Louisiana officials hope to use an extra two weeks of a stay-at-home order to ramp up coronavirus testing, a key weapon in the fight to slow the virus’s spread amid a phased reopening, as the federal government pledges 200,000 tests that would boost capacity to the level Gov. John Bel Edwards has called for to start loosening restrictions.
And officials say they plan to change their strategy for stemming deadly outbreaks at places like nursing homes and prisons by conducting mass testing of asymptomatic residents. That move comes as the U.S. Centers for Disease Control added to the list of people prioritized for tests those with no symptoms but who live in high-risk settings.
Louisiana has expanded access to testing from the early days of the outbreak here, where testing was scarce and leaders were flying mostly blind in the midst of the pandemic. Still, experts say the state needs to continue to ramp up its ability to test people, something that will become crucial for the state to start reopening responsibly by closely tracking new infections and the people they come into contact with to isolate them.
Dr. Alex Billioux, assistant secretary of the state’s Office of Public Health, said state and federal health experts now believe it is useful to test asymptomatic people at places like nursing homes, long-term adult care facilities and prisons, where outbreaks have proliferated with deadly results across the state.
Billioux said “significant numbers” of people who don’t have symptoms are actively shedding the virus, meaning they are contagious, and that is most concerning in places like nursing homes where vulnerable people live in close proximity to one another. He said officials now believe it is helpful to test those people, after weeks of limiting tests to mostly those showing symptoms.
“While we are excited and grateful there will be testing resources coming to the state, 200,000 is still not enough to test 4.7 million Louisianans,” Billioux said. “We still need to be thinking about who is a priority for testing, especially that the most vulnerable individuals to COVID-19 get as much testing as possible."
Testing of asymptomatic people has already started at some nursing homes that have gone ahead with mass testing on their own, Billioux said. And the Louisiana Correctional Institute for Women tested asymptomatic inmates after an explosion of cases there and found 116 were positive, according to the Department of Corrections.
Until recently, officials have largely said they did not recommend mass testing of asymptomatic people. Dr. Catherine O’Neal, an infectious disease specialist at Our Lady of the Lake Regional Medical Center, said it is still true that testing asymptomatic people who don’t live in nursing homes or prisons can backfire. That’s because people may get a negative test the day before they start shedding virus, and believe that they aren’t infected. That false assurance could cause them to spread the virus unknowingly.
O’Neal was among the health experts advising Edwards Sunday on whether to extend the state’s stay-at-home order or lift it May 1. After O’Neal and other health experts agreed the numbers of new cases and hospitalizations weren’t falling adequately in several regions of the state, Edwards extended the order until May 15.
“We felt strongly that without widespread testing and contact tracing, and with three regions that are seeing increasing cases, we may not be in the best place to lift the stay at home order,” O’Neal said.
Health experts also said the state needs to boost its testing abilities and the number of contact tracers at its disposal to begin safely reopening. Edwards said the state will soon get a weekly allocation from the CDC of testing materials like swabs and transport fluid to get the state to 200,000 tests, which is the level he has said is ideal to start reopening.
“I don’t think we’re there yet,” Dr. Susanne Straif-Bourgeois, another expert who advised Edwards Sunday, said of the state’s testing abilities.
In the meantime, the state should also be boosting its cache of personal protective equipment for health care workers and first responders, said Straif-Bourgeois, a former official at the Louisiana Department of Health who is now at LSU Health Sciences Center New Orleans.
While data looks promising in the New Orleans region, Straif-Bourgeois said other regions that were hit later with the virus need to see steeper drop-offs in cases and hospitalizations. She also warned that opening on a parish-by-parish basis could cause the virus to make a resurgence, especially if people from a current hotspot travel to a city that has reopened.
Some Republican lawmakers have questioned why Edwards is not reopening on a regional or parish basis, and business groups have criticized his move to extend the stay-at-home order.
O’Neal, of the Lake, also said testing access varies across the state. Some parishes with less than 100 tests likely don’t have adequate access. And low-income people in urban centers also struggle with access, part of the reason East Baton Rouge Parish recently opened a community testing site at Our Lady of the Lake’s North Campus, near predominantly black and low-income neighborhoods in Baton Rouge.
“I think if we can get an influx of tests that allows us to cover areas where we aren’t testing well and improve that in areas we are testing,” the state will be in a good position to start to reopen May 16, O’Neal said.