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With limited testing, symptoms are key sign


(3/25/2020)

by CHRIS ROGERS

 

Winona area residents with any symptoms of COVID-19 need to assume they may have the virus and isolate at home, except to seek urgent medical care if needed, health officials advised. Most will not receive a test to confirm their diagnosis because a nationwide shortage of testing supplies limits the ability of local health care providers to test patients.

Minnesota health officials acknowledged the limitations on testing capacity are not ideal, but stressed that, with or without a test, the steps people with symptoms need to take to protect themselves and their neighbors are the same.

Although there are still no confirmed cases in Buffalo and Trempealeau counties as of press time, the limited testing makes it more likely that unconfirmed cases of the virus may be present in local communities. Authorities in both Minnesota and Wisconsin cautioned that there are likely undiagnosed COVID-19 cases in their states.

“I think it’s really important that we not give people a sense of comfort that, ‘Oh, if I’m not in one of those counties I don’t need to be concerned about COVID-19 at this time. We really believe there is widespread community transmission of COVID-19 in this state,” Minnesota Department of Health (MDH) Infectious Disease Division Director Kris Ehresmann said. “People should assume that COVID-19 is circulating in their communities and they should take the precautions we are outlining,” she advised.

Similarly, Winona Health CEO Rachelle Schultz said earlier this month, “While we do not have any confirmed positive cases to date in our community, I would suggest … that we assume we have the coronavirus in Winona and we respond accordingly.” Winona County Health and Human Services Director Karen Sanness stated on Thursday, “We don’t know how many people are positive.”

 

Winona providers have limited testing ability

Because of a nationwide shortage of laboratory supplies for COVID-19 tests, Winona Health and Gundersen Health System are only testing the types of patients that public health officials identified as top priorities, including hospitalized patients and health care workers.

To test a patient for COVID-19, providers take a specimen — such as a nose or throat swab — and send that specimen to a lab where the specimen is tested for the virus. The MDH runs a public lab that does a large share of testing for Minnesota health care providers, but MDH officials said that its lab — and most labs across the country — have a limited amount of key supplies needed to conduct the tests. Those supplies include things such as reagents, chemical compounds used to identify the virus in tests, as well as ancillary equipment and hardware. Health officials are trying to get more of those supplies, but because of worldwide demand, they are hard to come by.

Because of that limited supply, the MDH lab will only test high-priority patients: hospitalized patients, health care workers, and people in congregate living settings, such as assisted living facilities. The MDH’s priorities mirror guidance from the U.S. Centers for Disease Control (CDC).

The reason those patients are high-priority is because knowing whether they had COVID-19 has a big impact on how the health care system responds, MDH officials explained. A test result can inform what type of bed or room a hospitalized patient is placed in, for example, or whether a health care worker can get back to doing their critical job. “We need to focus on individuals for whom the positive test will make a significant difference either in their care or in our health care system,” Ehresmann said. For hospitalized patients, she explained, “Having a positive lab test helps inform the facility of the necessary infection prevention activities that need to be undertaken.” Conversely, for people with symptoms they can manage at home, getting a positive or negative test result will not change how they are treated because there is no cure for COVID-19, Ehresmann said.

On Thursday, Winona Health issued this statement about testing availability: “Due to a national shortage of testing supplies, at this time laboratories will only test samples from critically ill patients in ICU (or emergency department patients awaiting ICU admission), critically ill long-term care patients, and health care/emergency medical service workers who have signs and symptoms of coronavirus.”

In addition to the MDH lab, some privately owned laboratories have launched their own federally approved tests for COVID-19, including the Mayo Clinic. Earlier this month, Gundersen Health System officials said they were developing their own lab test, as well. According to the MDH, private labs are free to set their own criteria for what patients to test, though the CDC continues to advise doctors to prioritize what kinds of patients they sample.

