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Before someone's COVID-19 test can be sent to one of the region's labs for the nearly weeklong testing process, the patient must find a place that will screen them. In Hamilton County and across the United States, that can be hard to do.

As the pandemic spread across the world over the last three months, countries such as Australia, South Korea and Singapore have aggressively screened citizens by the thousands as a preventative measure, while other countries, including the United States, have taken a reactive approach, testing only high-risk, symptomatic patients.

In Hamilton County, like many other parts of the country, screening is limited to those with both known exposure or other risk factors and symptoms matching the virus.

As of Friday, one week after the first positive test came back to Hamilton County, 15 days after the first case in Tennessee and two months after the first confirmed case in the United States, Hamilton County has tested just 59 of its more than 360,000 residents, eight of whom have tested positive, according to the Chattanooga-Hamilton County Health Department.

While the actual procedure of screening seems simple — a patient shows up, gets a deep nose swab, and the swab is shipped to a lab — personnel and supply shortages are spread too thin for mass testing.

"We all want more testing for COVID-19, but some of the biggest issues we're having right now is the availability of personal protective equipment, of testing supplies and of the lengthy time it takes to get test results either from the state labs or from private labs," Chattanooga-Hamilton County Health Department Administrator Becky Barnes said. "We have a lot of people here working on this effort, and as soon as we can get these issues resolved, there can be more testing in our community."

Barnes said the lack of protective equipment such as masks and gloves for health care professionals was the county's current focus to help expedite screening.

"And then we really don't want to overburden labs that are already taking a lot of tests so we're trying to prioritize those tests," she said.

Some of the first local confirmed cases of COVID-19 involved places where large numbers of people gather — a big church, the campus of the University of Tennessee at Chattanooga and a local elementary school. Many residents fear exposure but are still not being tested.

Around three dozen local residents are on mandatory quarantine by the health department because of exposure, but even they won't be screened unless they become ill.

"People on restricted movement currently are people who had some kind of potential exposure," Barnes said on Wednesday, when the count had grown for the first time to three confirmed cases. "We wouldn't recommend or move to get them tested unless they have symptoms. These are just people in quarantine. They are not currently ill."

Late last week, the health department shared news releases imploring those who had potentially been exposed to the one confirmed local case known at the time to practice social distancing and to call their health care providers about screening if they began to exhibit symptoms including a dry cough, shortness of breath and a fever of 100.4 or higher.

On the other side, people who are symptomatic but have no known exposure have been struggling to get screening as well.

"I have had shortness of breath, an unbelievable cough and an off-and-on fever for weeks, but I haven't been able to get tested," an Ooltewah woman who did not want her name published for privacy reasons told the Times Free Press Thursday. "I'm in my late 60s but as soon as I told my doctor that I had no travel history and I don't think I have been around anyone who has it, but who knows, she wrote me off and I didn't get tested and I don't think I'm going to."

While a drive-through screening facility has been set up for personnel of Erlanger hospital, the only way a Hamilton County citizen can get screened for coronavirus is if they are sent to an assessment site by their health care provider after being tested for other illnesses and determined to meet symptom and risk criteria set by the U.S. Centers for Disease Control and Prevention and the health department.

Asked Friday about the regions of the county affected by existing cases and how the county health department will develop broader screening procedures for citizens, Barnes shared few details.

"We're working to develop that, but with so few cases right now it's a little early to release that kind of information yet," Barnes said, adding that the supply issue was too widespread to predict. "It's an international problem and we're doing everything we can to solve the problem locally. I think eventually there will be some national relief, it's just not here today what we're planing to do is get all the logistics, get the place and the people and everything ready to go, and then as soon as we have the supply problem solved, we'll be ready to go."

Barnes again blamed supplies when asked why drive-through assessments are available in other urban Tennessee areas including Davidson, Williamson and Shelby counties, but not locally.

"The supply situation is very sporadic across the country," Barnes said. "They might have already had those or they might have been able to find some protective supplies that weren't available in other parts of the state, but all I can do is assure you that we are trying really hard and working really good with the community to address that problem."

While she said hospitals were working with their usual vendors for such supplies, Barnes did not share any specifics about how the county or local health care providers are pursuing the required protective supplies or when she expected improvements to public testing.

Rae Bond, CEO of the Chattanooga-Hamilton County Medical Society, said the medical community must ration medical supplies so they're on hand to treat the most vulnerable patients and protect personnel.

"Our community is facing the same challenges as many other communities in our state and country. That is, many people who are concerned but do not have symptoms wish to be tested [for COVID-19]. CDC guidelines do not provide for testing without clinical symptoms," Bond said, representing Erlanger Health System, Parkridge Health System and CHI Memorial on Friday. "It's important for the public to know that if a large number of health care workers in any community is exposed to a virus — forcing them to leave their jobs — it would be impossible for hospitals to adequately care for all the vulnerable patients they treat, many of whom have life-threatening illnesses or injuries."

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