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Collecting, testing and documenting COVID-19 locally — explained
Testing ramped up, but with supply a concern, priority given to symptomatic, exposed
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The Longstreet Clinic holds COVID-19 testing Friday, April 10, 2020, at a temporary drive-thru shelter in the parking lot of the clinic. - photo by Scott Rogers

By Jeff Gill

and Megan Reed

Although COVID-19 testing is becoming more widely available, testing is still being prioritized for higher-risk groups and those who have been exposed to the virus.

Social distancing, however, can prevent people from getting sick.

Lacking the supplies “to test everybody,” Jo Brewer, executive director of laboratory services for Northeast Georgia Health System, insists people abide by Georgia’s shelter-in-place order.

“We don’t have the supplies, and even commercial labs don’t have the capacity yet,” for wholesale testing, she said.

“It is getting better with capacity and different vendors bringing forth COVID testing, but it is simply not quite enough yet to test asymptomatic people,” she said. “And there’s a bunch of them out there, spreading the disease.”

Brewer said because people are asymptomatic, meaning they’re infected even though not showing symptoms, "it’s critically important that everybody stay home. We really don’t have enough supplies … either in-house or external labs to test everybody.”

COVID-19 testing that’s on the market now is mostly uniform among patients and involves swabbing a patient’s nose or throat to collect a specimen to test. It “is very sensitive and very accurate,” Brewer said.

Several medical providers are doing testing, including the health system as well as primary care and urgent care facilities and the state Department of Public Health.

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A visitor to The Longstreet Clinic gets a COVID-19 test Friday, April 10, 2020, at a temporary drive-thru shelter in the parking lot of the clinic. - photo by Scott Rogers

There is a shortage of supplies needed to collect specimens, Dr. Joe Conway, laboratory medical director for Northeast Georgia Medical Center Gainesville, said.

“We can’t use wooden swabs with cotton tips, because that would give us a false negative test. The swabs have to have certain characteristics,” he said.

NGHS has been testing about 250 to 300 patients a day. Since the beginning of the pandemic, the system has collected more than 3,600 tests, and more than 550 of those have come back positive, as of Thursday afternoon. Those numbers are systemwide for NGHS and include its hospitals, urgent cares and medical offices in several Northeast Georgia counties.

And that number is “slowly ramping up,” as well as “a jump in the number of positive (results),” Brewer said.

“Having a local Alpharetta lab, we can courier them down and get back results such that we’re managing the volume of patients that we’re having right now,” Brewer said.

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Specimen Processors Julia Deltoro and Quinton Bryant work inside inside the Northeast Georgia Medical Center Core Lab testing blood for the hospital's needs Friday, April 3, 2020, in Gainesville. - photo by Scott Rogers

NGHS can’t process its own tests, as testing equipment is being allocated “and they haven’t gotten to us on the list yet,” Conway said.

“We’re hopeful in the next few weeks … to start getting some supplies in so we can perform some of the testing here, but even with that, there’s a limited amount we’ll have. So, we’ll have to reserve for the most critical patient,” he said.

Brewer said the reliability of a test often relies on the quality of the specimen collected. 

“There’s no perfect test. There’s always going to be false positives and false negatives with any test,” she said. “… But this is a good one. The methodology is pretty laborious.”

The Longstreet Clinic has set up a drive-thru testing site outside its Gainesville office on Jesse Jewell Parkway. Patients need a referral from a Longstreet physician to be tested.

As of Wednesday evening, the clinic has tested 259 people, 152 at the drive-thru site and others in medical offices, according to Loren Funk, Longstreet’s chief operating officer. Of those tests, 37 have been positive, while 198 have been negative and the clinic is waiting on results for 24 patients. 

Funk said turnaround times for results have been about two to three days, quicker than the average of five days it took toward the beginning of the pandemic. Longstreet has been sending patient samples to commercial labs.

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The Longstreet Clinic holds COVID-19 testing Friday, April 10, 2020, at a temporary drive-thru shelter in the parking lot of the clinic. - photo by Scott Rogers

At the testing site, patients drive up to the tent, then call a number to notify medical staff that they are waiting outside, Stephanie Brown, Longstreet’s lab services manager, said. The test could be either a nasal swab or a throat swab, depending on what kit is available, she said.

Patients are given guidelines about how to quarantine while they wait for results or if they test positive for the virus.

“They’re anxious about what is going on with this virus,” Brown said. “(Testing) doesn’t take long. It takes longer to go through the explanation of how we’re going to do the collection process.”

Funk said Longstreet is testing about 15 to 20 patients a day. The testing materials needed for COVID-19 are similar to what is needed to test for other viruses, and Longstreet already had a supply before the pandemic.

“I wouldn’t say that we have an abundant supply, but we have an adequate supply right now for the testing,” Funk said. “But it has been difficult to get any more (supplies).”

The Northeast Georgia Diagnostic Clinic, which has locations in Gainesville and Braselton, is offering testing for its own patients but not outside referrals, according to Katherine Watson, a spokeswoman for Northside Hospital, which operates the clinic. Tests are sent to a commercial lab. 

Guilford Immediate Care is offering COVID-19 testing for patients who meet criteria after consulting with a physician. Guilford has two locations in Gainesville, on Jesse Jewell Parkway and Dawsonville Highway, as well as locations in Oakwood and Cleveland. Practice manager Amy Robertson said samples are being sent to NGMC, and Guilford is seeing about a two-day turnaround time for results. 

