UAMS, the Arkansas Department of Health and others are ramping up their COVID-19 testing capabilities, but a shortage of testing swabs is creating bottleneck in the process, members of the city of Little Rock’s COVID-19 Task Force discussed Wednesday afternoon. The swab shortage is a national problem.
Dr. Steppe Mette, UAMS Medical Center CEO and a task force member, said that UAMS expected to be up and running with its in-house developed test early next week and has received one testing machine and expects to get two more next week. He said by the end of next week UAMS would have the capacity to perform more than 600 tests per day.
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Dr. Naveen Patil, the medical director for infectious disease at the Arkansas Department of Health, said ADH could perform 160 tests per day and may be able to increase capacity to 200 soon.
Members of the task force reported that Natural State Laboratories in North Little Rock said it would receive 4,000 testing kits Thursday. Task force members planned to co-ordinate with Natural State.
Mette said UAMS was working on developing a testing process that didn’t involve swabs.
Last week, the task force tentatively planned to move forward on establishing the southwest campus of Baptist Health as a centralized screening and operations center to manage Little Rock’s response to the pandemic. Greg Crain, president of Baptist Health and a task force member, said a number of issues still needed to be worked out, including the lack of swabs, staffing the facility, securing a medical director, staffing security, getting a MEMS unit on-site and developing signage.
The task force spent much of the meeting discussing how to deal with strain on their infrastructure.
“We’re starting to run into severe resource limitations — space, personnel and equipment,” Mette said of UAMS. He said patients from around the state were traveling to UAMS. He said the number of people UAMS had screened had doubled each of the last four days.
“We all have to share the burden equally the best we can,” Little Rock Director Dr. Dean Kumpuris, a gastroenterologist who chairs the task force, said. That’s why the mayor formed the task force, he said.
The task force asked city staff to create one 1-800 telephone number for patients in the Little Rock area who are concerned they have contracted the coronavirus to call to be pre-screened. The task force discussed allowing callers to pick their preferred hospital from a menu or having a “first available” option.
“We’ve now gone in a week from having inability to test to the ability to test, and we’re now going to get the opposite effect where everybody in the world who has sore throat and flu thinks they need to be tested,” Kumpuris said.
Officials repeatedly stressed that people who are concerned that they have symptoms call a hospital to be pre-screened before they show up for a drive-thru screening.
Dr. Amanda Novack, an infectious disease specialist with Baptist Health and a task force member, emphasized the message people needed to understand about screening centers.
“There has to be the expectation set,” she said. “This is not Sonic. You can’t just drive up and be tested.”
But UAMS’ Steppe acknowledged the reality: “People are going to show up no matter what.”
He said at UAMS about 30 percent of those who were pre-screened online or on the phone were directed to come to UAMS’ drive-thru to be screened further. Of those, about 30 percent were tested, and of those 12 to 15 tested positive. UAMS has had five patients test positive since March 16. Mette said four of those had minimal symptoms but “pretty convincing contacts.” The fifth patient was sick enough to be admitted, but was discharged after 24 hours. He said the patient had “medical sophistication.” He said the levels of screening work well if people will follow the process.
The task force is working to develop an algorithm (or checklist of sorts) that all hospitals use to determine when to screen patients.
Jon Swanson, executive director of MEMS, brought up a concern for the future.
“EMS is sometimes abused [by patients] with the assumption that if you come by ambulance you can get to the front of the queue in the hospital process. But we are looking at, down the road, an important change in our paradigm,” he said. “Right now, because of Health Department rules and our liability, every paramedic is taught to encourage a patient to go to the hospital. … We realize that we’re going to quickly into another stage of this and recommend that a patient doesn’t need to go to the hospital, and ultimately we’re going to get to the point where we’re have to refuse to take the patient to the hospital because they don’t meet the criteria.”
He said of course that scenario wouldn’t include serious health conditions.
The task force plans to meet again next week.