Dr. Sterling Ransone is a family physician in Deltaville and a member of the Virginia Testing Task Force, a task force convened in late April to stimulate the state. once-slow COVID-19 test rates.
Twice now, on conference calls, he’s heard what he described as “proclamations” from state officials about the number of days Virginia has gone without a reported shortage of equipment. Individual protection.
“Quite honestly, that really concerns me,” Ransone said. “And each time I had to speak up because the reason they don’t get reported PPE shortages is because we’ve been asked to reuse disposable gear.”
Ransone has two N95 respirator masks, sanitized by one of the state’s Battelle decontamination systems, which he runs throughout the week. In his office, surgical masks are reused unless they are dirty or wet. Disposable gowns are carefully removed and stored for future use.
This careful preservation worries him when it comes to testing for COVID-19, a process that typically involves direct contact with saliva, snot and other virus-carrying particles. Ransone’s practice, owned by Riverside Health System, is offering testing on a limited basis — Ransone said he was doing 10 tests a day, which was enough for him to meet current demand. But he worried about what would happen if demand for testing increased in the coming weeks, both from a supply and safety perspective.
“If I can’t keep my staff safe, I can’t do tests,” he said. But in Deltaville, a town of just over 1,000 that juts out into the Chesapeake Bay, it’s also the main source. The closest hospital is 30 minutes away, Ransone said. The city does not have a single listed testing location within 50 miles, according to the state map of COVID-19 testing sites.
Virginia, like the rest of the country, has spent months battling supply shortages in an effort to build a comprehensive network of COVID-19 testing sites. But despite its numbers gradually increasing (the state averaged more than 11,000 tests a day over the past week), many primary care physicians are still reporting difficulty finding the basic supplies that make in-office testing possible.
Dr. Sandy Chung, a Northern Virginia-based pediatrician and president of the Virginia Chapter of the American Academy of Pediatrics, said protective equipment still remains a key barrier, especially for independent practices that are not linked to a broader health system. “Practices always reuse the same N95 mask that they have had for a month, two months,” she added. “The places that sell us PPE, it’s three to five times the normal cost. So at the same time that the practices have reduced income due to all the reduced visits, we are being asked to pay extra.
His office is also offering testing, but on what Chung described as a “very limited capacity.” A part is rapid antigen testa more recent diagnostic tool, which carries the risk of false negatives and must sometimes be confirmed by much more reliable nasal swabs.
Chung said there’s a disconnect between the ongoing limitations for primary care providers and Virginia’s recent shift to phase three reopening. Like many doctors, she sees a growing demand for testing as offices reopen and more Virginians return to their normal routines. “We have reasons like, ‘I just got back from Myrtle Beach and would like to know if I’ve been exposed,'” Chung said.
But at present, availability of testing by primary care physicians is still limited, particularly by region. Dr. Clifford Deal, president of the Medical Society of the Virginia, said some practices are simply not interested in providing it given the risks involved. Both Chung and Ransone said they were concerned about the coming months, particularly if transmissions increase, the need for testing continues to grow and doctors are still unable to stock up.
“The state has held many large-scale testing events,” Chung said. “We want to be able to serve our patients, but I would say your private practices are always left out.”
State health officials say moving more tests to primary care settings is also a top priority moving forward. Part of that is an effort to increase testing across the board in Virginia, which still ranks among the 15 lowest states in terms of testing per 100,000 people — well below neighbors such as Maryland, Tennessee and Washington, DC, according to data from Johns Hopkins University.
But from a health perspective, linking testing to medical care is also an important aspect of the fight against COVID-19. While the tests themselves have become more available through community events and retail pharmacy chains, these settings don’t necessarily allow patients to ask follow-up questions or know what symptoms might need further care.
“It’s absolutely critical that primary care clinicians get involved,” said Dr. Parham Jaberi, deputy commissioner for public health and preparedness for the Virginia Department of Health. “We want people to stay connected to their medical home. A doctor can interpret the results, realizing a person’s condition. We know there are all those false positives and false negatives. If someone is older, has diabetes and heart disease, and has a fever and a cough – well, even if their test is negative, as a doctor, I will look at it differently than I would a healthy 22. -years.”
However, extending resources to primary care settings is a different matter, especially given the current challenges with purchasing personal protective equipment statewide and nationally. Jaberi said a few practices have obtained protective equipment through local health departments, but resources are still almost exclusively directed to hospitals, nursing homes and other large facilities, which also reuse normally disposable supplies.
“The answer is always ‘No,'” said Chung, who added that a colleague of his was told his local department was no longer providing equipment to doctors.
Efforts have been made to direct resources to providers in underserved communities. Shortly after organizing the state’s testing task force, leaders reached out to the Virginia Community Healthcare Association, which represents more than 100 affordable health centers across the state. CEO Neal Graham said many were interested in testing but faced some of the same hurdles as private doctors.
Ultimately, members were able to increase testing by approximately 2,000 per week through a partnership with VDH and the Richmond State Laboratory, which provide health centers with free testing supplies and protective gear. , said Graham. About 50 to 55 sites — about a third of the state’s total — now offer some form of regular COVID-19 testing.
The state has also made use of free clinics which, like community health centers, provide free or heavily subsidized care. Rufus Phillips, CEO of the Virginia Association of Free and Charitable Clinics, said 27 sites offer testing through free kits provided by the state lab.
Like most practices, however, these tests are limited. Dr Wendy Klein, the recently retired medical director of the free clinic Health Brigade in Richmond, said her office was only receiving 75 kits a week. CrossOver Healthcare Ministry, another free clinic in Richmond, received the same number of kits and tests from about as many patients each week, CEO Julie Bilodeau said.
“I think in an ideal world we would do more testing,” she added. But she also pointed out that labor is one of the main restrictions for her practice, which runs largely on volunteers.
There are other challenges that make testing in primary care offices difficult, Klein said. A significant concern is infection control, particularly if offices are not testing outdoors. Logistically, community testing events — largely orchestrated by local health departments — can also accommodate far larger numbers of people than individual practices, said Departments Director Dr. Danny Avula of Richmond and Henrico Health.
They can also be time consuming for health service staff, depending on the number of tests performed. Avula said her department’s events — currently scheduled in four-hour shifts about three times a week — typically take eight staff members and seven to eight volunteers from the state’s Medical Reserve Corps. “I would like to move more tests to the primary care setting, but I think it is difficult, given that we can do up to 300 tests,” he added.
Until now, this has been the goal of the state. As of July 5, the state health department had conducted testing at 341 long-term care facilities and 199 community events. Jaberi said expanding testing to primary care factors in the state’s long-term testing goals, but there are still immediate issues with access to some of the most vulnerable populations, including nursing home residents. nursing care and the uninsured and underinsured.
“I agree there has to be that balance,” Chung said. But many primary care providers say they are playing an increasingly important role in testing, especially as restrictions loosen and demand – as well as cases – remain likely to grow.
“If the state has PPE, I think the focus now should be on the primary care providers and the frontline providers who have to do the testing and take care of these patients,” she said. added.
This article originally appeared in the Virginia Mercury.