State adopts new testing strategy as cases surge
Guidelines set priorities for tests based on symptoms, risk factors
In an effort to get the coronavirus pandemic under control, California’s top health care officials on Tuesday rolled out new guidelines focused on expanding testing among communities and populations that are particularly vulnerable to the disease, and prioritizing the analysis of samples from people with symptoms.
The news comes amid a sharp spike in cases throughout the Golden State, particularly among Black and Latino residents who are less likely to be able to work from home. The state reported more than 10,000 new cases Tuesday, and some testing sites and labs say they have been overwhelmed by demand even as it has become more difficult to get all the necessary supplies. The situation mirrors the early days of the pandemic, when there were severe shortages of test kits and some critical components.
But back then, in early April, the state was conducting around 2,000 tests a day. Now, that figure is north of 100,000. Still, California Health and Human Services Secretary Mark Ghaly said during a news conference that there is more to be done as communities contemplate reopening schools, offices and more.
“We all know that testing in California is a vital piece of our response,” Ghaly said.
And while the state wants to “maintain access” to testing for the general population, it will focus first on those with symptoms in an effort to curb transmission of the deadly virus, Ghaly said. Previously, leaders had
been pushing to offer a test to everyone who wants one.
According to the new guidelines, health care providers should prioritize testing of people hospitalized with COVID-19 symptoms. The next priority — identified as tier two in the guidelines — should include other people with symptoms and those without symptoms who work in a high-risk sector like health care, police officers and firefighters, or those who live or work in congregate settings like nursing homes or jails.
Tier three includes people who work in retail or other jobs where they interact regularly with the public, including teachers. The fourth tier includes asymptomatic people who believe they are at risk of being infected, along with routine testing by employers. The state says people in the last
category should only be tested when turnaround times are two days or less.
As the state develops a targeted testing plan, it is calling on private hospitals, clinics, labs and other health care providers to offer COVID-19 tests in a bid to expand access, especially to hard-hit communities. Many are already offering some testing services, but the state hopes to increase the number of places where residents can go and encourage those places that are already running tests to do more. In a similar move at the local level, Santa Clara County recently called on health care giants like Kaiser and Sutter to boost testing.
“Over time, the county cannot maintain the ability to provide this type of service for the entire community and entire population,” Marty Fenstersheib, head
of the county’s testing task force, told this news organization last week. “So, realizing that, as we open up, we need to be able to contain this disease.”
But some health care providers have warned that national limitations on testing reagents used in labs could make it challenging to expand access, particularly in vulnerable communities with lots of essential workers where need is high. Earlier this month, Sacramento County shut down five testing sites in low-income areas because of supply issues, despite the higher rates of infection among Black and Latino residents.
UC San Francisco on Monday said it had 56 days’ worth of testing kit supplies on hand, but warned that the spike in cases will impact testing capacity everywhere.
“With the current surge,
we are already seeing much longer turnaround times in outside labs (from about 24 hours before to 6-7 days now), so we have been getting increasing requests for testing in ours,” UCSF said.
Lourdes Castro Ramirez, the secretary of the Business, Consumer Services and Housing Agency, praised health care workers for their fight against the virus during Tuesday’s news conference.
“I know they will continue to play a key role,” she said.
Ghaly announced two new leaders of the state testing task force: Gilbert Chavez, from the California Department of Public Health’s Center for Infectious Diseases, and Bechara Choucair, senior vice president and chief health officer for the Kaiser Foundation Health Plan.
“While we have learned a ton about COVID-19 and we’ve made a lot of progress, our recent surge in cases makes it clear a lot more must be done to protect our communities from this unprecedented pandemic,” Choucair said.
The task force will look for ways to reduce the cost of testing, in part by exploring possible innovations like pooled testing, where samples from multiple people are analyzed at the same time. Right now, Ghaly said, providers pay about $100 per test, but the state would like to see that figure decline.
“We must be deliberative and also creative,” Castro Ramirez said, “about how we are continuing to meet this moment.”