By Missy Schrott | [email protected]
As of March 26, the United States leads the world in confirmed coronavirus cases – 226,378 as of April 2 at noon. While New York City, New Orleans and other hot spots for the pandemic struggle to keep up with demand for hospital beds and test kits, Alexandrians are wondering whether our city is ready for a similar surge. In other words, is Alexandria responding to the COVID-19 outbreak in the best way possible?
Americans everywhere are looking to local, state and federal governments, wondering who has control over different aspects of disease response. Frequent questions include: Why isn’t there more widespread testing? Who decides who can be tested? What will we do if we run out of hospital beds?
To seek answers to these and the other questions circulating throughout the community, Times Editor Missy Schrott spoke with Dr. Stephen Haering, director of the Alexandria Health Department, and Craig Fifer, city director of communications.
The following interview has been edited for length and clarity.
Schrott: Where is Alexandria getting our testing kits?
Haering: The biggest resource for testing is through private providers, through … urgent care centers and the hospitals. There’s actually a list on the city’s alexandriava.gov/coronavirus page that … lists a lot of the urgent care centers and private practices and the hospital centers that are doing testing. … There are many more test kits available to private providers than through the state public health lab.
Schrott: Is there a reason that kits are more readily available for private practitioners than public health departments?
Haering: That’s part of how the system is set up, the healthcare delivery infrastructure. There’s many, many physicians, there are nurse practitioners, all throughout the city and of course the hospital as well, so it’s important to recognize that the system’s actually set up that public health is not just for testing and for health care delivery. Our role includes synthesizing information, whether it’s from World Health Organization, Centers for Disease Control, Virginia Department of Health, and sharing that information with the community as well as with physicians.
Schrott: People are concerned with the number of test kits available in Alexandria. It seems to be low compared to other jurisdictions. We don’t have any drive-through sites yet. I’ve read that Virginia compared to other states is ranked 42 out of the 50* states in testing per capita. So why is Alexandria and why is Virginia so far behind these other states?
*Based on data from the New York Times, Virginia actually ranked 38 out of the 44 states reported in testing per capita as of March 26. At the time, Virginia had conducted 6,189 tests and had 460 positive cases of COVID-19. As of April 2 at noon, the state had tested 17,589 people, 1,706 of whom tested positive.
Haering: I think there’s a couple of different layers to this and I think the first layer is why is the United States behind? … This is something that everybody is asking. We’re asking this in public health, the community’s asking this, policy makers are asking it, the media’s asking it, and I don’t have the answer to that.
I don’t know, in terms of the number of tests that have been done in Alexandria versus other communities. I do acknowledge that there is data out there that the amount of tests that have been done in Virginia is lower, I think, in a per capita basis than other states. Some of that might be driven by demand. So when we look at New York, for instance, when there’s an outbreak, people will tend to go to their clinician much more quickly and readily.
The important thing to recognize right now is that if somebody [in Alexandria] wants testing, they can get it. …They would have to have a fever or a cough or shortness of breath, if the clinician is following the CDC guidelines, to warrant testing, … but if somebody has the symptoms of COVID, then they can get testing. And that’s true as of now. I will say that a short while ago, three weeks ago, that was not true.
Schrott: What changed over those three weeks?
Haering: The amount of private lab availability. LabCore and Quest. … The CDC first had to figure out how to do the testing and then the state public health labs did, then the private labs did, so even after their ability to spin up and do it, then they had the issue of getting the lab kit test out to their clinicians. But those sorts of things are being ironed out as we move through this pandemic. Again, the important thing right now is that anybody who needs testing can get testing.
Schrott: Is anyone in city or state government working on getting more test kits for our area?
Haering: I wouldn’t say it’s even the state’s role to quote “get test kits.” … It’s not the city’s role either to get test kits. It’s really the private sector in terms of the healthcare delivery sector to drive that force.
Schrott: It protects the community if there’s more widespread testing available, so I would think that people in the city would be working on being able to more widely test. Is that not happening in the city right now?
Haering: No, what the city has done, I should say both the state and the city, … they’ve actually done things instead of waiting for test kits, because it’s not just a matter of testing and test kits and test results. Those are very, very important parameters of all this, but instead of waiting for a lot of test kits and for a lot of test results, the governor closed all schools. … The city similarly has progressively decreased or changed the nature … of how they’re running the business of government.
There’s been a lot of things that the city and the state have taken that’s called a community mitigation strategy that is actually another very important parameter of addressing the pandemic. So it’s more than just the test. It’s what do you do to stay as many steps ahead of this as you can.
Fifer: What the city’s been focused on … is controlling the things we can. We are using the opportunities that we have and the authorities that we have to basically distance people from each other.
We get the question a lot: “Why isn’t the city shutting down everything? Why aren’t we shutting down restaurants? Why aren’t we locking down?” We just don’t have that authority in Virginia.
The role that physical distancing can play in stopping the spread of this virus may be just as important, or maybe more important, than widespread testing of people who aren’t sick.
Haering: That’s absolutely right. There is no role of testing somebody who’s not sick.
