Featured Story Written by Dr. Jean Allais

Testing the key to reopening our economy

Alllais spotlight

Albany Coun­ty Health Offi­cer. Dr. Jean Allais dis­cuss­es test­ing and care­ful next steps in her Boomerang column.

In the begin­ning of the COVID-19 pan­dem­ic, if you had mild symp­toms and were able to recov­er at home, you were not test­ed. Nobody had test­ing in place for sev­er­al reasons.

Because it was a new virus, a test had to be devel­oped. Then there were prob­lems obtain­ing the sup­plies need­ed for test­ing. There were not enough tests. Tests were reserved for peo­ple who were at high­er risk of severe ill­ness. Mov­ing into the new phase of start­ing to reopen the econ­o­my, Pub­lic Health wants every­one who has symp­toms to get test­ed, and now there is the capa­bil­i­ty to do that. Know­ing what is going on local­ly helps us to con­trol out­breaks and pre­vent spread in our community. 

How can the econ­o­my be reopened safe­ly? To under­stand, let’s go back to the begin­ning. The Coro­n­avirus was a new virus, and every­one was sus­cep­ti­ble to it. Remem­ber those graphs with the steep curves? Those were based on the dou­bling time of infec­tion of the virus. Let’s say the dou­bling time is 2 days. If there were 5,000 cas­es on Mon­day, on Wednes­day there would be 10,000 cas­es, and on Fri­day 20,000 cas­es. Social dis­tanc­ing keeps that curve flat. Stop social dis­tanc­ing, and there will be a rapid resur­gence, a steep curve. That would occur in two weeks, the incu­ba­tion peri­od of the virus. The chal­lenge as the econ­o­my begins to reopen, is how to deal with the fact that there can be a rapid rebound? 

There are two pub­lic health response strate­gies. One is mit­i­ga­tion, in which the goal is to keep health care sys­tems from being over­run. Gov­er­nor Gor­don declared a state of pub­lic health emer­gency on March 13. Gath­er­ings of 10 peo­ple or more were pro­hib­it­ed, schools were closed, and peo­ple were asked to stay home. In addi­tion to this social dis­tanc­ing, increased hygiene mea­sures with fre­quent hand wash­ing and san­i­tiz­ing pro­ce­dures were rec­om­mend­ed. The goal with con­tain­ment is to reduce num­bers such that cas­es can be con­tact traced and iso­lat­ed. It is a much more aggres­sive strat­e­gy, as we try to iden­ti­fy every­one who has COVID-19 and their close con­tacts. Pub­lic Health is mov­ing from a mit­i­ga­tion strat­e­gy to a con­tain­ment strat­e­gy as the pan­dem­ic evolves. 

Does social dis­tanc­ing work? Yes, sig­nif­i­cant­ly reduc­ing con­tacts dra­mat­i­cal­ly reduces the infec­tion rate to a more man­age­able lev­el. We as a com­mu­ni­ty suc­ceed­ed in flat­ten­ing the curve and pre­vent­ing a big spike in infec­tions that threat­ened to over­whelm the health­care sys­tem. But it was nev­er expect­ed to wipe out the virus com­plete­ly, or to thor­ough­ly con­tain it. Now that flat­ten­ing the curve has suc­ceed­ed, it offers the oppor­tu­ni­ty for many peo­ple to go back to work, or oth­er activ­i­ties, under care­ful­ly con­trolled con­di­tions, so that we can keep the curve rel­a­tive­ly flat. Those con­di­tions con­tin­ue to include social dis­tanc­ing, good hand hygiene and san­i­tiz­ing procedures.

Albany Coun­ty Pub­lic Health, work­ing with com­mu­ni­ty lead­ers and the Wyoming Depart­ment of Health, is fol­low­ing a step­wise approach to eas­ing of restric­tions. There will be con­tin­ued atten­tion to social dis­tanc­ing, hygiene mea­sures as well as use of face cov­er­ings. Ini­tial­ly the restric­tions are being lift­ed in areas that are of least risk, like places that rely on one-on-one encoun­ters, such as hair and nail salons and bar­ber shops. Gyms have been able to open with lim­its on num­ber of peo­ple in an area, and increased space between exer­cise equip­ment. On Fri­day, May 8, restric­tions were eased on bars and restau­rants and oth­er food and bev­er­age estab­lish­ments in Albany Coun­ty. Tables must be at least 6 feet apart, and there will be less con­tact between wait­staff and patrons. San­i­tiz­ing between cus­tomers will be increased. 

As these changes are imple­ment­ed, we are watch­ing our data in Albany Coun­ty, sur­round­ing coun­ties, and the state. That data includes num­ber of new cas­es of COVID-19, per­cent of tests that are pos­i­tive, amount of com­mu­ni­ty spread, num­ber of hos­pi­tal beds avail­able, par­tic­u­lar­ly ICU beds, and avail­abil­i­ty of per­son­al pro­tec­tive equip­ment (PPE) and oth­er equip­ment. There also must be capa­bil­i­ty of wide­spread test­ing. Test­ing is our ear­ly warn­ing sys­tem. Pub­lic Health must have the capac­i­ty to con­tact trace, iso­late and quar­an­tine people. 

It is a bal­anc­ing act, and the bal­ance so far has been tipped towards restric­tions. As we move to loosen restric­tions, the bal­ance is start­ing to be reset. Test­ing is a key piece to the reset. Test­ing has the poten­tial to move us away from the wide­spread clo­sures and restric­tions and move us towards a set of dis­ease con­trol mea­sures. We want to diag­nose as many peo­ple with COVID-19 symp­toms as pos­si­ble. What will be the response to those tests? Pret­ty much the same as now. Those with mild symp­toms will be iso­lat­ed. Those with severe symp­toms will receive med­ical treat­ment. We want to test every­one who has symp­toms of COVID-19. We will be much bet­ter able to trace con­tacts and quar­an­tine peo­ple who have been exposed, so we can keep that curve flat. The test that deter­mines if you have active infec­tion is the viral test. Cur­rent­ly, anti­body tests are not reli­able enough to use as a basis for reopen­ing strategy.

If you have symp­toms of fever, cough, or short­ness of breath, or think you have COVID-19 call your health care provider. Stay home except to seek med­ical care and to get test­ed. More severe symp­toms include trou­ble breath­ing, per­sis­tent pain or pres­sure in the chest, con­fu­sion, or inabil­i­ty to stay awake and you should call the emer­gency room right away. Be sure to call ahead first to let them know you think you have COVID-19 symp­toms. More infor­ma­tion can be found on the Albany Coun­ty Pub­lic Health web­site: pub​lichealth​laramie​.org, the Wyoming Depart­ment of Health: health​.wyo​.gov, or the Cen­ters for Dis­ease Con­trol: cdc​.gov.

Dr. Jean Allais is the Albany Coun­ty Health Officer. 

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