As Florida moves closer to returning some businesses back to work next week, healthcare operators and public health experts are raising doubts about claims by Gov. Ron DeSantis that the state has enough testing capacity to meet the need to keep people safe.
“Our ability to test exceeds the current demand,’’ the governor boasted at a White House briefing with President Trump on Tuesday, where he brought charts and photos of Florida’s drive-through testing sites.
DeSantis was in Washington to underscore a message he has been delivering since last week: Recent partnerships with private industry, purchases of testing equipment and supplies, and the opening of new drive-up and walk-up testing facilities have increased Florida’s ability to test for the disease caused by the novel coronavirus. He said he will make an announcement Wednesday about reopening the state in what he called “Phase 1.”
But while Florida’s capacity to test the public for the virus has grown significantly in the last two weeks, with the governor promising to have 18,000 tests a day at state labs by the end of May, the governor’s pronouncements about abundant testing have clashed with reality.
Hospitals say they continue to be constrained by supply shortages for testing components such as kits and chemical reagents needed to run the tests. Nursing homes and elder-care facilities continue to complain that they don’t have the access to COVID-19 tests needed to diagnose staff and residents. And both the Florida Department of Health and the Centers for Disease Control and Prevention advance guidelines that don’t allow everyone who wants a test to get one.
“Expanding testing is exactly the right way to go and the only way we get ahead of this. The challenge is, it isn’t enough, especially as we look to reopen the state,’’ said Steve Bahmer, president of LeadingAge Florida, a trade association representing 500 nursing homes, assisted living facilities and congregate care centers.
Bahmer is a member of the governor’s Re-Open Florida task force and for weeks, as the number of positive COVID-19 cases at elder-care facilities has risen, his industry has been clamoring for testing kits and protective gear so it can test every employee and resident.
Although the governor has sent the National Guard to conduct 500 tests a day at long-term-care facilities, Bahmer and his colleagues say the state needs to do significantly more to make sure that asymptomatic carriers of the virus don’t bring the disease into elder care homes.
His organization is recommending that to get businesses back to work, three things will be needed to happen for elder care facilities: widespread testing of staff and residents, repeated testing of staff and residents, and rapid results.
Thousands of daily tests recommended
Epidemiologists say that for Florida, like the rest of the nation, to safely reopen restaurants, movie theaters and other businesses it needs to be testing thousands more people on a daily basis.
Florida needs to test at least 150 people for every 100,000 residents every day —that’s about 33,000 people every day, more than double the current rate, said Dr. Charles Lockwood, the dean of University of South Florida’s College of Medicine at a news conference with DeSantis at Tampa General Hospital on Monday.
“The disconnect is that we’ve been conserving our supplies while trying to anticipate the surge,” Lockwood told the Tampa Bay Times. ”We know that’s not going to happen now, so we need to begin testing everyone. We are still in the early stages of changing this.”
State officials have claimed that Florida is third in the country for testing, with the governor’s spokesperson at one point falsely saying that was measuring per capita, citing the COVID-19 Tracking Project, a voluntary journalistic effort to track national testing and case data.
But the data only ranked Florida third in total testing, which is largely attributable to its population size. In per capita testing, Florida actually ranked 22nd, according to data compiled by the Kaiser Family Foundation and updated Tuesday. That analysis shows Florida tests about 16.6 per 1,000 — below the national average of 17.1 per 1,000.
Michael Lauzardo, chief of the University of Florida College of Medicine’s division of infectious diseases, said the state’s reopening will have to be gradual — with a focus on protecting the elderly and vulnerable populations in nursing homes and other institutions.
“If you open too soon, we’ll be overwhelmed in terms of the numbers of cases and it will be just too challenging,” he said.
Businesses will have to monitor workers
Large employers will be especially challenged to monitor their workforce and respond to an outbreak. Businesses will need to test their employees as they return to work, and then have the ability to identify those who fall ill and isolate them, the public health experts said.
“You go from a model where we’re basically isolating all of ourselves, which is what we needed to do initially, to where we go to isolating just those who are sick,” and that will require “huge numbers of testing,’’ Lauzardo said.
He is advising the University of Florida — an institution with more than 2,600 instructional staff and more than 52,000 students enrolled — to wait until there’s a steady decline of cases over a two-week period before the university system begins to bring back faculty, staff and eventually students.
“We’re going to test everybody as they come back,” he said. “That will take time. We’re going to gradually do that.”
Testing is an important tool for curbing the spread of the coronavirus, but it’s only part of the needed response. Lauzardo said employers will need the ability to quickly identify cases, trace close contacts, and then isolate infected and exposed individuals.
DeSantis has signaled that he is close to allowing hospitals around the state to allow non-COVID patients to return to their facilities and, to do that, hospitals have said they will conduct COVID-19 tests on all those admitted.
