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As Hamilton County learned of its first confirmed COVID-19 case Friday, Chattanooga's major health systems failed to answer questions about how they're handling testing for the virus at their emergency departments, physician practices and urgent care facilities across the region.
Dr. Anthony Fauci, the top infectious disease expert at the National Institutes of Health, told The Associated Press on Friday that testing for the new virus has lagged across the country, meaning the government is failing to account for what could be thousands of additional infections.
"The system is not really geared to what we need right now," Fauci said. "That is a failing. It is a failing, let's admit it."
In a joint press release with the Chattanooga-Hamilton County Medical Society, CHI Memorial, Parkridge Health System and Erlanger Health System officials said "hospitals are working to develop more community testing sites" but did not share any additional details or respond to a list of questions, including if they are taking test samples from patients at drive-through sites or how many patients had been tested at their facilities.
Rae Bond, CEO of the Chattanooga-Hamilton County Medical Society, spoke on behalf of the three hospitals during a news conference announcing the county's first confirmed COVID-19 case on Friday afternoon.
"Many medical practices are rapidly developing protocols to handle the expected influx of patients," Bond said. "Please understand that all medical practices, hospitals and other facilities are ramping up as quickly as possible, and they've been constrained by the simple availability of all of the testing mediums and processing for those tests."
The Hamilton County man confirmed to have COVID-19 on Friday was diagnosed with pneumonia after traveling to Kentucky for a conference in late February. However, he was only tested for COVID-19 this week upon learning that someone from that conference had tested positive for the virus — supporting some residents' fears that Hamilton County's low case count could simply be due to a lack of testing.
Like other infectious diseases, a coronavirus test must be ordered by a health care provider, such as a doctor's office, an urgent care facility or an emergency department. Specimens are obtained through a nasal and throat swab, then sent to a lab, which could be the state's department of health lab in Nashville or a commercial lab. By law, labs must report positive test results to the state and county health departments.
Commercial labs, such as LabCorp and Quest, only recently gained the ability to test specimens for the virus. Previously, all samples were sent to the state's lab or the U.S. Centers for Disease Control and Prevention.
That limited testing capacity, combined with the unknowns of a new virus, "has been very challenging" for providers, according to Charlie Lathram, practice administrator for Galen Medical Group — the largest independent medical practice in Chattanooga.
"This is definitely something that's unprecedented, and it's causing us to shift the way we normally practice medicine," Lathram said. "All of those things that you know about influenza, you don't know about this yet. Our physicians are learning, just like everyone in health care."
Earlier this week, Galen began implementing a "very thorough and detailed triage procedure" for sampling based on CDC guidelines, Lathram said. The goal is to limit exposure.
Patients are instructed to call the office and say if they're experiencing symptoms — high fever, cough and shortness of breath. Members of the triage team screen patients and determine if their case warrants a virtual visit via telemedicine or the phone. Based on that visit, they determine whether or not to test, he said.
For those needing a test, Galen established a drive-through testing facility at the practice's north internal medicine office.
"You will not even have to get out of the car," Lathram said. As patients await results, case managers check in to make sure they're doing OK as they remain isolated at home.
Lathram did not say how many testing specimens Galen had collected so far, but he said providers have been sampling. So far, the process is working well, he said.
"I think that speaks to our providers. They've approached it in a very cool, collected, methodical, evidence-based way," he said, adding that other practices interested in learning about the procedures can contact Bond at the medical society.
"My physicians have all expressed a very sincere willingness to talk to other health care providers, to walk them through our process," Lathram said. "We'd love to learn from what other people are doing, and it's going to take truly a community effort to defeat this."
People should contact the provider or facility they plan to visit before arriving in case there are special protocols in place. It's unclear whether the Erlanger, Memorial or Parkridge facilities and physician practices have sampling strategies similar to Galen.
Since it can take several days for lab results to return, Dr. Paul Hendricks, Hamilton County Health Officer, said anyone with symptoms should remain isolated at home to avoid potentially exposing others. While the risk of serious illness to those who are healthy remains low, he said during Friday's news conference that isolation of potentially infected people is key to protect the most vulnerable — seniors and those with chronic conditions.
People with a fever of more than 100.4 degrees and respiratory symptoms should call their health care provider before arriving, Bond said. Those without a primary provider can call urgent care facilities, or if absolutely necessary, emergency departments. Bond also encouraged people to reschedule any routine or non-urgent medical visits.
"We'd all like to know if we're at risk. It's really important as we expand our capacity in this surge, that we reserve testing, reservere medical appointments for people who have symptoms," Bond said. "If you're just curious if you're at risk, I probably wouldn't want to go to a medical office anyway — just because of the risk of possible exposure."
Contact Elizabeth Fite at firstname.lastname@example.org or 423-757-6673.
The Times Free Press asked local health systems the following questions on Friday:
1. How do providers determine if someone warrants being tested for COVID-19?
2. Are providers overwhelmed with requests for testing?
3. What does your health system do if someone calls with symptoms that warrant testing? Are you taking samples from people in their vehicles?
4. Where does your health system send samples for testing?
5. How many samples has your health system sent for testing?
6. How did your health system communicate to its providers its testing protocols?
7. Anything else people should know?
Instead of responding, they issued a joint statement:
In the next few days, COVID-19 testing should become more widely available as testing labs, including LabCorp and Quest Diagnostics, expand their testing capability. In addition, hospitals are working to develop more community testing sites. Testing must currently be done at a health care facility, not at the testing labs themselves.
Similar to testing for other infectious diseases, such as the flu, the Coronavirus test is not available to the general public on request. Individuals will need an evaluation by their health care provider, urgent care center, or emergency room before a test is ordered.
In the meantime, if you are experiencing mild symptoms please self-quarantine at home – and that means staying at home and maintaining distance from other family members who aren’t experiencing symptoms.
If you have a fever greater than 100.4 degrees and respiratory symptoms, call your normal health care provider. If you do not have a health care provider, call the closest urgent care center. Please call the facility before arriving in case of special protocols.
Many medical practices are rapidly developing protocols to handle the expected influx of patients.
Individuals who are elderly and/or frail, are encouraged to call to reschedule any routine or non-urgent visits for at least four weeks. In addition, please stay at home and avoid crowds.
Everyone in the health care community is working as fast as possible to address this situation, which is complicated by the closure of schools and the need for parents to find alternative resources for their children. For instance, the Medical Society will be opening a play room for employee’s children next week to allow them to continue working.
It is hard to be patient when you are concerned about your health. Medical practices, hospitals, and other health care providers are ramping up as quickly as possible and working to utilize all available resources.