The federal Centers for Disease Control and Prevention says that any American with a doctor's note can now be tested for COVID-19, the illness caused by the novel coronavirus. But in Rhode Island, so far state health officials have only tested about 45 people. To find out why, health reporter Lynn Arditi spoke with Dr. Jeremiah Schuur, chief of emergency medicine at Lifespan, the state's largest hospital system.



Lynn Arditi: So in Rhode Island, we've as you know, we've had three people [the number has risen to 5 since this conversation was recorded] who tested positive for COVID-19. And state health officials say that so far, we tested about 45 people for the virus. These numbers sound small. In Massachusetts, as of last weekend, they reported 28 people tested positive. Is there a reason to think there are people in Rhode Island who have the virus, but we just don't know it?

Dr. Jeremiah Schuur:  I think it's definitely a possibility. The  thing I would say to our listeners is, I don't think there's any reason for the public to be panicked. We're testing everyone in whom there's a clinical reason that they need it for their care. So people who are sick, who are at risk are getting tested. The gap is the amount of testing we would need to do to determine if there is community spread….We can’t say that reliably about Rhode Island right now because we haven’t been doing enough testing because the tests have not been available from the CDC.

Arditi: The CDC last week, as you know, expanded the criteria which would allow you and other clinicians to decide who should be tested for COVID-19. But as you know, Rhode Island has not expanded this testing. We're not doing what's known as the surveillance testing or community wide testing. And at what point should we maybe consider trying to do that?

Schuur: I think we should do it when we have the tests available. I want to be clear that there has been very clear communication between the clinicians at the front line, hospital infection control experts and the State Department of Health on all of the cases that we've been involved in, and whether or not we should initiate testing, and if it makes sense for the patient to be quarantined. But as you point out, if we've, as a state only done around 45 tests, there are likely more patients who we might do testing to determine if there has been secondary or tertiary spread.

Arditi:  Why couldn’t Rhode Island just call and say we want an extra kit, we want to ramp up testing? What's the bottleneck?

Schuur: The federal government controls diagnostic tests and what can be approved. And it was only a couple weeks ago that they loosened the restrictions on making new diagnostic tests. And now companies and health systems are working on trying to create new tests. So for most health systems the only tests that are available are those that are through the CDC, to the Department of Health. And so there's just a limited supply available to all of the states.

Arditi: Dr. Schuur, you've been talking a lot about the fact that the SARS epidemic has some lessons for us. What lessons can we take from what happened with the SARS epidemic?

Schuur: I think we can learn a lot about how a novel virus like this will affect patients in the healthcare system, and the healthcare system. And so just to the north, in Canada, there were a couple of outbreaks of SARS. And close to 500 people got ill. And what we know is the majority of those individuals had some contact with the hospital. And that there were health care providers who got very ill and there were two nurses and a physician who died. And so it's why we've been really thinking ahead about the hospital system's preparedness, making sure that the staff are trained, that we have the protocols to protect them. And then thinking about what we do if this spreads further so that we have enough critical care beds, and it's the motivation for things like limiting visitors to the hospital. Because out in the community the risk is rather low. But as patients get sick, they will get to the hospital,so that is the place where there's the greatest likelihood of transmission.

Arditi: Do hospitals in Rhode Island currently have enough of the kind of equipment that your clinicians would need --  the N-95 ventilator masks and other protective gear that would be needed -- if the virus did suddenly ramp up and we were aware of community spread, something similar to what's happening in Massachusetts or, God forbid Washington State?

Schuur: I can't speak for all of the health systems. Lifespan's very well prepared. We've been having regular meetings daily for several weeks and part of that is reviewing the stockpiles and supplies and we have what is needed to provide the appropriate care to patients coming in. We will continue to watch that and we'll need to adjust if there is wider spread of this. 

Since this interview was recorded, two more people in Rhode Island have tested positive for the coronavirus, bringing the total to 5.