ARIZONA — State Health Director Dr. Cara Christ last week called on doctors to reduce testing for the COVID-19 virus, although Arizona’s already dead last when it comes to per-capita testing.
She cited a lack of test kits and urged doctors to simply treat all patients with symptoms as though they were infected. The state also has a critical shortage of the gear doctors and nurses need to even administer a test.
“Keep working with your commercial vendors for testing, but do not depend on having test results for your management,” she said in guidelines to doctors. “There is no specific treatment or manage strategy and results should not change clinical management.”
The notice means Arizona cannot pursue the strategy used in Singapore, South Korea and other countries used successfully to contain the virus through aggressive contact tracing to identify and isolate infected people before they showed serious symptoms.
A database published by the New York Times Friday showed Arizona has so far done 13 tests per 100,000 population. That compares to an average of 177 tests per 100,000 in the United States. New York has done the most testing – 627 tests per 100,000. Even the second-lowest state – Oklahoma – has done more than twice as many tests per capita as Arizona. According to the database (https://www.nytimes.com/interactive/2020/03/26/us/coronavirus-testing-states.html?action=click&module=Top%20Stories&pgtype=Homepage).
Nationally, health officials and doctors are now doing 65,000 tests per day, with people lined up in many areas. However, health experts estimated we would need to do at least 150,000 tests per day to mimic South Korea, which moved aggressively early in the epidemic to identify and isolate anyone infected based on contacts or even mild symptoms.
It takes 5-7 days from the point of infection for symptoms to develop in most cases. Studies show people without any symptoms at all can still spread the virus.
Flaws in the initial U.S.-developed test coupled with a delay in mobilizing private labs put the U.S. weeks behind the international curve in developing and distributing enough tests. The US still doesn’t have a reliable, rapid screening tests – which means it can take days to get test results back.
Dr. Christ told doctors this week that “current reality” means the state doesn’t have enough test kits to meet demand and doctors should manage their patients without relying on getting test results back in time to make a difference.
Moreover, the state’s facing a critical shortage of gloves and gowns and other protective gears doctors and nurses should use when administering tests to people potentially infected with the virus – even though so far about 90 percent of the tests have come back negative. She encouraged doctors to administer the testing outdoors as much a possible and to reuse some protective equipment like gowns.
The recommendations come in the face of computer modeling of the epidemic in Arizona that predicts new cases will peak in mid April and the load on hospitals will peak in May. This means the state must stretch the limited supply of gloves, masks and test kits to last through the weeks to come.
Arizona health officials weeks ago assured the public they had enough supplies and test kits on hand, but at that point the virus was not widespread and the testing efforts focused on people returning to the state from areas with widespread infections – like China. The test criteria limited testing to people with symptoms and a documented exposure to someone with a positive test for the virus. The state expanded the criteria to people with serious symptoms once it became clear the virus was spreading in the community, which soon overwhelmed the testing system – resulting in long delays in getting results.
As of Monday, the state health department’s website listed 1,157 confirmed cases and “widespread” presence of the virus in the Community. Gila County had one confirmed cases, while Navajo County had 88 and Apache County had 17. The state website said 1,157 people had been tested. Of those tests, 61 took place in the state lab and 1,096 in private labs.
The United States now has more infections than any other country in the world, surpassing the peak number of cases in China, where the infection rate has slowed dramatically.
South Korea managed to contain the outbreak without the kinds of widespread lockdowns and shelter-in-place orders on which states like New York and California have come to increasingly rely.
South Korea rushed to develop tests as soon as the virus was identified and genetically sequenced in neighboring China. The nation in early January developed a test and pressed manufacturers to mass produce test kits before the virus had become widespread. The nation of 51 million within weeks had free, drive-through test centers operating across the country.
The containment effort suffered a setback there when members of a secretive religious sect who had been holding mass meetings started getting sick. Health officials quickly tested people who had attended the gatherings and isolated anyone who tested positive.
South Korea quarantined tens of thousands of people, but did not therefore have to resort to the large scale business closures and state-at-home orders that have marked the US response to the virus.
Japan followed a similar approach, with rapid deployment of testing coupled with aggressive isolation of people exposed to the virus. The quick response apparently prevented widespread spread of the virus within the country.
All those nations benefitted from the lessons they learned from SARS in 2003 and MERS in 2015, both coronavirus strains much more lethal than COVID-19, but slower to spread.
South Korea used surveillance cameras, credit card transactions and cell phone to track the movements of people who tested positive in the days before the test. This allowed health officials to track down and test contacts. South Korea also released details on infections to the public. The notices didn’t provide the names of those infected, but sometimes identified the block on which they lived – helping alert people to the movement of the virus through the community.
By contrast, Arizona simply provides a tally by county – without revealing even which city or community in that county have someone who has tested positive.
Dr. Christ urged doctors to simply manage patients with a cough, fever and other symptoms of COVID-19 as though they were infected – which means wearing full protective gear and keeping them isolated from other patients. She noted that no drugs exist proved to lessen the course of the virus.
However, the state also recently concluded Arizona has about half of the intensive care beds it will need to cope with the projected increase in infections.
So absent tests, mass stay-at-home guidelines, the shutdown of public gathering places and social distancing remain the only way to slow the spread of the virus and prevent overwhelming healthcare facilities.