I listened to the WHO press conference today. I found it confusing. In his opening remarks, Dr. Tedros emphasized testing: test, test, test. It sounded like he was saying that everyone with symptoms should be tested. Later in the press conference, he clarified that all "suspected cases" should be tested. "Suspected cases" is a term of art at the WHO and is specifically defined. I looked at the definition again, and spotted a change at the end of February that I hadn't noticed. WHO does recommend testing a broader swath of people with "mild" symptoms. The requirements are (1) acute respiratory illness (fever plus at least one sign of respiratory disease; (2) no other etiology that explains the symptoms; and (3) " a history of travel to or residence in a country, area or territory that has reported local transmission of COVID-19 disease during the 14 days prior to symptom onset" "Local transmission" is another term of art, and is defined in the daily situation reports: "Local transmission indicates locations where the source of infection is within the reporting location."
Both King and Snohomish Counties are locations where local transmission has been reported. So, under WHO guidelines, people who meet conditions (1) and (2) should be tested in those counties. In other areas of the country, not yet.
This made me curious, so I checked for federal, state and local testing guidelines in my area.
The CDC offers some "guidance" to help individual doctors decide who to test:
Clinicians should continue to work with their local and state health departments to coordinate testing through public health laboratories. In addition, COVID-19 diagnostic testing, authorized by the Food and Drug Administration under an Emergency Use Authorization (EUA), is becoming available in clinical laboratories. This additional testing capacity will allow clinicians to consider COVID-19 testing for a wider group of symptomatic patients.
Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested. Most patients with confirmed COVID-19 have developed fever1 and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing). Priorities for testing may include:
Hospitalized patients who have signs and symptoms compatible with COVID-19 in order to inform decisions related to infection control.
Other symptomatic individuals such as, older adults and individuals with chronic medical conditions and/or an immunocompromised state that may put them at higher risk for poor outcomes (e.g., diabetes, heart disease, receiving immunosuppressive medications, chronic lung disease, chronic kidney disease).
Any persons including healthcare personnel2, who within 14 days of symptom onset had close contact3 with a suspect or laboratory-confirmed4 COVID-19 patient, or who have a history of travel from affected geographic areas5 (see below) within 14 days of their symptom onset.
There are epidemiologic factors that may also help guide decisions about COVID-19 testing. Documented COVID-19 infections in a jurisdiction and known community transmission may contribute to an epidemiologic risk assessment to inform testing decisions. Clinicians are strongly encouraged to test for other causes of respiratory illness (e.g., influenza).
Mildly ill patients should be encouraged to stay home and contact their healthcare provider by phone for guidance about clinical management. Patients who have severe symptoms, such as difficulty breathing, should seek care immediately. Older patients and individuals who have underlying medical conditions or are immunocompromised should contact their physician early in the course of even mild illness.
The state of Washington just provided updated guidelines today:
[quote]There are currently no restrictions on who can be tested for COVID-19 and commercial testing is becoming more available. Healthcare providers may test any patient with symptoms consistent with COVID-19 (e.g., fever, cough, shortness of breath) but until testing supplies and laboratory capacity are widely available, public health is asking providers to follow the below recommendations.
The following patients with COVID-19 symptoms should be tested for COVID-19:
Patients hospitalized with severe lower respiratory illness
Staff that work in any setting where healthcare services are delivered (e.g., clinics, hospitals, behavioral health care clinics).
Patients in other public safety occupations (e.g., law enforcement, fire fighter, EMS)
Patients who live or work in in an institutional setting (e.g., corrections, long term care
facility, homeless/shelters)
The following patients with COVID-19 symptoms should contact their healthcare provider and be tested for COVID-19 if their symptoms worsen or their healthcare provider recommends testing:
Patients older than 60 years
Patients with underlying medical conditions
Pregnant women
Younger, healthy individuals with mild illness do not need to be tested and testing is not recommended in persons who are asymptomatic. A negative test result does not rule out an infection.
And finally, my local health department simply links to the updated state guidance.
I need to check the transcript when it's posted, but Dr. Tedros sounded like he was recommending that all people with COVID symptoms be isolated away from their homes in a dedicated isolation facility. This would be like, for example, what China did in stadiums. And that people in close contact with confirmed cases also be isolated away from their homes in a separate facility. I think the current guidelines allow for self-isolation at home, but I thought Dr. Tedros was saying the best practice was to use separate facilities.
Finally, the emphasis was really on contact tracing, which is very labor intensive. Our first case involved over 200 interviews of contacts. And they never found who he transmitted it to. I checked with my local health department to see if they are still doing it at all. Yesterday, they listed 0 cases under investigation.
Then, I watched the Feds' press conference. Trump's new rationalization is something like "we had to destroy the testing system to save it." But ignore him. The professionals were, I thought, much more transparent and helpful than in past press conferences. The head of HHS was excellent at explaining the supply and distribution problems related to testing and what they were doing to fix them. The promises seemed much more realistic. So, I'm cautiously optimistic that things are starting to get better at the federal level.
“The ideal subject of totalitarian rule is not the convinced Nazi or the dedicated communist, but people for whom the distinction between fact and fiction, true and false, no longer exists.”
― Hannah Arendt, The Origins of Totalitarianism, 1951