Expanded testing at Essentia Health and St. Luke’s Hospital will help to better control the spread of the coronavirus, but that’s not all that is needed, say specialists in infectious diseases at both facilities.
Gov. Tim Walz announced last week that the state has increased capacity to process as many as 20,000 tests per day statewide. Earlier goals were set at 5,000 tests per day. As a result, both facilities will offer tests to people who are showing symptoms of an active infection, in addition to those at high risk of infection. Both facilities indicated people should contact their physician or clinic to find out more.
Dr. Andrew Thompson, infectious disease physician at St. Luke’s, said while expanded testing is a critical step, it’s just part of the equation.
Following potential positive tests, he said it’s important to trace the contacts of the person who tested positive to be truly effective. Once someone tests positive, public health officials must identify other people that may have come into contact with them and determine if they may benefit from a test as well.
“Increased testing is wonderful and it’s a headline, but a lot of work needs to go into it after we have the ability to run a test in a lab,” he said Thursday, when he and Dr. Jon Pryor, president of Essentia Health’s East Market; Dr. Nicholas Van Deelen, chief medical officer at St. Luke’s; Dr. Rajesh Prabhu, infectious disease physician at Essentia Health, met with reporters for a weekly briefing.
Thompson said a positive test in an otherwise well person doesn’t mean hospitalization, but instead must be followed by self isolation for at least seven days or at least three days after symptoms are resolved.
“It’s a critical time period,” he said.
Prabhu stressed that the 20,000 number is the capacity of all health systems in the state. “It doesn’t mean 20,000 symptomatic people in state will be tested each day,” he said.
Now, he said his facility has tested 1,800 people so far, showing an average of 3.6 percent of those testing positive.
The doctors said the low prevalence of positives in the northland are a reflection of the area’s devotion to social distancing, hand washing, and wearing a mask.
“We’ve done a really good job of this, and we know people are getting antsy,” he said. “But this is a life or death matter. We need to show our grit and until there’s a vaccine, we need to stay away from each other a minimum of six feet, and wear mask a whenever possible.”
Prabhu agreed the multi-pronged approach needs to continue, and shouldn’t be diminished because of the expanded testing capacity.
“If it truly says only 3.6 test positive, that’s good, and it could be even lower in the future” he said. “It means it’s working, but it also means if we stop social distancing, open the economy and all businesses and see people go back to normal, you’ll see positivity rates of 10-, 20-, 30-, 40-, 50-, 60- percent, and we don’t want to get there. That means the curve has not been flattened.”
The doctors said they know the economy is hurting and they are grateful for state and federal relief bills from which their hospitals have benefited.
Cutting nonessential visits has reduced revenue for both facilities, with Pryor noting most health care facilities are down 40-50 percent of the revenue they expect, and the health care margin of profit is already low.
A survey by the Minnesota Hospital Association estimates health care facilities in the state are losing about $1 billion each month.
“None of us wanted to be here with the economy in general struggling,” Pryor said. “But we’re in this together and we’ll get out of it together.”
Surge, peak?
The doctors again said there is no way to precisely predict when a surge leading to a peak of cases will come, and as communities continue to practice social distancing, hand washing and face masking it has been delayed.
“We think sometime mid-summer, but that can move up or back depending on social isolation, and if we continue to stay apart, stay home and wear a mask,” he said.
Prabhu said testing all symptomatic patients gives an opportunity to flatten the curve or reduce the number of infected in community further. “Projections into the future will change with this intervention,” he said.
Van Deelan also said more data on active infections will help models be more accurate. But, “like the weather, the further out we get, the harder to predict,” he said.
Any chance the area may not get a surge of cases, or has already peaked?
Pryor said the best that could happen is the expanded testing shows no peaks and it’s no big deal.
“That would be a win; the worse we can do is assume it’s not important and hundreds of more lives will be lost. If we value life, and each other, we’ll do the right thing and not assume there will not be a peak and take precautions.”
Thompson agreed. “But we are a susceptible population, and most people in the region are still susceptible to the virus,” he said.
“If we stop everything we’re doing, and open up, we will most certainly see a huge surge,” he said, adding it’s difficult to balance keeping people safe, while opening the economy.
“If we stop social distancing and open all businesses as usual, we will become like other parts of world — inundated with cases,” Prabhu added. “In a pandemic, it’s better to be over prepared than under prepared.”
Van Deelen urged against complacency, saying the actions and behaviors put in place now have already saved hundreds to thousands of lives.
“We need to foster reinvigorated economic activity, but at the end of day we’re talking human lives and that’s why we have to be very, very careful and we are, and the results are great.”
Vaccines are being developed and tested more quickly now than ever, they said. Normal time frames are four to five years; this vaccine could be approved in about one year.
Prabhu said it’s crucial to have a vaccine because coronavirus is not likely to be a “one-and-done” virus, and is likely to resurge in the fall.
Antibodies
Testing blood for antibodies can determine if someone has been exposed and recovered from the virus, but is more useful to consider as a population base, but has limitations on an individual basis.
“I would caution policy makers against using the idea of a passport — once positive for having disease, you’re all clear and good to go,” he said. “We need more research to inform policy decisions.”
Prabhu noted both facilities assisted with the Governor’s Office in developing the new strategy for testing. Prior to that, 1,300 tests were being conducted per day on average in the state.
“This is good news to get a feel for how many people have a symptomatic infection in Minnesota and surrounding our service regions, including Wisconsin,” he said.
Van Deelen said the volume of people testing positive now remains low and part of the reason is that nonessential visits to the hospitals were delayed in mid march, which helped delay the surge.
“We feel prepared for a surge of patients to come,” he said.
Pryor said the governor’s order not to do elective surgeries helped preserve personal protective equipment and protected staff and patients, but what was elective may not be required. Walz enlisted the assistance of the Minnesota Hospital Association to develop a plan for those surgeries, which will be unrolled shortly, he said.
