What’s happening now: “We are in freefall.” Uncontrolled virus transmission has led to a doubling of Florida’s new cases in the last ten days. Contact tracing can’t catch up.

Be Here Now– photo by Harald Lepisk courtesy of pixabay.com

Dr. Rochelle Walensky, chief of infectious diseases at Massachusetts General Hospital, said on Monday that “We are in free fall” but she wasn’t referring to Massachusetts, one of the few states with stable or declining new case numbers.  She was referring to pictures of people on the beach over the weekend.  Dr. Peter Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine in Houston, said “free fall” was accurate for Texas.

The New York Times daily case counts for Florida show newly reported COVID-19 cases roughly doubled between June 24 and July 4. Idaho’s case counts have doubled, from 219 on June 25 (with a rolling 7-day average of 161) to 368 on July 5 (7-day average: 322) and 423 (7-day average: 350) on July 6.  For Texas, the 7-day rolling average quadrupled from 1607 on June 5 to 6814 on July 5, and 9181 new cases were reported for July 6.

Numerous public testing sites have recently closed, either temporarily or permanently.  The site at Los Angeles’ Dodger Stadium was closed for four days over the Independence Day holiday weekend, but is expected to re-open today (July 7.)  Appointments for tests today are already fully booked, so if you call, you might get an appointment for tomorrow or Thursday.  This site will be able to run 6,500 tests a day (up from 6000 last week), half of Los Angeles County’s public testing.  Closures at some public testing sites will dramatically reduce daily case counts in their areas because they represent such a large proportion of overall tests in that area.

Those testing sites that have not closed are overwhelmed and have repeatedly run out of supplies with which to perform tests.  (One thing that might help with supplies is to switch to a saliva test, where you just spit into a vial.  No swab, no technician, and no intrusive deep intranasal swabbing is required.  The saliva test could be sent out and returned via mail, to be done in the home.  The saliva test is being evaluated in Southampton, United Kingdom currently.   Tests have shown the saliva test is not quite as sensitive as the swab, but this could be improved by “hacking” and coughing, and running your tongue around your mouth to collect cheek cells.)

The alternative to a public site (which is often free) is for an individual to visit their doctor for a written order to test, which can then be carried out by a lab– assuming that the lab has the needed supplies.  When performing a test under a doctor’s order, the patient will have to pay something, either out of pocket or with the help of an insurance company.  The test itself is reimbursed up to $100 by Medicare and Medicaid (cms.gov, April 15); it’s supposed to be free to the patient under the new law.  Private insurers probably pay more, and cash patients may pay $229, according to one web site.

For example (npr.org), a 25 year old woman who on March 11 visited her primary care physician with a persistent sore throat (a common and not particularly serious complaint, except that she had lupus) under her Aetna insurance was charged $2.121 (of which she was responsible for $536.46.)  She was tested for more than a dozen respiratory diseases.  She was positive for influenza B, so the lab did not run a test for SARS-COV-2.  On her doctor’s advice, however, she had a test done ten days later at a drive-thru site; the doctor reasoned that people could be co-infected with both SARS-COV-2 and influenza B.  She was negative for SARS-COV-2, the causative agent for COVID-19, and the test was free.

The federal government passed a law in March making coronavirus tests and some other associated care available at no cost to the patient (although insurance companies are on the hook) but this patient visited her health care provider before the law went into effect.  Her insurer, however, had already promised to provide the test at no patient fee.  Because of the limited availability of the test at that time, patients were required to have other conditions ruled out before running the COVID-19 test.  After being notified by a reporter of the circumstances surrounding the case, Aetna waived the patient’s portion of the bill.

What comes after being tested?  If your test is positive, you are supposed to receive a call from a contact tracer.  News reports indicate this is not happening in Florida.  To be sure, some people are not cooperating when they are contacted; one particularly recalcitrant group received subpoenas.  The bottom line, though, is that there are too many new cases for the present group of contact tracers to follow up.  This was true a month ago, and even with attempts to hire more people, it is even more true today.  This from CNN and WMUR:

“The cases are rising so rapidly, that we cannot even do contact tracing anymore. I don’t see how it’s possible to even do that,” Dr. Peter Hotez, dean of tropical medicine at Baylor College of Medicine, told CNN Monday.

The Republican governor of Florida, Ron DeSantis, who has been criticized in the past for his actions in relation to the coronavirus crisis in his state, said in an interview on July 7, “Contact tracing is not going to be enough”, although he did not give clear indications of what additional measures the state government would take to address the problem.  He did say that $138 million has been allocated to the State Department of Health but claimed that individual counties could hire contact tracers with CARES Act funding, so apparently the State would not be doing so.  He stated that young people with no symptoms are driving the increased infection rate and that they often didn’t cooperate with contact tracers.  He also stated that the virus is transmitted more easily by people talking loudly over music.  All these things are true, but he didn’t say how the state government was going to respond to them.   There is little or no apparent state-level direction to the fight against the virus in Florida.

(PS: there are many good articles about the novel coronavirus in “The Conversation”, a website that is supported by a number of academic institutions.  In “Who We Are”, it states, “The Conversation US arose out of deep-seated concerns for the fading quality of our public discourse – and recognition of the vital role that academic experts can play in the public arena.”)