Connect Commentary: COVID-19 Testing Confusion

Sick today, gone tomorrow: ConnectLocal opines on the issue of COVID-19 testing and the confusing reporting process.

There is very little about the COVID-19 pandemic that garners as much attention – not only in the mainstream media, but in social media posts, community discussions and questions posed to public health and government agencies, from the local level all the way to state and federal officials – as COVID-19 testing.


While testing is but a single aspect of the COVID-19 response, there are a number of different aspects – all of which garner public attention and incite widespread concern, anxiety and suspicion, and seem to put the public and public health officials on opposite sides of an issue that should, instead, bring us together.


Both sides of that issue have valid, logical concerns.


The public is concerned that the they are not getting the whole picture; that there are mistakes, and oversights, and conflicting information, incorrect information, or even worse, outright intentional disinformation, as well as a complete absence of information on facts, policies and procedures that the public, as a whole, feel they have a right to know.


And they are right.


They see evidence of cases appear and disappear on daily updates, they see “unknown” counties of residence, “unknown” age, and even “unknown” gender designations. They are told to “get tested” if they think they might have the disease, or been in contact with someone who might be contagious.. then they are told that only the elderly, the at-risk populations, and first responders and medical staff are being tested. They are told by the highest authority in the land that “we are doing more testing than anyone, and everyone will be able to be tested” and then are told that even health officials are worried about the lack of tests. They receive conflicting information from so many sources – most of them supposedly official sources – that even those that are not naturally suspicious of “the government” begin to feel doubt.


Health officials are worried that unbridled access to information will incite panic, that information that includes guidelines, rules or requirements will be chopped up by the public and stripped of those facets, and the remaining information used to disrupt an already overwhelmed medical response to a worldwide pandemic.


And they are right.


One only has to look at the empty toilet paper shelves at the local store, the healthy individuals walking around with n95 mask on their face, plastic bags on their feet and a double layer of surgical gloves, to realize that panic is human nature’s middle name. One only has to witness groups of people gathering at the park, in the store, at the post office, anywhere and everywhere - in the midst of a social-distancing campaign that is probably the most market-saturated media message of this generation, to realize that voluntary compliance with recommendations – even when in their own best interest – are apt to be ignored and scoffed at by a population determined to do things “their own way.”


Of all the typical questions about COVID-19 testing (many of which are addressed in the FYI portion of this editorial below), one of the most voiced is in regards to statistics – often the public’s only way of tracking the progression of the virus in Georgia.


Why are there discrepancies in testing results? The Georgia Department of Public Health – which provides twice-daily updates on the number of COVID-19 tests conducted in Georgia, the number of confirmed positive cases, the number of hospitalizations, and the number of fatalities – collects this information on tests and test results from an increasingly large number of entities.


Originally, testing was conducted in very limited facilities, and processing of those tests was conducted by the DPH labs. Now, tests swabs collected at a quickly-multiplying number of facilities are funneled into not only the DPH lab, but at least two private labs as well. Added to the problems caused by the increasing number of tests conducted and the multiple routes through which the data can come to the DPH, is the fact that you are dealing with people.. human beings, who may not give correct data, who may not have the same address on their licenses as they put on the testing paperwork, who may not want to reveal their address, who may write sloppy or spill coffee on the paper – a multitude of reasons why incorrect information could be fed into the DPH statistics stream. Now add in clerical errors and user error, and you have a system that is prone to errors.


That being said, protocols and procedures for exactly this type of situation, both statewide and nationally, should have been created, tested, refined, tested again, had “worst-case-scenario” testing, refined again, and put in place with repeated real-time practices with pertinent individuals, organizations and entities. Local-level DPH and healthcare officials are managing to keep on top of the situation as it spreads into month four of this emergency. State and National response, on the other hand, is dropping the ball.


