Testing, Testing, 123- The Basics from Community Level

Karanja A. Ajanaku, Tri-State Defender
Dr. Reginique Green (Courtesy photo)

Dr. Reginique Green of Christ Community Health Services, Inc. openly values the flow of solid COVID-19 information, thinking that “we haven’t seen the worst of it” and knowing that “some people are still not believers.”

Models projecting how many people could die in Shelby County have included the mind-boggling total of 20,000 to far, far less yet still numbing figures. The date and extent of the projected surge also has varied, with the City of Memphis now reportedly looking at April 15 as the peak date for the coronavirus here.

That’s according to a model that suggests the peak gets here before it was projected earlier and that area hospitals would not be pushed beyond capacity. In conjunction with stay-at-home orders, frequent hand-washing and social distancing, testing is a huge part of the projection and preparation.

Testing 1,000 a people a day is the goal of the Memphis-Shelby County COVID-19 Task Force, whose mission includes putting together a testing strategy that makes more testing available to so-called vulnerable populations and under-served.

Green serves on the COVID-19 Task Force and is one of two people now handling coronavirus testing for Christ Community Health Services, Inc. (CCHS), one of the first to do so in Shelby County. Testing there is by appointment only, with Green adding that restriction is administered liberally.

“It is only by appointment because we want to create social distancing. We want to control the environment. We don’t want any densely populated areas. People are staying in their cars,” she said.

Signs of the time. (Photo: Karanja A. Ajanaku)

On Monday, CCHS increased its daily COVID-19 testing capacity to 200, up from 50 to 75.

“You lower your window and there’s very minimum chance of you contaminating or infecting anybody else, if you’re actually positive,” said Green, a graduate of Xavier University (undergrad) and Creighton University in Nebraska. “In order to be tested, you are screened and chances are you would be more likely to be positive than negative if you’re being screened.”

The test is serious business.

“So, you do have to stick a very, very tiny swab, much smaller than any Q-tip, 10 times smaller than a Q-tip in their nose, but you have to go all the way back to the back of their throat, what we call the pharynx. Folks call it nasal pharyngeal flap.”

Green said the nose route provides “a much better sampling.” Accounting for weekends and lab delays, results are being returned in 24 to 48 hours. Timing is essential in testing.

“What we’re trying to do is buy time until we have a cure or an immunization to give people. Really, were trying to quarantine everybody, but once you find someone who is truly having the disease, you don’t want to quarantine them, you want to isolate them.”

Quarantine involves taking a healthy person out of circulation so they don’t mix in the population and give or get the disease. If doctors suspect you have it, they’ll sometimes order medical quarantine, with calls to patients to check on their status. You can also self-quarantine for a variety of reasons, including when temperature readings suggest difficulty.

“But once you are truly positive for COVID-19, that is isolation,” said Green. “Isolation is when an unhealthy person stays away from healthy people. You would need to isolate even from the people in your home by wearing a mask and having something called a sickroom and wiping down all common surfaces.”

Severe cases can develop into pneumonia or respiratory failure, requiring ventilators and hospitalization.

CCHS started testing on March 21.

“We just felt like we needed to…. We bring quality healthcare to the underserved, under-resourced. We want to be sure that everybody has a right to healthcare…. When this happened and we couldn’t get the testing vials because of the limitations, we were like, ‘Oh, my gosh. The entire City of Memphis is under-resourced.’”

They designated 50 of the about 200 vials on hand for testing, “just believing in God that He was going to replace it and bring increase to us.”

Local protocol is to follow CDC guidelines for testing, with the priority being for hospitalized patients.

“The second priority now is actually healthcare workers with symptoms. But the problem has been the criteria,” Green said. “The screening criteria to have the test has been pretty high and we know that we were missing some people….

“Because of the scarcity of supplies – provider protective equipment, the gowns, the gloves, the mask, the shield and the types of vials that we needed to use to test – that is why we kept the criteria higher.”

After a day of testing by appointment at the CCHS location on Third St. (Photo: Karanja A. Ajanaku)

None tested by CCHS had died at the time of this interview. Green said some were hospitalized and “currently fighting for their lives. …

“I’ve always been a crier, and last night I cried just to release…. We take an oath to forestall death and it’s always hard to lose that battle…. It’s hard to lose one life, but when you just see about 300 people dying a day across the country in a different city, it’s overwhelming. It’s overwhelming!”

There is no one the CCHS will turn away, said Green. And if you don’t have a car to make use of drive-thru testing (by appointment), you can still be served.

“If you text Test2020 to 91999 and speak with the nurses…and say that you do not have a car and that you’re concerned, then we have social workers and we will make special arrangements for you. The drive-thru testing is just the safest because you keep your window rolled up until it’s time for the test. We put your paperwork on your windshield. It just provides the safest environment to practice social distancing.”

Since CCHS transitioned to testing with nasal pharyngeal swabs, Green and Dr. Ben Andrews have been doing the testing at the Third St. location. The goal is to identify others well-trained to do so and increase testing capacity, making it available in other much-needed areas of the city.

For frontline responders such as Green, doing their jobs is a labor of love performed mindful of their own families. She has four teenaged children and her parents are in their 80s.

“I bring my parents groceries. They have not left their home. I leave them on the porch. My mom and I talk through her window. I chat with her on the phone, but we can look at each other, because it’s through the window and it’s just because I’m in such a high-risk situation.”

As a member of the three-pronged COVID-19 Task Force, Green coordinates closely with the community group, which includes federally qualified health centers. Members have been meeting twice a week, working to develop strategies and plans to increase testing sites and access to testing throughout the city.

“I want you to know Memphis has a robust medical community, more resources than a lot of cities that I’ve ever lived in or known about,” she said.

Green is among those who have been working seven days a week. She took off Sunday and plans to do so on Good Friday.

“Our testing center is going to be closed and we’re going to just pray for Memphis at Christ Community.”

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