Schrott: Do you have any response for residents who are frustrated that Alexandria doesn’t have more test kits or that the state appears to be falling behind?
Fifer: As Dr. Haering has said several times now, everybody who needs a test is getting a test, and we’re not getting complaints about people who need to be tested and can’t. … So when people say, “Why don’t we have more testing?” I think the answer I would give is we are also frustrated that testing has not been more readily available nationwide, but at the same time, we don’t believe that that’s preventing people who need tests from getting tests in Alexandria.
Schrott: Why isn’t there a drive-through testing center in Alexandria?
Fifer: We basically cannot currently operate a general public drive-through testing facility for a lot of different logistical reasons, the simplest of which is there aren’t that many test kits right now.
I think that when some people say “drive-through testing,” what they’re getting at is anybody can just drive through and get a test like it’s McDonald’s, and that isn’t the way that testing is supposed to work.
The places that people have sited in our region that are doing testing that involves not having to get out of their car, still involves a doctor’s order and an appointment, so really it’s not really different from the testing that doesn’t have the word “drive-through” in the name.
Schrott: The Virginia Department of Health has been listing both the number of people sick with COVID-19 and the number who have been tested. Do we have the number for Alexandria for people who have been tested?
Haering: Not readily, because the amount of work that we’re doing just to keep up with the contact investigations, I don’t have that number readily available.
Fifer: The most understandable, meaningful and objective number is the number of positive cases and those are being reported daily.
Schrott: What is the city doing to predict the curve of the disease in Alexandria? Do you have a prediction for when we will peak?
Haering: That’s definitely not the city’s role to make those predictions. I can tell you that we have not been able to make those predictions either. First of all, that’s very complicated modeling. The Virginia Department of Health is working with UVA and with other academic centers to help model what it will look like in Virginia in terms of what’s called the epi-curve.
The good news is that many of the strategies that we would want in place, or I would say all the strategies that we would want in place, to help flatten that curve are already in place. We’re going to see an increase in the number of positive test results in the coming week, but many of those test results are from things that happened a couple weeks ago, before people started physically distancing themselves, before they started staying at home and quarantining.
Fifer: It’s not necessarily a bell curve, because there’s a part of this that is controlled by the virus and there’s a part of this that individual people can control. For example, if we were to announce that we believe we have reached our apex, and then everybody just goes out again, that curve may not continue to turn down. That curve may go back up.
Haering: That wouldn’t surprise me at all that we would have another spike.
Fifer: Whatever the model is, … it can’t take into account the decisions that every individual makes today and in the future, and I don’t want to seem like we are passing the buck to the public. There is a definitely a role for local, state and federal government to play. There’s a role for public health, but there’s also a role for each individual to play and our message is basically, we each need to control the things we can.
Schrott: On that hierarchy of roles, what is the local government working on right now?
Fifer: From a very practical standpoint, one of the biggest challenges right now is that our city budget, the resources that the city has available … are really based on the economy. And this is a virus that has attacked the economy as much as it has attacked individual people.
We have to reassess where the city budget stands. … We have to pass a balanced budget by the end of this fiscal year and so does the state, so we are reassessing how we are going to allocate our resources when our revenues are going to be much lower than they would otherwise be.
Whatever programs we are coming up with to help businesses or to help individuals all have to be done within a balanced budget, and that’s what we’re working on identifying now. We took some immediate actions that did not require changes to the budget like deferring certain tax payments, making them due later in the year than they would otherwise be. … Other things we’re going to have to do within the context of a balanced budget.
Schrott: Assuming that things keep escalating at the pace that they are going, is there a plan in place for our city to create extra care facilities if Inova Alexandria Hospital runs out of beds?
Haering: What you’re talking about there is medical surge, and that’s something that is constantly under planning. … Inova Alexandria has already, even before the governor’s order that required them to, already stopped all elective surgeries. And therefore, that helped to open up some space.
Then secondly, they are part of a very large system, the Inova Alexandria Hospital, part of Inova Health System, so that they’re able to facilitate their needs and their resources, whether it’s staff or whether it’s equipment or whether it’s beds. And then the next thing, there’s also a regional hospital healthcare coalition … so that the healthcare system, Inova Health System, is not just reliant on themselves, but they’re also able to reach out to the other hospital systems in the network.
Schrott: In New York City, they’re setting up in Central Park, in Maryland they’re going to use a convention center – do we have any plans along those lines in Alexandria specifically?
Haering: I don’t know about the specifics; I do know that the Virginia Department of Health and the Virginia Department of Emergency Management are considering what’s called the alternate care facilities, but I don’t know a whole lot more than that. There is that planning at the very high level. That would be like a contingency plan if what I previously described was not adequately meeting the need.
Schrott: Is there anything that you would like to see the state government pursue more aggressively to address this public health crisis?
Haering: Yeah, I would say to increase the public health infrastructure, and it’s not just Virginia. But I would say at the federal level, if you look at the money that the Centers for Disease Control has gotten over the past 10 years and if you adjust for inflation, it has decreased. And there really is a very, there’s a lot of need for a more enhanced public health infrastructure.