It's not like the idea of a dangerous virus came out of the blue and snuck up on us with no warning; we had a re-emergence of Ebola in 2014, we had Bird Flu in 2013, we had MRS in 2012, we had Swine flu in 2009, we had SARS in 2002, and let’s not forget HIV in the early 80s and still going today. Yet in tonight’s DPH report update, Stephens County is once again identified as having two confirmed cases – and residents have no earthly clue whether that figure is accurate, or will drop back down to one tomorrow, and equally clueless as to where the confirmed case, if it actually exists, is physically located, or who may have come into contact with the individual. And to add to the uncertainty, neighboring Habersham was listed on this morning’s update as having one confirmed case… tonight, Habersham is not included on the list at all.


There is no “perhaps” about the statement that there should be better emergency protocols in place. I get it, Monday morning quarterbacks are a dime a dozen, and closing the barn door after the horse has trotted on down the lane is pointless, and every medical emergency of this nature is going to carry its own personality and challenges. But I find little excuse with as relatively few cases (and no, I’m not in any way making light of the 1,600 state residents who are fighting the disease, and most definitely not minimizing the 56 Georgians who have lost their lives) that we cannot get accurate, reliable, consistent data from the lead agency in the COVID-19 response.


The bottom line is, I believe (and that is why this article is marked as an editorial, because the word “I” especially combined with the word “believe,” never, ever ever, belongs in a news article) that our healthcare community – from local doctors to community and regional hospitals to state and federal Public Health officials, the CDC and WHO, are doing the best they can to test as many as possible given limited supplies, and to triage the testing according to the most efficient, effective hierarchy of need. But above the local level, they are falling down on the job when it comes to open and accurate communication. State officials need to take heed of the efforts and attitudes of local officials – and adopt them. Whether they are comfortable or not. Whether they pose the potential for difficulties or not. That information is not proprietary, it belongs to the public, by law, by ethics and by “its the right dang thing to do.”


But, on the other side of that coin, the public...we.. us.. we need to get it together. Stop panicking and wiping out the toilet paper isles. Find a mid-ground between fear and frivolous disregard. Use logic: follow the guidelines provided by science, and don’t force the government to force you to behave.


I’d like to see a time soon when I can say there are no “sides” to this editorial, and we’re all on the same road, headed in the same direction, and following the same map.

FYI

How many tests do we have? This number is a moving target, but the answer is, and most likely always will be, ‘not enough.’ In states across the country, health officials are severely limiting the sectors of the population who qualify for testing, and instituting strict screening measures to limit the number of tests conducted. A recent slew of posts on social media and tentative news stories about a new “at home test” have slowed as the company backpedaled and stopped COVID-19 testing services after the FDA issued a statement saying it "has not authorized any test that is available to purchase for testing yourself at home for COVID-19."


Do I need to be tested? According to the CDC, “decisions about testing are at the discretion of state and local health departments and/or individual clinicians”.


CDC provides as set of guidelines identifying the following priority levels for testing. Priority 1: Hospitalized patients, Symptomatic healthcare workers; Priority 2: Patients in long-term care facilities with symptoms, Patients 65 years of age and older with symptoms, Patients with underlying conditions with symptoms, First responders with symptoms; Priority 3: Critical infrastructure workers with symptoms, Individuals who do not meet any of the above categories with symptoms, Health care workers and first responders, Individuals with mild symptoms in communities experiencing high COVID-19 hospitalizations; Non Priority: Individuals without symptoms.


In Georgia, “tests are limited to elderly Georgians, members of the law enforcement community, first responders, long-term care facility residents and staff, and healthcare workers,” Gov. Kemp said on March 23.


I think I’m sick; how do I get tested? The process is very regimented for being approved for and getting a COVID-19 test.


