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Public health officials are struggling to bring the tests to the people.
Having widespread coronavirus testing much earlier would have been better.
That would have allowed states and counties to set up aggressive testing and tracing efforts before the virus had a chance to take hold. It could have prevented such an extended lockdown – as it has in South Korea, which recorded its first confirmed case on the same day as the United States.
Officials there used a simple formula: test, trace, isolate.
While it is too late to improve the United States’ early response to coronavirus, that simple formula still has the power to save lives and expedite a return to social behavior in San Diego, public health experts say.
Early on, local hospitals and clinics ramped up their testing capabilities – they now have the ability to perform almost the exact number that would constitute “widespread” testing – after it was clear the United States faced a testing shortage. But San Diego officials are still struggling to bring those tests to the people.
San Diego labs are only testing at roughly 60 percent of their capacity, according to the most recent data.
“My fear is that there is some magical thinking that if you build it, they will come,” said Dr. Thomas Tsai, a medical doctor and health policy researcher at Harvard University. “There’s no use having a bunch of tests in a warehouse. You have to get the tests to the people and the people to the tests.”
Indeed, one official with UC San Diego Health recently lamented a lack of demand for testing.
“One might argue we built too much testing capacity. At the time it seemed like too little. Here we are weeks later and it’s looking like too much,” Dr. David Pride, an infectious disease specialist, told me on April 21. “We’re really counting on state and local governments to help us figure out who needs to be tested.”
From the perspective of reopening the economy and society safely, it would be almost impossible to test too much, said Tsai.
Since April 21, UCSD has stepped up testing outreach, Pride said, and is now doing around 600 tests per day. UCSD can perform 1,000 tests per day right now. But it also has a second lab that could perform 600 tests per day that officials have so far chosen not to bring online.
Part of the problem, Tsai said, is that countries that implemented rapid testing have more centralized health systems that were well equipped to create and execute a single plan.
Within the United States, and even within San Diego, the health care system is fractured. Hospitals are used to competing for patients, not operating in concert.
But during an official state of emergency, public health officials, like those in San Diego, have special powers to coordinate the response.
“Public health officials have to create the demand,” said Tsai. “They have to meet the people where they are.”
Tsai said it would be better if the federal government coordinated a single approach. But in the absence of that, state and county leaders must execute centralized testing regimes, he said.
On April 17, Dr. Wilma Wooten, the county’s chief public health officer, announced the creation of a task force to address stagnant testing, first revealed by Voice of San Diego.
Nearly two weeks later the task force unveiled new testing criteria, which adjusted previous orders to test only people with the most severe COVID-19 symptoms. The new criteria allows testing for some asymptomatic individuals, including health care workers and certain vulnerable racial groups. But it didn’t include details about how public health officials would ensure these groups actually start showing up to get a test.
One of the most important testing strategies, Tsai said, is to ensure that everyone who comes into contact with a person who is confirmed positive with COVID-19 should be tested. Rapidly testing those who have been in contact with COVID-19 will allow public health officials to start isolating people who need to be isolated.
Test, trace, isolate. Ultimately, that will save lives, said Tsai.
Since creating their initial list of who should be tested, public health officials have expanded it to include those who have been in contact with confirmed COVID-19 cases.
That means now, in theory, anyone who comes into contact with a confirmed COVID-19 case will be recommended for testing. Initially, public health officials only quarantined those who had been in contact with a confirmed COVID-19 cases.
Implementing such a strategy will require a small army of contact tracers – workers who retrace the steps of infected individuals. These investigators would be responsible for contacting everyone who has been potentially infected and encouraging them to get tested.
Currently, the county public health department has roughly 160 contact tracers, but it will need many more. County officials say they have set an “initial goal” of training 450. Other official estimates suggest the number should be between 500 and 1,000 based on San Diego County’s population.
Public health officials also plan to test everyone living in congregate care homes, such as senior living facilities. They are already sending health care workers to these sites to perform tests, County Supervisor Nathan Fletcher said Wednesday.
Tsai confirmed that proactively sending workers out to test such vulnerable populations is key to creating a robust testing program.
But the county is still falling short of its goal to test 5,200 people per day. That target comes from a paper published by Tsai and some of his colleagues that suggested that the United States needs 152 tests per day per 100,000 people.
On average, just 2,800 people have been tested each day over the last seven days in San Diego County. But local labs and hospitals have the capacity to test more than 4,700 people per day, various local institutions have confirmed to Voice of San Diego.
The number is actually higher, if not above the 5,200 mark. The state public health department recently set up two testing facilities in San Diego with additional testing capacity. Kaiser Permanente also has the ability to do hundreds of tests per day in San Diego, though the exact number is unclear.
“In totality San Diego County has done well. Not as well as we want to do, which is why we have a goal that is significantly higher of where we’d like to be,” said Fletcher of testing.
Even though the virus is already well established in the United States, Tsai said it is still very important to test as widely as possible and follow a centralized strategy to make sure it happens.
“A lot of people think it is futile to contact trace now, because you can’t use it isolate everyone,” said Tsai. “The goal is not to snuff out the whole pandemic. The cat is already out of box. But we can save a whole lot of lives from doing lots of tests and contact tracing.”
Jesse Marx contributed to this report.