Testing and the Governor Are the Two Things Standing in the Way of San Diego’s Reopening - Voice of San Diego

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Testing and the Governor Are the Two Things Standing in the Way of San Diego’s Reopening

County leaders have laid out five criteria – four of which have already been met – that must be satisfied before the city can reopen.

A health care worker with Family Health Centers of San Diego speaks to a patient at a coronavirus testing center in Chula Vista. / Photo by Adriana Heldiz

Just five little data points.

That’s all that currently stands between San Diego and a gradual reopening, county leaders say.

Technically, as of Wednesday, it’s not even five. It’s only one.

County leaders have laid out five criteria – four of which have already been met – that must be satisfied before the city can reopen.

Here are the five criteria, which were first developed by the Centers for Disease Control and Prevention:

  • Downward trajectory in the percent of positive COVID-19 cases
  • Hospitals are essentially functioning normally and not using a “crisis care” model to treat a surge of patients
  • A 14-day downward trajectory in the number of people who are sick with flu-like symptoms
  • A 14-day downward trajectory in the number of people who are sick with COVID-like symptoms
  • A robust coronavirus testing program must be in place

Up until Wednesday, public health officials said San Diego had not met the fourth and fifth criterion. But on Wednesday, they revised that assessment. The number of people coming to hospitals with COVID-like symptoms has now been going down for 14 days, they said.

Image courtesy of San Diego County

That means the only barrier left to reopening is a lack of widespread coronavirus testing.

“We know we can and must test more individuals,” Dr. Wilma Wooten, the county’s chief public health officer, admitted earlier this month.

Public health leaders and hospital officials have differed on what exactly is preventing San Diego from ramping up testing capacity.

Various local institutions – including local hospitals and clinics – have the capacity to test at least 4,700 people per day, representatives for those institutions told me.  And yet for the past seven days, an average of 1,976 tests has been reported each day.

That’s just 42 percent of full capacity.

Widespread testing allows doctors to understand the prevalence of infection in different parts of the community. In other countries, such as South Korea, it has been the key to emerging from lockdown and letting people go back to work.

Gov. Gavin Newsom has suggested that California needs 152 tests for every 100,000 residents per day to have a robust testing program. In San Diego, that would represent roughly 5,074 tests per day, based on U.S. Census estimates.

San Diego’s capacity is near where it needs to be.

But public health officials have said the 4,700-tests-per-day capacity is only theoretical. They say some institutions don’t have the protective gear they need – such as gloves or masks – to take the test samples.

But officials from most major hospitals said this isn’t the case. Representatives from UC San Diego Health, Sharp HealthCare, Rady Children’s Hospital and One Medical San Diego – which account for the bulk of the tests – said they stand ready to do more tests.

Despite their initial denials, public health officials now seem ready to admit that hospitals can greatly expand their testing efforts. On Wednesday, Wooten said she expects the number of reported tests to start increasing by 500 every day.

The county’s Health and Human Services Agency – which houses public health – is responsible for coordinating the local response to the outbreak. That means the agency is responsible for getting local hospitals that normally compete with one another to work together in a synchronized testing strategy.

Wooten announced Wednesday that a recently formed testing task force had created guidelines for who will get tested as capacity increases.

For starters, everyone with COVID-like symptoms will be tested. (Previously, only the most sick had been tested.) But many priority groups will also be able to get tested, even if they are asymptomatic. These groups include health care workers, people who have been exposed to COVID-19, people in rural areas and many other groups.

Image courtesy of San Diego County

Even if San Diego begins running 5,000 tests per day next week – which Wooten suggested might be possible – local officials say they’ll still be beholden to the governor’s directives.

We still have to wait on the governor,” said Wooten. Everything does hinge on the governor’s guidance and directive.”

Newsom said on Tuesday that California is currently in the first stage of a four-stage reopening process. Stage one is largely about preparation and laying the groundwork for going back to work, he said. Stages two and three open up various workplaces and stage four will end the stay-at-home order, he said.

Dr. David Pride, an infectious disease specialist at UC San Diego Health, said he believes the five criteria represent a common-sense baseline for gradual reopening. (If anything, the plans coming out of the CDC are too generic, he said.)

“If your goals are to limit mortality and overwhelming of hospitals, reopening everything tomorrow is not a good idea,” he said. “But if your goal is to bring people back to their jobs quickly, you certainly could achieve that by reopening tomorrow.”

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