Dr. Ronald Perry of Lanier Urgent Care on Thompson Bridge Road said testing is also available at the urgent care, and results take about 24 to 48 hours. 

Patients at Good News Clinics are referred to the Georgia Department of Public Health for testing, according to Executive Director Liz Coates. She said some patients are screened over the phone, while some may go to the clinic for other tests such as the flu. Coates said April 14 that the clinic has referred 12 patients for testing. One has tested positive, and seven patients' results were pending. 

Testing is not done at the Hall County Health Department facility, but nurses are screening callers by phone, according to Georgia Department of Public Health spokesman Dave Palmer. If the nurse decides the patient needs testing, the patient is given a phone number to schedule a time to go to a drive-thru testing site. Residents can also call the state’s COVID-19 hotline at 1-844-442-2681. The drive-thru testing site is referral-only.

As of Friday, Georgia had more than 11,000 confirmed cases, with about 20% of those people hospitalized.

But those numbers from the Georgia Department of Public Health can be delayed because the information sent by health care providers to the state could be inaccurate or incomplete.

Palmer said state epidemiologists verify the information before it is posted in the department’s status reports, which are updated online daily at noon and 7 p.m. Cases may be listed as “unknown” in location while information is verified, he said.

Cases are listed under the person’s county of residence, not where they have been treated.

Palmer said the delay in reporting “cannot be quantified as results are sent from many different sources statewide.” 

Labs and health care providers can send test results to the Department of Public Health using the state’s electronic notifiable disease surveillance system, Palmer said. In some areas, faxes are still used and the data is entered either by the local health department epidemiologists or state epidemiologists.

Brewer said NGMC infection prevention and control sends disease information to the Department of Public Health.

The state receives death notifications in several ways, Palmer said. Hospitals can report deaths. The Department of Public Health also checks death certificates weekly for COVID-19 deaths. In some cases, coroners and medical examiners report the deaths.

Hall County Coroner Marion Merck said deaths are reported to the Department of Public Health through death certificates after consultation with a medical examiner. But Merck said the coroner’s office only handles cases where a doctor did not sign the death certificate because the person had not recently received medical treatment.

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Specimen Processor Tammy Cronic places a specimen vial inside a bag Friday, April 3, 2020, inside the Northeast Georgia Medical Center's Core Lab where they perform coronavirus tests. - photo by Scott Rogers

NGHS spokesman Sean Couch said one challenge is determining whether COVID-19 was the cause of death or a complicating factor. 

“A patient could be COVID-positive, could pass away, and if that is not clearly delineated in our system, it doesn’t appear that way at the Department of Public Health. That’s when we’re relying on their tracking to then follow up with the coroner, with the medical examiner, to find out if that is in fact a death due to COVID,” Couch said. 

When NGHS identifies a positive patient, they communicate the information to the Department of Public Health, which then tracks the patient.

Palmer said the department works to notify people who may have been exposed to the virus.

“When a confirmed positive case is reported, our epidemiologists contact the person who has tested positive. The person is asked where they have been and who they have had close contact with – 6 feet or less for more than 10 minutes,” Palmer said. “The people identified by the case as close contacts are notified and given instructions based on the circumstances of their exposure.”

If a contact is experiencing symptoms, they are asked to self-isolate, and if they are not experiencing symptoms, they are asked to self-quarantine and monitor for symptoms. 

Toward the beginning of the pandemic, the state’s testing capacity was limited to 100 a day. That has gradually increased, and the state announced a plan on March 31 to increase capacity to 3,000 tests a day by collaborating with clinical labs at several of Georgia’s universities.

As of Thursday afternoon, only Augusta University was actively involved, although labs at Georgia State University, Georgia Institute of Technology, Georgia Tech Research Institute, University of Georgia and Emory University will soon join the effort.

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Specimen Processors inside the Northeast Georgia Medical Center Core Lab test blood for the hospital's needs Friday, April 3, 2020, in Gainesville. The lab also performs coronavirus testing. - photo by Scott Rogers

Palmer said daily testing capacity had increased to about 2,500 for the state’s lab and its partners. The state has partnered with CVS Health to set up rapid testing on Georgia Tech’s campus in midtown Atlanta, with results available in as little as five minutes. The Department of Public Health is working with the commercial labs Quest Diagnostics, LabCorp and Ipsum Diagnostics. Atlanta-based Ipsum began processing tests on Thursday. 

As of Friday afternoon, commercial labs had processed about 43,000 tests, while the Georgia Public Health Lab had processed about 3,000, according to data from the Department of Public Health. About 25% of tests sent to commercial labs had come back positive, while the Georgia Public Health Lab’s tests were about 18% positive.

And health care providers are monitoring the virus to try to predict whether it could come back.

Testing for the disease is being and will be evaluated later “as to how pervasive this (outbreak) was and help us with information for next season,” Brewer said.

“People suspect (COVID-19) can be seasonal, but we just don’t know,” Conway said. “(Experts) are still trying to collect information and figure this out.”

Public response to a future outbreak is “speculative,” Conway said.

“Everybody is ramping up their supply chain so, if it does come back, we will be so much better off, as far as testing and managing it,” he said. “And I know they’re doing all types of clinical trials on medications. If we get anything close to a Tamiflu (influenza medication) for the coronavirus, that’s going to be a game changer.”

The Associated Press contributed to this report.

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A sign points in the direction of a COVID-19 drive-thru testing site Friday, April 10, 2020, in the parking lot of the clinic. - photo by Scott Rogers
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