Austin-Travis County Medical Director Dr. Mark Escott said the state lab in Austin, which serves the 20-county Central Texas region, can only test 10-25 potential cases per day. Escott emphasized the limited resources need to be used wisely.
“The reality is, there’s not enough tests to test all of those people,” Escott said in a March 10 briefing to the Travis County Commissioners Court. He said health officials are determining which cases to test based on risk and working to ensure medical resources do not get overstressed.
“As we know, the vast majority of people who will get this infection have a mild illness; they don’t need to be in the hospital; they probably don’t ever need to see a hospital,” Escott said. He said most people who get the illness should treat it like the flu. “The vast majority of people who get the flu don’t need to see a hospital. The vast majority of people who will get COVID-19 do not need a hospital either.”
Escott said local and state health officials are prioritizing testing for vulnerable patients—those who would likely experience complications if they acquired the virus, especially those already hospitalized or stationed in nursing homes. For already hospitalized patients, Escott said, testing is vital to inform hospital staff whether an isolation bed and extra measures to prevent spread of the virus are needed.
Area hospitals and clinics do have the ability to swab patients who present symptoms, Escott said. The swabs are then sent to the state lab for analysis. Guidelines issued by Texas Health and Human Services state all swab submissions must be preapproved by the local public health entity—Austin Public Health, in Travis County’s instance.
To gain preapproval, an individual may need to meet certain criteria in addition to presenting upper respiratory symptoms, as cited by U.S. Centers for Disease Control and Prevention, including close contact with a COVID-19-positive patient within 14 days and recent travel to highly affected geographic areas, including China, Iran, Italy, Japan and South Korea.
Young and generally healthy individuals with mild symptoms are less likely to be tested, Escott said during a March 10 Austin City Council meeting. Without a course of treatment, he said that a positive test would do little to help those individuals; instead, they should practice ordinary health measures such as avoiding work and public places when experiencing cold or flu-like symptoms.
“At some stage, testing mild cases may not be necessary because it’s not going to change what we do,” Escott said. “At least at this stage, we have no specified treatment plan for this. It’s important right now to contain it, but once that’s breached the testing may not be as relevant unless people are hospitalized.”
Escott told City Council he expects the state’s testing capacity to increase soon, but right now resources need to be hyperfocused on the most vulnerable populations.
“I do want to offer the option of testing to those folks who want to be tested, but right now, at least for the foreseeable future, we’re still going to have to triage and prioritize those folks who are hospitalized so we can differentiate those who need the isolation and those who don’t,” Escott said.
Escott said the illness has had the highest impact on older populations and those with deficient immune systems; however, he said the coronavirus, though it induces some illness, is not as deadly to the wider population.
“When we get to the vast majority of people getting sick, that [fatality rate] is probably close to 0.2 to 0.4%,” Escott said. “This is not Ebola, where everybody gets critically ill and a significant number die. This is not that. This is not as bad as ... MERS or SARS. But if it gets in the wrong places, it will be impactful. If it gets into nursing homes, assisted-living facilities, it could be devastating for those facilities. If it gets into hospitals in an uncontrolled fashion, where there’s already people suffering from illness or injury, it could be devastating. That’s why we’re taking steps right now to secure those facilities.”
