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The Pandemic

As COVID-19 surges, Memphis testing systems underused, complicated

Christ Community Health Services staff members collect nasal swabs during at a drive-thru coronavirus testing site on Wednesday, Oct. 20, 2020 on Lamar Ave. (Mark Weber/The Daily Memphian)
Christ Community Health Services staff members collect nasal swabs during at a drive-thru coronavirus testing site on Wednesday, Oct. 20, 2020 on Lamar Ave. (Mark Weber/The Daily Memphian)

A woman who works as a nurse at a local hospital called her minister friend the other day after another long, difficult shift.

“After the usual how’s your family talk, I said, ‘How are you?’” recalled Rev. Lisa Anderson, pastor of Colonial Cumberland Presbyterian Church.

“There was no answer and then a very slow and steady sob for several minutes,” Anderson said. “I waited and I cried with her. The only words I ever made out was, ‘There are just too many.’”

Too many patients. Too many patients with COVID-19. Too many patients who are dying. Eleven new deaths were reported Thursday, Dec. 3 by the county health department.

Memphis area hospitals are nearly full. Emergency rooms are packed; some patients are waiting two or three days for a room. Ambulance drivers are being told to expect delays.

Public health officials are urging people to take more personal responsibility to keep the surging coronavirus from overwhelming the local hospital system.

That includes another push for widespread, asymptomatic testing during the holidays.

“The key to beating this thing, after a vaccine, of course, is to know you have it,” said Tim Hodges, senior director of pathology for  opens in a new windowUniversity Clinical Health (UCH), affiliated with the University of Tennessee Health Science Center.

“The only way to know you have it, if you are asymptomatic, is to get tested. We want to identify those people as quickly as possible so they can be isolated and stop spreading the virus.”

The  opens in a new windowlocal COVID-19 testing system has the capacity for 15,000 individual tests and up to 40,000 pooled tests every day. But tens of thousands of available tests are going unused every day, even as the virus surges.

With so many different kinds of sites, procedures, and requirements, the system can be confusing and difficult to navigate.

There are at least 18 “community sites” that provide free testing, and 22 other “commercial sites” that base fees on insurance coverage.

This weekend and every weekend until Christmas, the city will be providing free asymptomatic testing to the general public in at least two locations − Poplar Healthcare, 3495 Hacks Cross Road, and Tiger Lane, 450 Early Maxwell Blvd.

Hospitals, physicians’ offices, and some medical labs also offer testing − some to the general public and some to patients or employees only.

Most testing sites request that you make an appointment or register online or by text, but some don’t require an appointment at all.

Most sites have enough space to accept appointments on the same day, but some make you wait a day or two.

Most sites are drive-thru but some are walk-up. MATA will provide free transportation to two sites − Church Health and UCH.

Some sites test only those who have symptoms or have been exposed to someone who tested positive, but most sites now allow anyone to be tested regardless.

Some sites administer nasal swabs, others allow you to self-swab, and, soon, some will provide saliva tests. At the moment, only one commercial site offers rapid testing.

Most sites provide results within 24 hours, but fluctuations in demand and other variables can cause delays of two or three days.

Health officials acknowledge that the testing supply system can be challenging, but with hospitals struggling to care for everyone, they are much more concerned about the nagging and perplexing lack of demand.

“People don’t want to get tested,” Dr. Manoj Jain, the infectious disease expert advising the city’s COVID-19 response. “It’s very disheartening. We have all of this testing capacity, but the general public doesn’t want to get tested, not even for free. I don’t know why.”

TESTING THE SYSTEM

Elise Foster, an elementary teacher and mother of a toddler, wants to be tested as often as possible.

Her charter school provides “assurance testing” every eight days. But just before the holiday break, she worried that she might have been exposed to someone who tested positive.

She stayed home from work and made an appointment online at University Clinical Health’s drive-thru site on Appling Road and was tested the following day.

“In addition to the nasal swab, I took two other tests,” she said. “The first I was instructed to ‘brush my tongue like with a toothbrush’ with a cotton swab. Next, I was given a tube and asked to spit into it. Both were relatively effortless and minimally invasive.” She got her results 14 hours later. She tested negative.

Foster’s three-part test was part of a study. UCH/UTHSC is developing oral and saliva tests. Hodge and his colleagues are completing the study this week, and hope to begin offering oral tests to the general public very soon.

“Not everyone can handle the nasal swab,” Hodge said. “There have to be alternatives. This will lower another barrier to testing. Ultimately, there should be no barriers.”

COVID-19 testing isn’t just for people who feel unwell or think they might be sick.

On Tuesday, Dec. 1, the CDC said local and state governments “should consider implementing an expanded screening testing strategy to rapidly identify people without symptoms who are contributing to the silent spread of infection, because they are unaware that they are infectious.”

Memphis health officials have been pushing for such expanded “assurance testing” for weeks.

As Dr. Scott Morris, Church Health founder noted in a recent email to church leaders, health officials are urging the public not to hesitate to be tested for these other reasons:

  • If you think you might have been exposed because you were around someone who has tested positive, even if you have no symptoms.
  • If you plan to host people in your home who don’t normally live there.
  • If you are planning to travel during the holidays and want to be sure you will not be spreading the virus without realizing you are infected.
  • If you travel and were around people outside your usual household “bubble” and want to be sure you did not become infected while you were away.

Bob and Theresa Lorsbach were planning to celebrate Thanksgiving together with their adult children this year, as always.

They didn’t.

