L.A. County gives up on containing coronavirus

L.A. County gives up on containing coronavirus, tells doctors to skip testing of some patients

https://www.latimes.com/california/story/2020-03-20/coronavirus-county-doctors-containment-testing?fbclid=IwAR0WbZEFPXvi83iGptYup2FtDs-vI0LHzV32Vk7SEaIEfrNPpd3SzgvPSEc

The nation’s second-largest municipal health system has told its staff that it is essentially abandoning hope of containing the coronavirus outbreak and instructed doctors not to bother testing symptomatic patients if a positive result won’t change how they would be treated.

The guidance, sent by the Los Angeles County Department of Health Services to its doctors on Thursday, was prompted by a crush of patients and shortage of tests, and could make it difficult to ever know precisely how many people in L.A. County contracted the virus.

The department “is shifting from a strategy of case containment to slowing disease transmission and averting excess morbidity and mortality,” according to the letter. Doctors should test symptomatic patients only when “a diagnostic result will change clinical management or inform public health response.”

The guidance sets in writing what has been a reality all along. The shortage of tests nationwide has meant that many patients suspected of having COVID-19 have not had the diagnosis confirmed by a laboratory.

In addition to the lack of tests, public health agencies across the country lack the staff to trace the source of new cases, drastically reducing the chances of isolating people who have been exposed and thereby containing the outbreak.

For years, state and local health officials have been warning that steep cuts to federal grants meant to boost preparedness for a pandemic would mean there wouldn’t be enough equipment and staff on hand to respond in the crucial, early stage. Those fears have come to fruition now, officials said.

A front-line healthcare provider who was not authorized to speak to the media and requested anonymity said county doctors are interpreting Thursday’s letter and other advice coming from senior L.A. County public health officials to mean they should only test patients who are going to be hospitalized or have something unique about the way they contracted the virus.

They are not planning to test patients who have the symptoms but are otherwise healthy enough to be sent home to self-quarantine — meaning they may never show up in official tallies of people who tested positive.

The letter also says that, with the increasing availability of tests at private labs, the health department will focus on testing aimed at detecting and preventing outbreaks in hospitals and “congregate living settings,” such as nursing homes.

Department officials did not immediately respond to a request for comment.