Louisiana took its first small step Monday toward loosening restrictions aimed at slowing the spread of the coronavirus, telling medical providers they can resume time-sensitive medical procedures that were put on hold as the number of tests and staff needed to begin reopening the economy came into sharper focus.
Gov. John Bel Edwards said providers could restart some non-emergency procedures on April 27th, a week from Monday. The Louisiana Department of Health had halted elective procedures to help conserve protective equipment and other resources for hospitals facing a surge of coronavirus patients.
“We believe we need to allow people to resume going to the doctor for things that may not be an emergency,” Edwards said.
The move only applies to procedures that are “time-sensitive,” said State Health Officer Jimmy Guidry. Those that can be postponed “without putting the patient at risk” should continue to be delayed, he said.
Still, the order represents the first easing of draconian restrictions in place in Louisiana and across the country to stem the rise of a virus that has killed more than 1,300 people in the state.
Officials believe people are avoiding hospitals out of fear of the coronavirus, Guidry said, and the state is encouraging people to return to providers to get procedures done if they’re essential. He said the state was still reviewing how the order will affect abortion clinics, which Edwards’ administration and Republican Attorney General Jeff Landry’s office have investigated for potentially violating the order to halt elective procedures. Guidry indicated women could receive abortions if they are approaching the deadline at which Louisiana considers the procedure illegal.
The order also applies to providers like dental clinics, but only if providers deem the procedures time-sensitive, such as those done to prevent infections, officials said.
The Louisiana Hospital Association welcomed the reopening of some clinics, after seeing health systems across the state take a hit from the virus. Two of the state’s biggest health systems, Ochsner Medical Center and Our Lady of the Lake Regional Medical Center, have in recent days reported steep financial losses from the virus, stemming in part from the cancellation of elective procedures.
Ochsner expects to lose up to $130 million in March and April after seeing the number of patients across the provider’s hospitals and clinics fall by as much as 70%. On Monday, Our Lady of the Lake said it expects to lose $120 million in March and April, as the nonprofit system cuts hours for certain staff among other steps to fill the holes. The organization received $40 million from the federal stimulus bill.
As the state sees continued improvement in key metrics for the virus, officials are planning for a phased reopening of the state’s economy, vast swaths of which have been shuttered.
For the past week, Louisiana has been trending toward meeting thresholds that the White House recommends states should meet before they start “phase one” of a gradual reopening. Edwards said Monday that means Louisiana is seeing a downward trend in people reporting symptoms similar to COVID-19, confirmed cases and hospitalizations. That doesn’t mean each day must be better than the last, he added, only that the overall trajectory is in the right direction.
The Louisiana Department of Health will brief the governor this week on its own state-specific guidelines for reopening, said Alex Billioux, assistant secretary for the state’s Office of Public Health.
“What we have right now is a White House proposed plan,” Billioux said. “That doesn’t necessarily reflect all of the details that we’re proposing to the governor.”
State officials and health experts say Louisiana not only needs to experience a downward trajectory in cases and hospitalizations in order to reopen. The state is working to get a strong enough handle on the virus to be able to identify new cases and isolate not only the patient, but also those he or she came into contact with, a process known as contact tracing.
To do that, Billioux said the state needs 700 contact tracers on hand to track down those people. The state has only 70 as of Monday, he said.
Louisiana also needs the ability to test at minimum 140,000 people a month, Edwards said. Ideally, the state will be able to test around 200,000 a month, which would represent roughly doubling the state’s current capacity, according to Billioux.
It was not clear Monday when the state would be able to meet those levels of contact tracing and testing, though Billioux said officials were working to have them in place by May.
Courtney Phillips, the new secretary of the Louisiana Department of Health, said the agency is exploring how to best boost its number of contact tracers, suggesting call-center workers could be used for some of the work. The agency has already repurposed some staff to do the work, she added.
Edwards also rejected the idea of having different parishes open up at different times, something Louisiana House Republican Caucus Chairman state Rep. Blake Miguez, R-Erath, urged in a letter to the governor dated Sunday. The governor said the idea was not “workable.”
New Orleans Mayor LaToya Cantrell already has extended a stay-at-home order for the city until mid-May, and said the city would need to see up to three weeks of low numbers of confirmed positive cases before she would lift restrictions. Edwards has repeatedly indicated the state could keep its restrictions in place past May 1, when they’re set to expire.
Along with contact tracing and diagnostic tests, Edwards has repeatedly said serology tests, which may determine whether people have immunity to the virus after recovering from it, is a key part of the state’s strategy to reopen.
In recent days, the prospect of widespread serology testing in the immediate future has appeared grim, as officials report problems with many of the tests being used by commercial labs, which often give false positives.
But Dr. G.E. Ghali, chancellor of LSU Health Sciences Center Shreveport, said the school’s researchers have developed a serology test along with researchers at the Icahn School of Medicine at Mount Sinai Hospital in New York City that could get emergency approval from the federal Food and Drug Administration in the coming days.
Unlike many serology tests that also test positive for other types of coronaviruses, like the common cold, Ghali said the school’s own serology test has a sensitivity and specificity of 99.75% for the novel coronavirus. While there are still unknowns about what the testing offers – such as how much immunity people may get from having antibodies – Ghali said such testing will be key to phasing in a reopening of the economy by determining who may not be at risk of catching the virus again.
“The lower risk populations are probably the ones that can go back to work in early May or mid- May, whenever the governor determines is the appropriate time,” Ghali said. “The whole question is really how to stratify that. Because we’re never going to be fully protected as a society until an immunization or vaccination for this becomes available.”