With COVID-19 tests out, number of cases uncertain

By , Daily Memphian Updated: April 12, 2020 10:21 AM CT | Published: April 11, 2020 4:00 AM CT

On Friday, 65 people with positive COVID-19 test results were in hospitals across the city, 35 of them in intensive care units and 19 on ventilators.

But far more resources, including ICU beds, ventilators and staff in personal protective equipment (PPE), were being used to care for patients whose results aren’t certain: No one knows if they’re positive or not because their tests are still out.

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According to data released by Memphis Mayor Jim Strickland late Friday afternoon, 278 patients are in city hospitals — 85 of them in ICU — awaiting a final diagnosis.

Based on Memphis data on the novel coronavirus disease so far, at least 20% are expected to be positive.

“There are a number of tests coming back negative, but they are clinically positive,” said Dr. Manoj Jain, infectious disease expert advising the Memphis-Shelby County COVID-19 Joint Task Force.

In his weekly update Friday, Strickland released data on bed counts in regular rooms, emergency departments and intensive care units in city hospitals, and the number of COVID patients in each.

At a media briefing earlier in the day, Alisa Haushalter, head of the Shelby County Health Department, refused to release the information, saying what she had was state, not local data.

“At the current time, we as a health department are not able to release that data. We are trying to work with the Tennessee Department of Health to receive permission to release what we think is most pertinent,” she said.

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“However, we do use that information daily to be prepared for the surge and to plan for the surge and to make sure that we’re ready, here in Shelby County,” she said.

Strickland’s data coincides with what the task force has been receiving in its morning briefings, including figures on the number of patients under investigation, or PUIs.

<strong>Alisa Haushalter</strong>

Alisa Haushalter

Thursday, 316 PUIs were hospitalized, 80 in ICU beds and 28 on ventilators, according to information provided to The Daily Memphian and corroborated by another official source.

“We have a lot of PUIs right now because testing results have been taking several days, so they can’t be classified as confirmed until those tests come back,” said Dr. Jon McCullers, associate dean of the College of Medicine at University of Tennessee Health Science Center and chief pediatrician at Le Bonheur Children’s Hospital.

The numbers may be deceiving, according to Dr. Stephen Threlkeld, infectious disease expert at Baptist Memorial Hospital-Memphis, who has held daily media briefings since March 9, the day after the first COVID-19 case was identified in Shelby County.

“People sick enough to be in the hospital now are almost all being tested,” he said.

“We are testing everyone, from ‘Wow, this person almost certainly has it,’ down to ‘I wonder if this person could possibly have it. Let’s be on the ultimate safe side and test them,’ ” he said.

The result is that people who come to the hospital for a variety of illnesses end up on the PUI list until their COVID tests come back.

Baptist has run a one- to two-day turnaround for most of the last three weeks, Threlkeld said. Some other clinics in the city are taking longer, including those using the American Esoteric Laboratories facility here, which had an equipment breakdown this week.

UTHSC was running its own tests in campus labs and promising fast turnaround times, but it also had a malfunction this week.

Wednesday at the Tiger Lane testing site at Mid-South Fairgrounds, people were told to expect their results in five days.

“If you don’t get tests back fairly quickly, you have people who are staying in isolation rooms that eventually don’t need to be there. Staff are using extra PPE in those situations. Having those tests come back fast is a very important factor,” Threlkeld said.

“Inadequate testing in all forms — the inability to do it at all, the inability to get it back in a reasonable time – puts stress on those systems,” he said.

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Funeral homes in Memphis have asked the task force to require that every person who dies in a local hospital be tested, even if they died of cancer or other unrelated causes, said Ford Canale of Canale Funeral Directors, who is also a Memphis City Council member.

“Some of the bodies being delivered we were told could be possible COVID patients. We have to treat them as though they are,” which requires the same precautions as working with hepatitis or HIV patients, he said.

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Death certificates in those cases did not list COVID-19 as the cause of death, creating reason to think the death toll could be higher than reported.

Testing deceased people is important for accurate mortality rates and as the city tries to plan for the surge, Canale said.

Baptist said it runs the tests if families request them.

Methodist, in a statement Friday, said it “was focusing our resources, including testing, on COVID-suspected and positive cases.”

Jain said he had not yet made a recommendation on the issue to the task force.

“Individual hospitals are looking into it as far as I know.”

The issue of false negative tests is worrisome and stands to potentially increase as more asymptomatic people are tested, Jain said.

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“We don’t know what the issues are,” he said noting that it could be variation in technique among clinicians, delays in getting the sample to the lab, or even that the virus is not in the nasal cavity “but attaching to another part of the body.

“Biology could be part of it. Transport in the viral media could be an issue. It could be a delay in transport decreases the sensitivity. I do not know.”

Thursday, Baptist Hosptial-Memphis began infusing a patient with plasma with antibodies from a patient who had fully recovered from the disease.

“The person remains in critical condition but is improved. It would be premature to suggest they improved because of the antibody infusion, but it is certainly encouraging,” Threkeld said. “I am about to contact a few additional people who are willing to donate plasma.”

For now, Baptist can accept only donors whose cases it can document. As antibody testing becomes better and more widely available, he says Baptist will be able to take more donors, including those who had the infection and didn’t know it.

The treatment is experimental and requires FDA approval.

“FDA has been good about opening it up and giving access,” he said, noting that it requires strict documentation.

Methodist is “rapidly finalizing plans” to also use the treatment for those who are critically ill. “While this is promising, it is still an investigational treatment,” a hospital spokeswoman said.


Dr. Mano Dr. Jon McCullers Dr. Stephen Threlkeld Mayor Jim Strickland Alisa Haushalter Ford Canale
Jane Roberts

Jane Roberts

Longtime journalist Jane Roberts is a Minnesotan by birth and a Memphian by choice. She's lived and reported in the city more than two decades. She covers business news and features for The Daily Memphian.


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