State’s top health officer moves to improve access to coronavirus testing

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Eric J. Shelton/Mississippi Today, Report For America

Mississippi State Health Officer Dr. Thomas Dobbs discuss the state’s first case of COVID-19, also known as the Coronavirus, during a press conference at the Mississippi State Department of Health Thursday, March 12, 2020.

After weeks of confusion and lack of clarity around testing, state health officer Dr. Thomas Dobbs has made one thing clear: if physicians feel they need to test a patient for COVID-19, they can and should.

Referring to clinics and hospitals, “Anybody can test, if it’s appropriate,” Dobbs said. “If you’re sick and worried, call your clinic, call your provider, call your doctor, and let them take care of it.”

Physicians no longer have to obtain Mississippi State Department of Health approval to test patients, a departure from previous guidelines. The new guidelines were announced Wednesday afternoon, before the state’s first confirmed case Wednesday night, and clarified Thursday morning in a news conference.

As of Thursday morning, physicians have complete discretion and ability to test patients they suspect might carry coronavirus and risk spreading the disease, COVID-19, which the World Health Organization declared a pandemic this week.

Any clinic can use their own equipment and follow health department guidelines to collect samples – a nose and throat swab – from patients, and submit the sample for MSDH testing.

Throughout the news conference Thursday, Dobbs reiterated the new protocol changes are to reduce barriers to testing: “It’s absolutely available through (MSDH) and private labs … if a clinic wants to send a sample, they are perfectly able to get it from us or private labs.” Tests are typically returned within 36 to 48 hours, he said. “We do not see at this moment any bottleneck at our lab running tests.”

Currently – though Dobbs made clear that the situation is constantly evolving – the state has tested 42 people, with one positive test. The lab can test 200 samples per day, and has capacity for 1,000 patients, he said, adding the lab is getting more supplies. In midst of testing shortages nationwide, the new guidelines address access to lab tests, not the number available.

Clinics themselves do not need a special kit to submit a sample – previously patients just had to meet stricter guidelines to qualify for a lab test. Now that those guidelines have been relaxed, labs’ supply of testing kits, which stabilize samples by adding chemical mixtures known as reagents, will determine number of tests run. The first round of “test kits” – not the collection materials for clinics, but the lab mixtures used to run the test on the back end – provided by Centers for Disease Control and Prevention were initially flawed, but officials say have since been corrected.

MSDH did not clarify what 1,000-patient capacity meant, but it seems to be a reference to lab test kits available, up from 225 reported earlier this month. “We have plenty of testing capacity, I am not giving the number of tests we have available – we are in good shape,” said Liz Sharlot, MSDH spokeswoman, in an email.

In light of the state’s first confirmed case – a Forrest County man under the age of 65 who recently traveled to Florida – Dobbs said the new guidelines are aimed at broadening access to testing.

Up until Wednesday afternoon, physicians had to obtain prior approval for sending test swabs, which were reserved for symptomatic patients who met criteria, such as recent travel to impacted areas and close contact with a confirmed or suspected case within 14 days of symptom on-set.

Who exactly needs to be tested can now be determined by physicians on an individual basis, but is generally considered those showing flu-like symptoms when other illnesses have been ruled out.

No further details about the Forrest County case have been released, other than that the man is voluntarily isolating at home, as are those he had close contact with so they can be monitored for symptoms. “That’s the exact right thing to do,” Dobbs said, of the man contacting his provider, who sent in a test.

Dobbs answered questions about panic and misinformation, explaining how the virus is contracted and spread. Cases will continue to grow, but most people who contract it will make a full recovery, he said after emphasizing that prevention is the best method of protection. “Only a small proportion – less than 1 percent – are likely to have severe outcomes or death,” Dobbs said. “We (public) are where we need to be with concern (on average). Some people are too concerned, some people aren’t concerned enough … Most people are not going to get COVID-19,” he said. “But more people are going to get sick.”

As of Thursday night, 36 people across the U.S. – 3 percent of the total number of cases – have died, according to the CDC, though this total largely reflects a stricter testing protocol than we are seeing now, where sick people were exclusively tested.

The state health department has been capable of testing in-house through pre-prepared CDC test kits since last week, and private commercial labs, such as Quest Diagnostics and LabCorp, brought testing online this week.

As for keeping up with new testing capacities, the health department added COVID-19 as a reportable illness, meaning clinics and labs must report positive tests to the state health department so they can keep track. As of Thursday 42 people have been tested but it’s unclear if the state will be able to continue to provide that level of transparency as testing becomes more widespread across private labs. As other states have quickly escalated testing, some are only reporting positive tests and have stopped reporting the total test count, according to The Atlantic’s nation-wide tracker.

Doctors across the country and state have expressed confusion over protocol around testing, saying test kit supplies were limited or that they didn’t know how to obtain them. Per the health department’s new guidelines, “limited tests” or not knowing where to get a test should present less of a barrier because clinics can send samples at will.

Physicians can order lab tests through the health department just like any other routine swab or blood test, Dobbs said. This means that clinics can use their own lab materials, swab a patients throat and nose, prepare and label the sample per MSDH guidelines, then send the sample to the state lab.

Col. Gregory Michel, director of the Mississippi’s emergency management, said the state is now at its highest level of emergency preparedness, telling reporters this is the first Level 1 status since Hurricane Katrina 15 years ago. The status is mostly one of preparation and not necessarily cause for alarm, he said. “It’s important to note that the reason (for Level 1) is to properly focus and posture all of our support in order to respond as we may need to do.”

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The state also announced ongoing measures to limit further exposure.

Visitation at state prisons will be temporarily suspended. A statement put out by the Mississippi Department of Corrections says that the agency is establishing sanitation and prevention protocols to prevent the spread of COVID-19: “Attorneys and essential visitors will be allowed, and the area of visits will be sanitized upon completion of each visit. Additional parameters will be determined as protocols are established.”

House Speaker Philip Gunn, R-Clinton, said the Capitol will not be closed because of the coronavirus, but people will be dissuaded from visiting. The legislative session, which is scheduled to end in May, will continue.

“Those who have business at the Capitol you are welcome to come,” he told members of the Mississippi House after meeting with the state health officer. “But if you don’t have business, it is recommended that you avoid mass gatherings.”

He described the Capitol during legislative session as a mass gathering. He said school groups and others who often visit the Capitol should stay away. The page program also will be discontinued, he said.

Many groups might be reaching the same conclusion to stay away from the Capitol on their own. On Thursday, the halls of the Capitol were near empty when compared to recent days as the House and Senate met in their chambers.

Dobbs reiterated people with flu-like symptoms should contact their physician, not a hospital emergency room and other recommendations to individuals, among perennial guidance to limit spread by reducing social activity and practicing preventive hygiene, like washing hands thoroughly and covering coughs and sneezes:

  • Avoid gatherings of 250 people or more, especially if there is evidence of transmission in your county or adjacent counties. If you do attend, remember to practice the hygiene and social distancing.
  • To prevent illness in those most vulnerable, anyone 65 or older OR with a chronic medical condition should avoid any gathering of 250 people or more
  • Avoid unnecessary (non-urgent) air, bus or train travel.
  • Limit visitation to older relatives or friends (especially in nursing or care homes).
  • Prepare for the possibility that schools or day care centers may temporarily close.