Testing Remains a Bottleneck in Ohio's Response to COVID-19

Mar 12, 2020

The number of cases of COVID-19 continues to grow in Ohio and the state health director said Thursday it is likely more than 100,000 people in the state are carrying the virus. 

Universities have suspended in-person classes, visitation at hospitals and nursing homes has been curtailed, polling locations are moving, and school districts are preparing to close.

Still, testing for the novel coronavirus remains restricted in Ohio.

We sat down with Summa Health Dr. Thomas File, who is also the president of the Infectious Disease Society of America, to talk about testing and the risks of contracting COVID-19. 

Q:  What is the number one message that you would like people to know as we enter this new phase of the coronavirus outbreak?

"There is concern, but be safe. And this can be done by, you know, avoiding people who are sick, trying to stay away from large crowds. If you have a fever or a cough, you call your primary physician and get directions. A lot of these respiratory viruses are spread from person to person on the hands. And so if we wash our hands frequently, we certainly are going to reduce the risk to us."

Q: What are the symptoms of COVID-19 that we should be looking out for?

The classic symptoms are fever, cough and shortness of breath, File said. But there are also cases where symptoms don't appear. 

"We also know there's a large spectrum of illness, and we also know that some people are infected and really don't have significant symptoms, so it can mimic any of the respiratory infections, such as the common cold or pneumonia, which would be more severe. So it's very difficult. We have to screen patients who are at higher risk so that if they, for example, have traveled from a country or an area where there's high level of circulating virus."

Q: Do we have enough tests available in Ohio?

"That's a very good question, and the answer right now is that the capacity is not what we would like. We literally didn't even have any testing in Ohio until about a week ago. This is a concern. It would be nice if we had faster turnaround time. Our lab at Summa is looking at developing the test within our institution, but that's going to take several weeks." 

Q: A big concern is that there are people who have COVID-19 out in the community and don't know it.  Isn't more testing needed to get a better handle on the number of cases ?

"We definitely need that. But if you have more mild infection and [you're] staying home, it's not necessary that you get tested. Eighty-five percent of patients will have a very mild disease that is self limited and will go away, so even if you have COVID-19, you're going to do okay, unless you're older, or have underlying conditions. Another consideration for testing is if you are older and have underlying conditions for which you would be at risk or have further complications. This is the protocol for how we do our testing because of the limited number of tests that are available right now in Ohio."

Q: Is the Ohio Health Department the only place that tests are being done? And how are those decisions being made on who gets tested?

"We have a protocol if somebody calls a physician's office and is at risk, and are concerned about the COVID-19. That physician will call a number that goes to one of our infection control practitioners. They discuss the case, if they think testing [should be] done, then they're directed to go to a hospital facility so that the testing can be done. We then contact the local public health department who will then send that specimen to Columbus for testing by the Ohio Department of Health."

Q: Dr. Amy Acton, director of the Ohio Department of Health, talked about how the Ohio medical system could be overwhelmed by an uncontrolled coronavirus outbreak. How is Summa preparing?

"We've been spending a lot of time the last two weeks trying to prepare, to develop protocols, to develop procedures and policies that, first of all, allow us to take care of our patients well because that's our mission."

Q: This has been labeled a pandemic, officially. What does that mean for you?

File believes it could have been labeled a pandemic weeks ago.

"That is the definition of a pandemic — if it is present in multiple continents, and there is continued transmission within that continent. And so that criteria is certainly fulfilled. And I think it is appropriate to consider it a pandemic."

Q: Have you personally seen any COVID-19 patients?

"No. We've evaluated patients that have been of concern. And we have some patients for whom we're waiting for the test right now. But I have not personally seen yet a patient who has been documented with a positive test."

Q: The coronavirus epidemic is a real concern for the public and healthcare providers. How does it compare to other outbreaks you've seen?

Dr. File is concerned by the nature of COVID-19 and its spread.  "The fact that at-risk people are getting complications, and for older patients and those with underlying conditions, it has a significant morbidity and mortality rate, we have to be concerned about this."

File says, other than HIV in the early 80's, there are no recent comparisons available.

"COVID-19 will likely have a significant effect on our healthcare system, and on society," says File.

He supports policies that are being put in place to slow the spread of the disease, the closure of universities and the extention of spring break for public schools.

"There's going to be a lot of inconveniences for all of us in our communities, but we need to do whatever we can to slow this down and to reduce spread from person to person. So all of these procedures and policies are going to be important. We'll see how it works out and hopefully, we'll have some benefit in reducing the spread. Two weeks from now we could have a very different situation."

Editor's note: This interview has been edited for clarity.