COVID-19 RLNC #9
TESTING & REOPENING
Many states across the country, including Florida, have started some form of reopening. This reopening movement is not without controversy given the concerns of scientists and doctors about the possible surge of coronavirus cases and its effect on already struggling healthcare facilities. What happens next in this pandemic is uncertain. There is no strong federal guidance on how to safely reopen and it can be confusing, chaotic and ultimately dangerous to human lives.
For example, the City of Naples reopened its beaches this weekend and then had to re-close them when masses of people showed up, many without facemasks and without observing any form of social distancing. This type of response by people will lead to spikes in numbers of cases and death once again.
We have to remember that people infected with Covid-19 yet without symptoms can spread this virus. This is because Covid-19 has an incubation period (time from exposure to virus to showing symptoms) between 2-14 days. Exposure is so often unknown.
According to infectious disease expert Dr. Carlos del Rio, a professor of medicine and global health at Emory University, states that reopen are at risk for a second wave of increased infections and deaths that could overwhelm hospitals and hit more Americans with expensive medical bills. He also notes that even states that adhere to stay at home restrictions can be affected by neighboring states that lift their restrictions as people cross state lines and move about.
Data scientist, Youyang Gu, whose projection model for coronavirus is cited by the CDC, and who has been analyzing data since late March states that you don’t want to rush the reopening because by the time you realize what’s happened, it will be too late to reverse the decision.
Dr. Gu notes that Japan, Hong Kong, and Singapore had resurgences of the virus after reopening, which led to stricter rules and some form of reinstitution of a shut down. He believes that what happens with reopening will depend on how rapidly the virus was spreading in a state before it reopened. He reiterates that recent studies indicate that if any state required all residents to wear masks, the likelihood of a steep increase in infections will decrease.
Testing and Contact Tracing Keys to Reopening
In a prior blog http://www.romanolawgroup.com/blog/rlnc-covid-19-7, we discussed in more detail the current state of testing and the unknown reliability of the tests. Reopening requires more widespread reliable testing.
Sensitivity is the ability of a test to correctly identify those currently infected with the virus. If a test has a high "false negative" rate, that means it has poor sensitivity. If it is not "sensitive" enough it will not pick up all the patients who are infected with the virus.
The diagnostic rt-PCR test is the one that requires the swab, or in some cases saliva. (The antibody test will require blood, either from a blood spot or from a vein. That's a good way to tell them apart). The "rt" means reverse transcriptase. The COVID-19 virus is just a little strand of RNA, the first thing that needs to happen is to transcribe that RNA back into DNA, which is done through an enzyme in the testing kit. After that the polymerase chain reaction "amplifies" the DNA so that it can be more easily detected.
Again there are two distinct types of coronavirus tests you've probably heard about. One is the molecular diagnostic test that can test for the virus itself, commonly called an rt-PCR test. The other is a serologic test -- a blood test -- that detects antibodies, which are part of your body's reaction to the virus.
Certainly both tests are key and are part of the criteria to reopen the country. They are the tests that determine if someone currently has the virus in their body, if they need to be isolated and whether their contacts need to be found and possibly quarantined. Besides testing, contact tracing will help fight the Covid-19 pandemic. Contact tracing is the process of identification of persons who may have been exposed to (had contact with) an infected person. It is a well-known concept in the public health arena. In general, a public health staff member works directly with an infected person to help them recall everyone whom they had close contact with during a certain period. Contact tracing requires special training.
Some estimates are that the United States will need a minimum of 100,000 workers trained in contact tracing across the nation to keep Covid-19 at a manageable level. Having a solid plan and implementing a good system for contact tracing is essential to break chains of transmission, to manage ongoing epidemics of the virus, and to prevent future waves of outbreaks that will enable us to resume life, whatever that safely looks like.
Some states, including the tristate area of NY, NJ and CT have announced plans to hire somewhere between 6,400 to 17,000 contact tracers.
According to the CDC, all states need to have a system in place for hiring and training persons to do contact tracing. These contact tracers need to quickly locate and talk with the patients, assist in arranging for patients to isolate themselves, and work with patients to identify people with whom the patients have been in close contact so the contact tracer can locate them. The actual number of staff needed depends on multiple factors.
We all want to have some form of a “reopening” and “getting lives back.” Each person has the responsibility to help control outcomes as states reopen. We do this by continuing safe social distancing, staying six feet away from others, wearing a facemask in public and washing hands frequently. We are truly in this together and all need to learn how to live in whatever version of normal we can find during this continuing crisis.
We are Susan Ramsey and Amie Goldberg, both practicing attorneys and nurses here at the Romano Law Group. Here is a little more about each of us:
Susan Ramsey is both an attorney and an RN. Ms. Ramsey’s professional experience began as a Registered Nurse in the Intensive Care Unit at Yale New Haven Hospital. While pursuing her Bachelor’s Degree, she was a counselor with the New Haven Rape Crisis Program. During her time with the Program, Ms. Ramsey counseled sexual assault survivors and performed seminars for local police departments, universities, and high schools. During her time working as a registered nurse, Ms. Ramsey decided to attend law school. Ms. Ramsey graduated from CUNY Law School, and has practiced law in several different State and Federal Courts. She is a Florida Heath Care Risk Manager and a member of the Palm Beach County Sober Home Task Force. Ms. Ramsey actively litigates cases involving catastrophic injuries and wrongful death on behalf of survivors, cases include injuries suffered by victims of professional negligence, product liability and medical negligence.
Amie Goldberg is both an attorney and a certified APRN. After completing a Bachelor of Arts Degree at Whittier College, Ms. Goldberg attended nursing school at Emory University. Ms. Goldberg’s professional experience started as a Registered Nurse at Egleston Children’s Hospital taking care of children with congenital heart disease. After a few years, she continued working in all areas of the hospital while attending Kennesaw State University on weekends in order to get her Master’s Degree in Nursing with a specialty of Primary Care Nurse Practitioner/Family Nurse Practitioner. During her time as an APRN, Ms. Goldberg decided to attend law school at St. Thomas University in Miami, Florida. Since graduating, she has mainly practiced in the areas of personal injury and worker’s compensation, fighting for the rights of injured people. Since joining the Romano Law Group, Ms. Goldberg has been the Director of the Opioid Litigation Project. Ms. Goldberg also practices in the area of
medical malpractice and nursing home negligence, bringing an inside perspective and knowledge to help get justice for our clients.