ATLANTA — The White House Coronavirus Task Force has put Georgia back in the red zone this week.
The report said Georgia’s case rate is more than 101 cases per 100,000 people, and it made several recommendations:
- The silent community spread that precedes and continues throughout surges can only be identified and interrupted through proactive and increased testing and surveillance, as universities have done with frequent (weekly) required testing.
- This approach can be adapted to communities/counties in the orange or red zone with proactive weekly testing of groups from the community (teachers, community college students, county workers, staff in crowded or congregate settings, all hospital personnel, large private sector employers). These cases should be triangulated with cases among long-term care facility (LTCF) staff to identify geographic areas with high numbers of asymptomatic and pre-symptomatic cases, which should then trigger widespread proactive testing and isolation of positive cases among 18-40 year-old community members. These efforts to identify and reduce asymptomatic transmission should run concurrently with testing of symptomatic persons and contact tracing of cases.
- Expanded, strategic use of point-of-care antigen tests with immediate results will be critical to expanding this model into the community; these tests should be used among all individuals independent of symptoms in orange and red counties. Requiring use only in symptomatic individuals is preventing adequate testing and control of the pandemic.
- Antigen tests perform well in the highly infectious window and will be effective in identification of asymptomatic and pre-symptomatic infectious cases.
- Antigen tests do not perform well after 8-10 days post infection when nucleic acid cycle times are greater than 30.
- All antigen results must be reported with both the number of positive results and total tests conducted; positives must be reported as COVID cases.
- Proactive testing must be part of mitigation efforts inclusive of mask wearing, physical distancing, hand hygiene, and immediate isolation, contact tracing, and quarantine. All red and orange counties must begin proactive testing of 18-40 year-old community members.
- Georgia must expand the mitigation efforts statewide as test positivity and cases are increasing. New hospital admissions in Georgia continue to be at a moderate plateau; there must be increased mitigation at the community level. Mitigation efforts should continue to include wearing masks in public; physical distancing; hand hygiene; avoiding or eliminating the opportunities for mask-less crowding in public, including bars, and eliminating all social gatherings beyond the immediate household; and ensuring flu immunizations.
- We need to protect those we are thankful for in our families and communities. Ensure indoor masking around vulnerable family members during any gatherings due to the significant amount of virus circulating and the high rate of asymptomatic and undiagnosed infections among family and community members.
- Georgia needs to evaluate all its PPE reporting from hospitals, as there appears to be a significant issue with supply.
- Unrelenting and significant community spread is initiated by social gatherings among friends and family. People must remember that seemingly uninfected family members and friends may be infected but asymptomatic. Exposure to asymptomatic cases can easily lead to spread as people unmask in private gatherings.
- Ensure university students continue their mitigation behaviors to prevent further outbreaks on or off campus; ensure appropriate testing and behavior change in the 10 days prior to departure to hometowns for the holiday season.
- Ensure all nursing homes, assisted living, and elderly care sites have full testing capacity and are isolating positive staff and residents. There continue to be high levels of positive LTCF staff members, indicating continued and unmitigated community spread in these geographic locations.
- Specific, detailed guidance on community mitigation measures can be found on the CDC website.
A microbiologist who keeps a close eye on Georgia’s trends said the recommendation about surveillance testing jumped out to her.
“Georgia has been below the national average for testing per population since the beginning and that gap is widening,” said Dr. Amber Schmidtke. “It doesn’t paint a complete picture because Georgia is now relying a lot on that antigen test.”
Schmidkte told Channel 2′s Mike Petchenik testing of 18 to 40 year-olds, K-12 and college students, prison inmates and people living in long-term care facilities is key to finding people with asymptomatic spread.
“As the disease increases in an area we expand the testing to try to identify all those cases both for surveillance purposes but also through contact trace investigation.”
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Petchenik spoke to a Gwinnett County man who was getting tested proactively in Sandy Springs before taking an anniversary trip with his wife.
“We’re here today to have our testing done to ensure we can have our trip,” said Ashwin Patel. “This is my second one today. We’re taking extra precautions to make sure we get it in that three day time period.”
Patel said he supports the idea of more testing to stop the spread.
“How they’re doing it or requiring people to do it, that’s a different story,” he said.
Department of Health spokesman, Nancy Nydam, told Petchenik the state has no plans to conduct widespread surveillance in schools. She sent Petchenik a response:
"There are many considerations that go into surveillance testing for schools. Not all schools have the staff resources and training to do surveillance testing. There are legal considerations such as who will administer the tests, how tests will be paid for, and how results will be reported. Schools would also need to obtain a CLIA waiver (CLIA is the program that ensures quality laboratory testing) to do antigen testing with the BinaxNOW cards, for example.
"Antigen tests are most reliable when used for individuals who are symptomatic. There are reliability issues with antigen testing, particularly with false negatives.
"There are things schools can do to protect students and staff and that includes wearing masks, social distancing throughout the school, encouraging frequent handwashing and use of hand sanitizers, promoting respiratory hygiene, disinfection of facilities, classrooms and high-touch surfaces, and reinforcing the need for those who are sick to stay home.
“The CDC does not have evidence or guidance that indicates surveillance testing in schools provides any additional reduction in virus transmission over other less costly mitigation strategies like those mentioned above.”