Wednesday, March 18, 2020

Oshkosh health care providers asked to limit coronavirus testing as state labs are overwhelmed

Oshkosh Media
Kim Goffard, the county’s communicable disease nurse supervisor, addresses the Board of Supervisors.
By Miles Maguire
Oshkosh area health providers are being asked to restrict coronavirus testing because of a shortage of reagents and specialized swabs, a Winnebago County health official said Tuesday.

"We are now seeing the need for some priority testing now at this point,” Kim Goffard, the county’s communicable disease nurse supervisor, told the Board of Supervisors.

The Wisconsin State Lab of Hygiene “is asking providers--physicians, physician assistants [and nurse practitioners]--to limit the number of tests,” she said.

Patients who do not have symptoms are not to be tested, she said, citing new guidance from the state lab. Patients who have mild symptoms, unless they are health care workers, are also excluded from testing.

“Patients who need a test are going to get a test,” she said. Others may be sent home to convalesce.

The need for a test is determined by a new four-tier priority system, with only the top two tiers getting tests from public labs.

The following is from the state lab’s web site.

Tier One:

  • Patient is critically ill and receiving ICU level care with unexplained viral pneumonia or respiratory failure.
  • Patient is hospitalized (non-ICU) with fever or signs and symptoms of lower respiratory tract illness (cough, shortness of breath) AND either of the following high risk conditions: known exposure to a laboratory-confirmed COVID-19 patient or travel to an area where sustained community transmission has been identified
Tier Two:
  • Hospitalized (non-ICU) patients and long-term care residents with unexplained fever AND signs/symptoms of a lower respiratory tract illness
  • Health care workers with unexplained fever AND signs/symptoms of a lower-respiratory tract illness, regardless of hospitalization
Tier Three:
  • Patient is in an outpatient setting and meets criteria for influenza testing. This includes individuals with co-morbid conditions including diabetes, COPD, congestive heart failure, age >50, immunocompromised hosts among others
  • Health care workers with mild upper respiratory symptoms (rhinorrhea, congestion, sore throat) without fever
Tier Four:
  • Other patients, as directed by public health or infection control authorities (e.g. community surveillance or public health investigations)

Goffard said the state lab is loosening some requirements, including allowing a fewer number of swabs.

The state lab can handle 400 tests a day while the other public testing facility, the Milwaukee Health Department Laboratory, can do 150, according to the Wisconsin Department of Health Services.

These two labs received 700 samples on Monday and more than 450 on Tuesday morning, said Ryan Westergaard, the state epidemiologist.

“The nationwide supply chain for reagents and other testing supplies is very fragile as more laboratories begin testing,” he added.

He said the state is looking for additional labs to handle demand and urged health care providers also to look for other options.

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