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Limited access to testing could leave RI ‘blindfolded’ in fight against COVID-19

Target 12

PROVIDENCE, R.I. (WPRI) – Facing a global shortage of supplies, public health officials can only test a limited number of Rhode Islanders who feel sick for COVID-19, making it challenging to know just how far the illness has spread.

“We’re not where we need to be,” Democratic Gov. Gina Raimondo said.

Raimondo on Thursday called on the private sector to help out with proving medical equipment, including swabs for testing, as the state has grappled to get enough equipment through the federal government. The state has ramped up its testing ability throughout the month, but can only expand so much without the necessary equipment.

“We have a number of testing sites all over the state,” Raimondo said. “We have drive-thru sites. We are very capable of setting up more sites. The issue is the swabs right now.”

The second-term governor said earlier in the week she was receiving a major shipment of swabs, but day-to-day uncertainty about what materials will be available has forced public health officials to abide by strict qualifying requirements and prioritize who gets tested in an an attempt to conserve supplies.

“We are prioritizing certain populations for testing, including people who are hospitalized, people who live in nursing homes and other congregating living settings and health care workers,” R.I. Health Department spokesperson Joseph Wendelken said.

As of Wednesday, the Health Department had administered about 900 COVID-19 tests, averaging 53 per day since officials announced the first confirmed case on March 1. Raimondo says the state now has the ability to test upward of 100 people per day, and she has tapped the R.I. National Guard to help create drive-thru testing sites in preparation for more robust testing. (Those sites are only open to people referred there by the Health Department.)

But until the state can safely expand to include those who don’t qualify currently, health care providers are turning away many people who are seeking the test and feeling ill. Right now, the Health Department’s definition of a “suspected COVID-19 case” is based on symptoms, travel history or contact history, and those who don’t qualify will not receive the test.

“The more swabs we can get, the better this will be,” Raimondo said. “We’re doing our best at the moment.”

But the strict rules are raising concerns among people who want to know whether they’re sick with the disease, and feel like they’re left in the dark without a diagnosis.

‘Where are the tests?’

Rabbi Barry Dolinger of Congregation Beth Shalom in Providence issued a plea for help Wednesday on Facebook, saying multiple sick members of his congregation couldn’t get tests, even though many have serious pre-existing conditions and had even been at events with people who tested positive for the disease.

“When they try to get tested, at their doctors, hospitals, and urgent care centers, respectively, they’re all told ‘no’ unless they can give the name of the person who tested positive that they had contact with,” Dolinger wrote, noting that the names of those with the illness are not being disclosed publicly.

“Where are the tests?” he asked. “Total failure of the political and public health systems that will certainly lead to deaths.” (Dolinger did not respond to a request for further comment Wednesday night.)

Similar calls have come from many quarters.

“Testing, testing, testing,” Rhode Island U.S. Sen. Jack Reed tweeted Thursday. “America needs better #coronavirus testing.” He said the Trump administration “must be held accountable” for failing to get an adequate number of tests ready once the outbreak began in China.

Just over the border in Massachusetts, the CEO of New Bedford-based hospital group Southcoast Health warned at a news conference with the mayor Wednesday that his organization was delaying plans to start drive-thru testing because it only had about 200 COVID-19 tests.

“When you think about a patient population in the south coast region of over 350,000 people, we only have 200 kits available so we are using the criterion that has been developed by the state of Massachusetts in the deployment of those kits,” said CEO Dr. Keith Hovan. “And we are actually sending a fair number of those folks home without having been tested because they don’t meet the criterion.”

While defending their current approach, Rhode Island officials have also expressed a desire to expand testing as soon as possible.

“We are testing every suspected COVID-19 case,” Wendelken said. “We are prioritizing certain populations, but all suspect cases are being tested. However, we need the supplies to continue that testing.”

“While we want to be able to widen the testing circle, we would not want to test everyone who was self-quarantining,” he added. “It is very important that someone has symptoms. If someone is not symptomatic, the test is less accurate.”

While medical recommendations for treatment do not change based on an official diagnosis, experts say identifying more individuals who are infected could allow other precautionary measures to be taken to help save those most at-risk.

Currently, there is no cure for the new coronavirus that causes COVID-19, and most of the people who have contracted the disease so far in Rhode Island have been advised to recover at home.

It’s also why people are being asked to self-quarantine for two weeks and monitor themselves for symptoms if the state suspects they came into contact with someone with the disease.

To date, at least 2,500 Rhode Islanders are self-quarantining. At least six of the 44 confirmed cases reported through Thursday had been hospitalized for some period of time, and one was recovering at a nursing home.

The state has not disclosed where any of the infected people live, although the state might provide some county-level data in the coming days, according to health officials.

Fighting ‘Blindfolded’

In addition to leaving sick people in the dark about whether they have the illness, the limited amount of testing challenges state leaders’ ability to fully understand how quickly and widely the sickness is spreading.

Without reliable data, it’s hard to accurately predict the spread of the illness, whereas more complete information could offer a window into how long the public health crisis might last – keeping people in their homes and many out of work.

“You cannot fight a fire blindfolded and we cannot stop this pandemic if we don’t know who is infected,” Dr. Tedros Ghebreyesus, director-general of the World Health Organization, said earlier this week. 

The WHO has called for more aggressive testing across the world, and experts have pointed to South Korea’s efforts as a model.

But governments – including Rhode Island – say they’re hampered by limited quantities of testing swabs. There are only a few manufacturers that make the so-called nasopharyngeal swabs, rendering it difficult to keep up with the demand that’s skyrocketed amid a global pandemic.

Wendelken said not knowing what materials will be made available day to day makes it difficult to determine how many people could be tested. He would not offer a specific number but said the state could test “several hundred more patients at this point” based on the number of personnel and facilities available.

“The real challenge is the inconsistency,” he said.

State leaders are hopeful the recent extraordinary decisions made to shut down schools and parts of the economy will help slow the spread of the illness enough to ensure it doesn’t hit Rhode Islanders too hard.

But the strategy of social distancing without a complete understanding of where the illness exists could become problematic, particularly in determining when the highly contagious disease has died down enough for people to safely get back to some measure of life known before COVID-19.

Raimondo underscored that point Thursday, saying she’d like to see the state get to a point where it’s issuing massive amounts of tests, even to people who are asymptomatic.

“That’s where you want to be because then we can start thinking about potentially changing some of the extreme social distancing measures,” she said.

The goal is exactly what the WHO is urging of governments everywhere.

“We have a simple message for all countries: test, test, test,” Ghebreyesus said. “Test every suspected COVID-19 case. If they test positive, isolate them and find out who they have been in close contact with up to two days before they developed symptoms and test those people too.”

For those seeking tests and not receiving them, a diagnosis could go a long way, regardless of treatment.

“We have widespread community transmission at this point,” Dolinger wrote on Facebook. “I just want to get some people some tests. That’s all.”

Eli Sherman (esherman@wpri.com) is a Target 12 investigative reporter for WPRI 12. Follow him on Twitter and on Facebook.

Ted Nesi and Tim White contributed to this report.

Copyright 2020 Nexstar Broadcasting, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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