But the availability of testing and supplies is uneven. Most South Florida hospitals have only begun to ramp up their ability to test on-site in the last month, raising questions about their ability to do widespread testing within their own walls.
Baptist Health South Florida, the largest healthcare system in the region, was so constrained by supply shortages that it developed its own novel coronavirus test to lessen its reliance on private labs. But a pathologist there, Dr. Edwin Gould, said the proprietary test would only add capacity for 40 to 80 tests per day.
When asked how it planned to reopen with those testing constraints, Baptist Health spokesperson Georgi Pipkin said, “testing is an important component of being able to safely resume non-emergency procedures.”
“When we resume these services, we will be testing all patients before any surgery or procedure,” she said.
Testing at Jackson Health
Stephen D. Nimer, director of the Sylvester Comprehensive Cancer Center at UHealth, said Jackson Health did not start testing in-house until March 25, and a UHealth task force started five days later, with the ability to do 60 tests in a day at first.
Now, Nimer said, that capacity has expanded to 400 patients per day, but the health system is still hindered by supply shortages of nasal swabs, viral transport media and multiple reagents, which are used to expose the virus.
Nimer said despite building “redundancy upon redundancy,” supply chain issues have persisted. He compared the hospital’s efforts to wartime logistics. “We can order 1,000 [testing] kits,” he said. “Sometimes we get 50.”
By contrast, John Couris, president of Tampa General said his hospital is already screening all patients for COVID-19 and when the governor allows his executive order banning elective procedures to expire on May 8, “We will be up and running on May 11.”
Meanwhile, guidelines from the Florida Department of Health and the Centers for Disease Control and Prevention prevent everyone who wants a test from getting one.
For months, the guidance was to ration tests and give a priority to the most severely ill or hospitalized patients and health-care workers with symptoms. This week, the Centers for Disease Control expanded its criteria to now also give priority testing to first responders and people living and working in nursing facilities, prisons and shelters and anyone identified through public health investigations.
As Florida and other states prepare to reopen parts of the economy, the Trump administration has been aware of the need for expanded testing.
On Monday, the White House released what it called a blueprint on its testing plans and officials told the Wall Street Journal that the federal government is prepared to send all 50 states enough tests to screen at least 2 percent of their residents for the virus.
Pharmacies need a month to get ready
Federal agencies are working with executives of major pharmacy chains and testing labs to expand testing capacity and last week DeSantis waived Florida regulations to allow the pharmacies to order and administer tests. By Monday, the pharmacies said it would be another month before they can produce tests and, when they do, patients must have approval from doctors or public health offices to get them.
Walgreen Boots Alliance Inc. also said it is ramping up testing capacity, and Walmart said it will establish 100 self-swab test sites by the end of May with an initial focus on hot spots and under-served communities.
CVS expects to have up to 1,000 locations across the country offering this service by the end of May, with the goal of processing up to 1.5 million tests per month subject to availability of supplies and lab capacity, said Tara Burke, CVS spokesperson. “Our primary limitation is the availability of testing equipment and capacity of the labs to process the tests.”
In Florida, CVS said will offer tests at its “MinuteClinics” throughout the state, she said. There are 101 MinuteClinics in Florida, Burke said.
Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, said last week that the United States is testing 1.5 million to 2 million people a week, and that the nation needs to double that amount “in the next several weeks.”
Michael Mina, a physician and epidemiology professor at Harvard T.H. Chan School of Public Health, said there is no single number of tests that would apply to every state or region.
Testing needs will be related to the prevalence of the coronavirus in a community: the higher the case rate, the more surveillance and testing that will be needed to contain an outbreak. “Most of us working on the safest ways to open up the economy again place significant amounts of testing front and center to prevent significant outbreaks and monitor them,” he said.
“We haven’t actually rolled out serious testing to the population. We have the drive-throughs, which are relatively low throughput relative to companies having daily testing of their employees,’’ he said.
Last week, Dr. Deborah Birx of the White House’s coronavirus task force said that each state governor has a “roadmap” to testing capacity that lays out the locations of laboratories capable of running tests for the novel coronavirus. The roadmap includes lab locations, equipment and capacity information. The Miami Herald has requested a copy of the document from the governor’s office.
DeSantis acknowledged Tuesday that for the public to return to work will depend on how confident they are in their own safety, and the availability of testing will be part of it.
“A lot of this is confidence and building confidence with the public that the next step is going to be done thoughtfully,’’ he told reporters during the White House briefing. “It’s going to be done in a measured way, and it’s going to be done with an eye to making sure that we’re not pretending that this virus just doesn’t exist.”
This story was reported by Miami Herald reporters Mary Ellen Klas, Ben Conrack and Daniel Chang. Klas can be reached at firstname.lastname@example.org and @MaryEllenKlas
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