Testing delays cause strain in every facet of health care

By , Daily Memphian Updated: July 27, 2020 5:17 PM CT | Published: July 25, 2020 4:00 AM CT

General George Patton didn’t know a thing about COVID-19, but he knew all battle plans look good on paper. The test is meeting the enemy.

One of the growing flanks is testing and the days it is now taking to get results.


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In Shelby County, where testing was limited this week to people with symptoms or who have direct contact with a COVID-19 patient because test supplies are tight, it’s taking an average of 5 to 7 days to get results back.

The ramifications of that are serious for people not getting paid for missed work, and perilous in other ways too, including that it’s hard to keep people isolated at home if they are feeling fine and have errands to run.

When testing bogs down, hospitals see upticks in new patients whose status is unknown and must be treated as if they are positive.

For the hospitals now, where regular beds here are 90% full, there is another dimension: They cannot discharge patients to long-term care facilities if they have not been tested in 72 hours.

“We need to know what we are dealing with when they come into a nursing facility,” says Paul Martin, director of health operations at Trezevant Manor, which includes long-term care facility Allen Morgan Health and Rehabilitation Center.

“If we admit them and test them on the day of admission, and they come back positive, then the Tennessee Department of Health says that COVID infection happened in the nursing home,” he said.

“The Tennessee Department of Health puts on us on a list. And you know, the media has not been very kind to long-term care facilities. We are just not willing to take that risk or have the bad publicity that has nothing to do with the level of care that we are providing,” he said.


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To circumvent the issue, Baptist Memorial Hospital-Memphis is working with physicians and its home health care company to discharge other patients, even if they are still requiring oxygen, to go home to recuperate.

“It’s a win-win for our patients, and for us; it frees up another hospital bed,” said Dr. Ashley Harris, associate medical officer.

“We obviously have to be very mindful of how we utilize our resources, and hospital beds are certainly a resource.”

Methodist is working to shorten the wait time, noting that often two negative COVID-19 tests are required to discharge a patient to a long-term care facility.

Nursing homes are allowed to set their own standards for entry. Some, like Trezevant, require only one COVID-19 test. Trezevant will also take COVID-positive patients, if they meet the care levels it can provide. Many will not.

“Nursing homes are not like hospitals; they are not set up to do major-sick COVID care,” said Dr. Jeff Warren, medical officer at Trezevant, member of the Memphis City Council and the local task force on COVID-19. “They don’t have the staffing for that. … That’s why they want to know that patient is not actively sick.”

People hospitalized with COVID-19 are the sickest patients. They may still be infectious even more than 10 days later, Warren said, which is why nursing homes have strict requirements about testing.

“Let’s say they are still in the hospital, still have pneumonia and a positive test,” he said. “That is what the nursing homes are worried about.”

The problem, Martin says, is that hospitals are having difficulty meeting the 72-hour threshold.

“They want us to take people without a COVID test. We cannot take on that liability,” he said.


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As cases in hot spots around the nation skyrocketed in July, testing and testing supply chains bore the brunt.

Roche, which supplies American Esoteric Laboratories with reagents and other supplies, cut shipments to Memphis 40%, says Dr. Manoj Jain, the infectious disease expert on staff at University of Tennessee Health Science Center and advising Mayor Jim Strickland in the pandemic.

“There are always issues, but certainly in the last week, delays in testing have the caused the backup,” he said.

The strain began lifting late this week, he said, when the labs opened up other machines and moved tests the hospitals were sending to the front of the line.

“They are processing hospital samples in 24-48 hours. Those are getting priority.”

Testing itself remains problematic. Last week, the Memphis-Shelby County COVID-19 Task Force created a stoplight system to indicate testing center capacity. Green indicated the centers were operating at 75% or less of capacity. Red indicated they were operating at 90% or more and were prioritizing people with symptoms.

All community testing centers, including Christ Community’s, were red.

As a result, this week community testing centers prioritized people with symptoms and those who were close contacts, which means being within 6 feet of an infected person for 15 minutes or more.

Friday’s positivity rate was 16.4%. The reason it is high, Jain says, is because only people with symptoms are being tested.


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This week, employers were told they should not require employees who have been in isolation to be tested before returning to work.

“One of the things we have found is when most people get COVID, 10 days later, if they have been asymptomatic — that means no fever, no Tylenol for three days — they are not infectious anymore, and there is no reason to test them,” Warren said.

“I am expecting push-back because I think people will not understand that. They won’t understand they are not infectious.”

Josh Hammond, who runs Buster’s Liquors & Wines on Highland Street, understands and thinks the counsel is wise.

“We do have an employee out now who tested positive on Monday of this week,” Hammond said. “We’ll address his return hopefully at the end of next week.”

In the meantime, 11 Buster’s employees who had contact with that employee were tested this week. All tests came back negative.

“My head of HR found a place with a three-hour return. I said, ‘You go, Girl,’ because it’s been a lot of B.S. waiting for seven, eight, even 12-14 days to get tests back. What am I supposed to do, pay employees to sit at home?” he said.

“That’s kind of what we’ve been doing, quite frankly. You want to do the right thing.”

As of 5 p.m. Thursday, 8,055 contacts identified by the health department were in quarantine.

One of the interesting things Buster’s has noticed in the process is the varying advice testing clinics gave employees earlier this summer when Buster’s sent 38 employees for testing and had to close the store for two days.

“Some testing centers said you need to quarantine for 14 days, even if you have no symptoms. Another said, ‘Stay at home until you get the test results. If they are negative, go back to work.’

“The third said, ‘If you don’t have symptoms, and it’s been four or five days since you were around the person who was positive, go back to work and monitor your symptoms.’

“That’s what we got. We thought that was really interesting,” Hammond said, noting it’s no surprise to him people are confused.

Who can be tested has been a moving target and confusing because the direction changes quickly.

The initial plan has changed numerous time, Warren said because testing has to reflect the amount of virus in the community, the number of tests available and ability to get people in and results out.

“We’ve tested asymptomatic people at certain points. We’ve tested just sick people. We’ve tested people in certain industries at certain points, and now, we’ve got too many people who are sick to be able to randomly test people who aren’t,” he said.


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Late Thursday, several hospitals were on critical advisory overnight, including Saint Francis-Bartlett, which means they had run out of some categories of beds and therefore could not accept some new patients.

Another hospital, not named, was holding patients in the emergency department due to staffing shortages that may be caused by nurses taking leave to work in parts of the country that are spiking.

“We have nurses who are going to try to help out,” Warren said. “The fact that they are getting more money probably doesn’t hurt.”

Warren expects they are taking leaves that hospital administrators find difficult to deny.

“At this point in time, if you are a hospital administrator, you probably are not going to tell someone they can’t do that because you want them to come back.”

But Baptist’s Harris says the holds are more likely a combination of factors, including more admissions in general.

“Or perhaps there’s been a high volume of patients coming into the ER for a variety of reasons. The explanation is usually multifactorial.”

Topics

Dr. Ashley Harris Dr. Manoj Jain Dr. Jeff Warren Josh Hammond Trezevant Manor Paul Martin testing delays

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 healthcare and higher education for The Daily Memphian.


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