“We thought we could try to have some semblance of a normal Thanksgiving,” said Theresa Lorsbach. “We’ve all been very, very careful and had all the kids get tested before they came home. That was the smartest thing we ever did.”

Just before the holiday, both of their adult daughters tested positive for COVID-19. One was asymptomatic. The other, a nurse who takes care of COVID patients, had a fever and congestion but otherwise felt fine. Both are quarantined at home and recovering nicely.

“We were all so excited to spend that time together,” Lorsbach said. “It was only seven of us, so no big huge family get-together, but fate had different plans for us.”

The Lorsbachs, who lived in Memphis for years, now live near Cincinnati. But their approach to the holidays is one that local health officials are urging others to follow.

“We want to encourage citizens to get tested, and we’ve done just about everything we can to make it as easy as possible,” said Tiffany Collins, deputy director of general services for Memphis. “We hope we have normalized the idea of asymptomatic testing.”

The weekend before Thanksgiving, 2,623 people were tested for COVID-19 at one of the city’s expanded − and free − holiday testing sites.

Of those, 231 − 9% − tested positive.

Jain’s office called all of those who tested positive, reaching 150 of them (others didn’t answer the phone or call back). Of those, 72 reported having no symptoms at all, and the other 68 reported having very mild symptoms.

Even more troubling, local labs also processed 70 pooled tests that weekend (700 individual swabs). Forty of the pools were positive − meaning at least one in every 10 people had COVID-19).

“It’s mindboggling,” said Jain. “That’s a huge percentage of asymptomatic people who would have been out there spreading the infection if they hadn’t been tested. But those are just the people who got tested. How many didn’t?”

Earlier last month, New York University ran Shelby County’s COVID numbers and determined that cases would continue to rise until Jan. 1 − if 10,000 people a day were tested.

Dozens of Memphis area hospitals, clinics, labs and pharmacies have the capacity to test tens of thousands of people a day.

The city is ready, willing and able to provide and pay for that level of community “assurance” testing.

But since the third and largest COVID-19 surge began in October, fewer than 5,000 individuals a day were tested locally, on average.

That’s about the same number as in May after the initial surge of cases.

And it’s hundreds and even thousands fewer per day than in June, July and August, after the second surge.

The city repeatedly has offered to provide regular “assurance testing” to all schools, agencies and businesses, but only a handful are participating, and none require testing.

Jain doesn’t understand why all employers − especially hospitals, schools and businesses open to the public − aren’t requiring all employees to be tested regularly.

“Everyone has a responsibility to know whether they are infected. And the only way to know for sure is to be tested regularly,” Jain said.

The health department recommends but does not require regular testing.

“We can’t be everywhere at all times,” Dr. Bruce Randolph, the county’s public health officer, said Tuesday. “You, as an individual, must exercise the responsibility, discipline, and commitment to remain safe and protect yourself, and protect others.”

SLOWING THE SURGE

The health department predicted in November that area hospitals would have more than 500 COVID-19 patients by Christmas.

By Monday evening, Nov. 30, there were 501 COVID-19 patients in area hospitals.

Those numbers are likely to continue to increase by Christmas and the new year.

“We anticipate a surge, even if it’s a small surge, from Thanksgiving. Which means are are going to have a significant challenge in the hospital systems around the Christmas holidays,” Dr. Alisa Haushalter, health department director, said Tuesday. “And the issue is not just the number of admissions or the number of hospital beds available… There are significant staffing shortages.”

At any given time lately, dozens of patients in Memphis area emergency rooms are waiting for hours, and sometimes days, for rooms in the main hospitals.

And yet, as of 5 p.m. Wednesday, the system is reporting that 93% of local acute care hospital beds and 90% of intensive care units were occupied.

“They have empty rooms, but they don’t have enough nurses,” Jain said. “It doesn’t do you any good to have an empty bed if you can’t staff it.”

Hospitals don’t have enough nurses to staff the system’s 2,635 acute care beds and 479 intensive care beds, let alone the beds they might need to care for a rising number of COVID-19 patients.

They are planning to enlist medical and nursing students and retired health care workers to try to fill the void.

Meanwhile, front-line health care workers − nurses in particular − are bearing the brunt of the widening and deepening pandemic.

“When I go into health-care facilities, the staff look like they are in a warzone,” said Pennie Smith Giancola, a local licensed social worker. “It makes me feel so guilty that there are some bearing so much more of the brunt of this while others are out without a mask and traveling without a care in the world.”

Studies show that the COVID-positive rate of front-line health care workers is four times greater than the general population.

Hundreds of nurses and other local hospital workers are home because they have been exposed to COVID-19 or tested positive.

Doctors are seeing more cases of nosocomial COVID in the past month. Those are infections that originate in a hospital.

“It’s quite stressful, the virus is so dangerous, so contagious,” said Jackie Yates, a nurse in Regional One’s emergency department.

In recent days, Yates spent hours caring for a young man with appendicitis. After he was operated on, she learned that he also tested positive for COVID.

“He had no symptoms, no idea he’d been exposed,” Yates said. “You do what you have to do, but unless you test, you really don’t know who has it.”

Find a full list of public testing locations and details at  opens in a new windowCOVID19.memphistn.gov.

This story first appeared at dailymemphian.com under an exclusive use agreement with The Institute. Photos reprinted with permission of The Daily Memphian.

Written By

David Waters is Distinguished Journalist in Residence and assistant director of the Institute for Public Service Reporting at the University of Memphis.

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