Individuals who have a primary care provider should contact their PCP to discuss the need to be tested. Each PCP will have a process in place for those wishing to be tested. Processes include screening, most often with initial screening being done over the phone. If it is determined by the PCP that the patient meets the guidelines and needs to be tested for COVID-19, the PCP will provide the patient with further directions. Some PCPs now have the supplies on hand to be able to conduct the test swabs and collect the necessary specimen in-house; other PCPs will direct patients to a facility with the capacity to collect the test sample.


Individuals who feel they need to be tested, but do not have a PCP, should contact the Stephens County Department of Public Health by phone at (706) 282-4507 or call the Georgia Department of Public Health COVID-19 Hotline at (844) 442-2681. After a phone screening process, the local DPH will determine if a test will be conducted and will arrange and schedule for the patient to come get the test swab taken. After the swab is taken, the specimen will be sent to a designated epidemiologist, who will then convey the results to the patient once the test results are available.


No patient should go to any testing site without a referral from a PCP or the local Department of Public Health. Health officials at all levels, both private providers and government health officials, stress that patients must call ahead – whether it is to a PCP or the health department – if they are experiencing symptoms or are concerned they may have contracted COVID-19. This allows both for the pre-screening process, saving you a trip to the facility if a test will not be authorized, and allows the facility to prepare for your arrival, instituting the necessary precautions to protect other patients and healthcare workers.

Additionally, it is not only important, but mandatory, that a referral for testing be obtained before visiting a testing facility. This means don’t just show up at your doctor’s office for an impromptu visit because you have a cough. This means do not drop by the public health department to see if you should get a test. This means don’t play sleuth and try and find out where the testing sites are and just show up unannounced. And this certainly means don’t pop by the Stephens County Hospital emergency room without calling first unless you are experiencing a current, active medical emergency such as difficulty breathing.


Where are people being tested? According to Gov. Brian Kemp in a March 23 Twitter post, the state has 23 referral-only testing sites across the state (Cartersville, Rome, Dalton, Woodstock, Gainesville, Marietta, Atlanta, Morrow, Lawrenceville, Stone Mountain, Newnan, Dublin, Warner Robins, Augusta, Columbus, Valdosta, Tifton, Albany, Douglas, Statesboro, Brunswick, Savannah, and Athens).


In addition, local hospitals have been collecting test swabs and sending them either to the Department of Public Health lab, or one of the approved private labs, for processing and results. Now, private PCP facilities can also elect to conduct the specimen collection, according to a DPH representative. Not all care providers are choosing to do so, many are still referring patients to the nearest DPH testing facility.


Confusion over the actual process of testing, inadequate information distributed to the public through the media, public health offices or other means has leant an air of “top secret” test sites with infected individuals trooping in and out from who knows where.


It was private inquiries about this perception, combined with the questions brought about by inconsistencies in the reported confirmed cases in Stephens County, that sent ConnectLocal on an exhaustive search for such a “secret” test site in Stephens County. Inquiries to private healthcare umbrella companies resulted in “we cant tell you the answer” replies, and similar inquiries to state level health officials also resulted in answers referencing the need to keep the public from descending en-masse on testing sites without prior authorization.


The wording of these answers only served as a journalist’s red flag, and ConnectLocal dug deeper. I will admit freely that I can be somewhat persistent, insistent, and .. honestly, a big pain in the tukus, when I feel I am being stonewalled and my readers kept in the dark.


Finally, today, I spoke with an area public health official that took the time, and effort, to speak with me at length and explain the process and procedures; giving considered, and considerate, answers to my questions and providing details about how tests are conducted. I am now comfortable that there is not, in fact, a “top secret, virus-filled test site in Toccoa/Stephens County where unknown individuals are tromping in and out of the county to be tested and then sent on their merry way.


Could I be wrong? Is it possible that I’ve been bamboozled, and there is a grand conspiracy to cover up a testing facility here in our community? Sure. It’s possible – after all, I’m not infallible. But the fact that I am writing this, instead of continuing to call, visit and harass every public health official and medical facility public information officer to find answers is indicative of my level of confidence that this is not the case.

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