Focus on the most vulnerable and the most at-risk populations
May 7, 2020
Coronavirus testing and outreach should focus on the most vulnerable and the most at-risk populations. A good testing strategy is an essential part of an effective plan to treat the disease and create the conditions for an economic recovery.
Nationwide, we continue to suffer from limited testing. Locally, we’ve tested 3% of Columbia County residents (as of May 7). On April 2, Columbia County announced the plan to purchase more test kits and the shipment arrived in early May. Columbia County should expand testing and focus on the most vulnerable people.
Test the Most At-Risk
[When] more testing becomes available…the next priority is to protect high-risk populations, especially people living in nursing homes, assisted-living facilities, and other settings where infections spread quickly and accelerate a flood of patients in hospital intensive care units.
With limited testing, we need to prioritize people most at risk due to their:
- Symptomatic Individuals - people showing symptoms, particularly those in high-risk populations
- Contacts - People who have been in contact with people who have tested positive should be tested so we can limit the spread.
- Job - First responders, medical workers, and other essential workers come in contact with many people so they are at risk of both contracting the virus and passing it to others.
- Residence - Due to shared space and staffing, the virus can spread quickly through nursing homes, senior living facilities, large apartment complexes, and farmworker housing.
- Health and age factors - People with underlying conditions are more likely to have more serious consequences if they contract the disease.
- Lack of resources - People without primary care physicians have less access to testing and our public health plan needs to address these realities that could otherwise hinder our effective containment of the virus.
New York State Testing Guidance
On April 26, New York State issued testing guidance. The NYS guidelines focus on #1 - #3 of the recommendations I outline above.
Columbia County has issued a questionnaire for people to apply for a test. The questionnaire does not allow people to identify as essential workers other than healthcare workers and first responders.
In early May, there was a large spike in confirmed cases at The Grand at Barnwell. As of May 7, there are 117 residents with confirmed cases as well as over 20 employees. The quick rise of cases demonstrates the importance of testing early before there is cause for alarm. Without preventative measures, coronavirus spreads quickly, especially in at-risk populations. Waiting until there are confirmed cases will lead to large outbreaks.
On May 7, Columbia County announced the distribution of test kits to Whittier Rehabilitation & Skilled Nursing Center and the FASNY Firemen’s Home. This proactive testing is an important step and the county should continue to distribute test kits to vulnerable populations.
Adjust Testing and Community Outreach Based on Results
Where we have confirmed cases, we need to physically separate people so they don’t spread the disease as well as test people with whom they may have come in contact. Columbia County has found alternate housing for people so they could have housing separate from a family member with coronavirus.
If there are trends on who is contracting coronavirus, we need to increase community outreach to that area and also increase testing. For example, if we find that nursing home residents and employees are more likely to contract the disease, we should increase efforts directed to all nursing homes as well as similar institutions such as senior living facilities.
This data is central to understanding injustice and ensuring the optimal health of people, but it is gravely missing in this crisis — missing from health department websites, daily updates by political leaders and, until recently, news reports.
Columbia County and New York State should use demographic data to ensure we are providing effective access to tests and medical treatment.
Prepare for Re-Opening Columbia County
To re-open Columbia County, we need to understand the relative risks of different populations. When the time is right, people with the least risk and the most essential roles can re-open first. Sample testing will need to be done to determine if infection rates are increasing. If they are, then the re-opening will need to be scaled back. If the virus is not spreading, then the re-opening can be increased to the next less vulnerable group.
Re-opening begins by having access to tests and using them as the foundation of a public health strategy. Test the most at-risk, provide treatment, and use the data to inform our next steps.
Time to Care
No matter what we look like, where we live, or what’s in our wallets, getting sick reminds us that we’re all just human. To prevent the spread of coronavirus, everyone must have access to treatment and some way to make ends meet.
For too long, we’ve let a powerful few divide us. They pad their own profits by making life and health a product for sale.
We must rewrite the rules to ensure everyone can access the care we need. This is a moment that we must stand with and for each other across our differences to ensure all of us can care for our families and get and stay healthy.
Learn more about coronavirus response.