epidemic, particularly when it comes to testing efforts. For example, public health officials have said faulty tests from CDC and rules about which labs can perform tests have resulted in a shortage of tests needed to screen Americans for COVID-19, allowing the new coronavirus to spread in the country undetected.

    While the number of tests available in the United States and efforts to screen people across the country have ramped up over the past week, officials worry that the efforts are coming too late to make a difference, particularly in hot zones like New York City and Seattle, where testing has identified hundreds to thousands of people with the disease.

    Officials look to prioritize testing for health care workers, critically ill

    As the number of COVID-19 cases continues to spike in the United States, health officials in such hot zones have sought to restrict testing for the disease in an effort to conserve tests, ventilators, ICU beds, and protective equipment for health care workers and others at high risk of contracting COVID-19 and patients in critical condition.

    For instance, the Los Angeles County Department of Public Health last Thursday told providers it was "shifting from a strategy of case containment to slowing disease transmission and averting excess morbidity and mortality" by discouraging testing of patients with mild symptoms. The department recommended that providers test patients for COVID-19 only if a positive result would impact a patient's treatment, the Los Angeles Times reports.

    In Washington, where there is a critical shortage of personal protective gear for health care workers, officials have restricted COVID-19 testing to high-risk individuals, including health care workers and people with severe symptoms. "We've asked the public to understand we can't test everyone, especially if they have mild symptoms or are asymptomatic," Jeff Duchin, health officer for Washington's Seattle and King counties, told the Washington Post last week.

    The moves align with guidance released Saturday by the White House' coronavirus task force. According to Bloomberg, the task force recommended that providers prioritize testing patients who are hospitalized, symptomatic residents of long-term care facilities, patients older than 65, and health care workers. The task force said people who suspect they have COVID-19 but are asymptomatic or have mild symptoms should isolate themselves instead of visiting a provider for a test in order to reduce transmission of the disease and to preserve resources for critical patients.

    Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, on Saturday said, "Not every single person in the [United States] needs to get tested." He explained, "When you go in and get tested, you are consuming personal protective equipment, masks and gowns—those are high priority for the health care workers who are taking care of people who have coronavirus disease."

    Jennifer Nuzzo, an epidemiologist with the Johns Hopkins Bloomberg School of Public Health's Center for Health Security, said officials made a similar decision during the 2009 H1N1 epidemic. "[W]e stopped testing …. once the level of illness in the community was so high that it just made more sense to treat based on clinical symptoms," she explained, adding, "We'd cause more harms by encouraging the general public to run out and get tested if they are well or experiencing mild illness."

    'A new phase of response' that could cause confusion

    According to the Post, the moves represent a "new phase of … response" to the United States' COVID-19 epidemic, as health officials concede that efforts to contain the virus at this point likely will be futile.

    However, the moves to restrict testing come after federal officials last week announced plans to implement mass testing across the country, the Post reports. For instance, the federal government has announced that it would ship millions of tests to states, and several states have set up drive-thru testing sites to expand testing capacity.

    Officials are worried that those efforts could cause people with mild symptoms to leave their homes to get tested for the disease—raising the risk that they could spread the new coronavirus to others.

    "It's confusing to people to hear that testing is being made available in a much more convenient way, and they think, 'Hey, this is great, let's get tested,'" said Michael Fraser, executive director of the Association of State and Territorial Health Officials. "I'm just scared there's going to be mass confusion when people find out there is a testing site, are worried about their COVID status, and they're going to mob the testing site" (Johnson et al., Washington Post, 3/21; Dolan/Mejia, Los Angeles Times, 3/20; Wingrove, Bloomberg, 3/21).

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