The Mayo Clinic may be testing a wider variety of patients. “We are applying our own criteria based on the best knowledge we have and projections of our supply for testing. While subject to change, we have not yet had to reduce testing nor apply stricter criteria,” a Mayo Clinic spokesperson wrote in an email. The spokesperson declined to specify exactly what criteria Mayo is using to decided who to test, but wrote, “We are clinically screening patients via our call triage line for the presence of symptoms. Based on the phone screening, we are referring them to be tested … Our experts have developed a triage process that would balance resource utilization and patient needs. Since this is a very fluid situation and subject to change, we won’t go into specifics on criteria.”

A spokesperson for Gundersen Health System stated that Gundersen is using similar criteria to the MDH to prioritize whom to test.

 

Is that a problem?

Minnesota authorities are asking the federal government for help with testing. Sanness said that, in a conference call with county officials, MDH leaders expressed serious frustration with the lack of testing supplies.

In press conferences with reporters, Ehresmann said that while she wishes more people could be tested, the media’s focus on limited testing capacity is not helpful. “The message needs to be not how many people can get tested. The message is, people need to stay home when they’re sick,” she stated. For people who can handle their symptoms at home, Ehresmann added, “The laboratory confirmation doesn’t matter. What matters is that you and your household need to stay out of the public.”

 

Have symptoms? Here’s what to do

People who have any one of the symptoms of COVID-19 should assume they may have the virus and stay home, MDH officials said.

“If you have symptoms of a respiratory disease (these include fever, coughing, muscle aches, sore throat, and headache), you should stay home for at least seven days, and for three days with no fever and improvement of respiratory symptoms — whichever is longer. (Your fever should be gone for three days without using fever-reducing medicine),” the MDH advised. (https://www.health.state.mn.us/diseases/coronavirus/basics.html)

Does that mean people with just one of those symptoms need to isolate? “Yes, even one symptom, especially if the symptom is not one you have on a usual basis (some smokers have smoker’s cough, some people with COPD [chronic obstructive pulmonary disease] may frequently have shortness of breath),” MDH Information Officer Doug Schultz explained to the Post.

According to the CDC, “If you are sick with COVID-19 or think you might have it, follow the steps below to help protect other people in your home and community”: “Stay home except to get medical care,” “separate yourself from other people in your home,” “call ahead before visiting your doctor” if you have an appointment or need urgent care, “wear a face mask if you are sick,” “cover your coughs and sneezes,” “clean your hands often,” “avoid sharing personal household items,” and “clean all ‘high-touch’ surfaces every day.” Find more information at https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html.

MDH officials have repeatedly stressed that the single most important thing people can do is stay home if they are sick. The decisions individual Minnesotans make to follow that advice will have a big impact on the state’s ability to slow down the outbreak and prevent unnecessary deaths, they said.

Most people will be able to manage their COVID-19 symptoms at home, MDH staff advised. If the symptoms are mild enough that you would not have sought medical attention before the coronavirus outbreak, then you do not need to seek medical attention now, health officials said. “If you have symptoms and can manage those symptoms at home, you don’t have to seek health care or be tested for COVID-19,” the agency advised. (https://www.health.state.mn.us/diseases/coronavirus/basics.html) “Just stay home while you are sick. If you are older or have underlying medical conditions, it may be helpful to let your health care provider know you are sick. They may have some specific advice for you.”

People should watch their symptoms, however, and seek medical care if their condition worsens, the MDH advised. “Some people with COVID-19 have worsened during the second week of illness. If your symptoms worsen at any point, and you do need to go see a doctor, call ahead before going in,” MDH guidance states.

“If you develop emergency warning signs for COVID-19 get medical attention immediately,” the CDC advises. (https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html) “Emergency warning signs include: difficulty breathing or shortness of breath, persistent pain or pressure in the chest, new confusion or inability to arouse, [or] bluish lips or face. This list is not all inclusive. Please consult your medical provider for any other symptoms that are severe or concerning.” Inability to arouse is a medical term that refers to people not being able to become fully conscious. People experiencing a medical emergency should call 9-1-1, the CDC advised.

For more information, visit www.health.state.mn.us, www.cdc.gov, www.dhs.wisconsin.gov, www.winonahealth.org, www.gundersenhealth.org, and www.mayoclinic.org.

 

Chris@winonapost.com

 

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