For two years, Dr. Cort Lohff has been directing the Southern Nevada Health District’s preventive medicine program. In mid-March, like many in his line of work, he was pulled into the COVID-19 response, and in mid-June he became the district’s acting chief medical officer. Unlike the chief health officer, who’s got broader responsibilities for overseeing the agency, the medical officer focuses on clinical operations and, in the current situation, the medical aspects of the pandemic response. So, he thinks a lot about testing and the role it plays in stopping the disease’s spread. When we asked him about testing in Clark County, he said people who suspect they have it should still get tested, despite delays in getting results.
There’s been a lot of back and forth in the media about the best approach to testing lately. What’s the current thinking on that as you understand it?
The right approach really depends on how many test kits are available and what the capacity is of labs to run those tests. When you have a lot of testing available — test kits, staff to collect and process them, lab capacity to run the tests, and so on — then, certainly, everybody who wants a test should get one. But when you’re in an environment where it’s limited … whether because of supply or staff or lab capacity, then you want to try to target those tests to certain groups of people.
And what’s the case here? Who should be tested?
Certainly folks who are symptomatic, but also those who’ve had contact with known cases — to see if they develop symptoms, and if they do, whether it is COVID — and then folks who are potentially at high-risk for complications. That includes folks in congregate settings, like nursing homes and prisons.
And that’s currently the local approach?
Well, I wouldn’t necessarily say that. There are a lot of partners out there doing testing, and each may have their own way to go about it. With the health district, we are offering testing to anybody who wants to get tested, whereas other places, for example UMC, might want to do a more targeted approach. Neither one of those approaches is wrong; it’s just that people have different views on how to approach it and different resources.
So as far as Clark County goes, since that’s the area your agency serves, what are its resources?
I can talk a little about the testing we are currently doing. We have two sites where we’re offering testing to anybody in the community: (1) At the health district’s main office on Valley View; and (2) at All Saints Episcopal Church. Both of those are free of charge, done on an appointment basis, Monday through Friday. Between the two, we’re doing a few hundred tests per day.
Then we also are doing targeted testing at long-term care facilities, among homeless populations, and in some other high-risk congregate settings, and all those samples are sent to our public health lab, where they actually conduct the test and report the results out.
So you’re not relying on private labs?
To run the test, no, not for the specimens we collect.
Are your results faster than private labs?
There are delays here in getting the tests run and reporting the results also. I can’t tell you the current number of days, but we’re having the same issues in getting those results back quickly as other places are having.
(Anecdotally, a loved one of the author was recently tested and got results in five days.)
Why? What’s causing these delays?
Part of it has to do with supply and demand. There are a lot of folks who want to get tested, but we don’t have the full capacity to run those tests on a timely basis, so we have a significant backlog. And, of course, you continue to have more collections being done, so that just contributes to the problem.
What’s the backlog right now?
I couldn’t tell you. (A health district spokeswoman said the number is constantly fluctuating.)
Obviously, widespread testing wouldn’t be necessary if the disease weren’t spreading to begin with, which would require a massive prevention effort. What has the health district done in that regard?
I would agree that prevention is key. What we’re trying to do is make guidance and resources available on our website, and educate the public about what those measures are. We’re working with partners in our community to help them understand prevention measures and help them incorporate them into daily practices.
Schools, correctional facilities, long-term care centers.
School is supposed to start soon. Will widespread, regular testing at schools be feasible?
Because of the sheer number of students, faculty, and staff in CCSD, it is unrealistic to expect to be able to test all of them with some sort of frequency. I think that the better measure is to make sure there are appropriate prevention plans in place to help avoid introduction of the virus, along with mitigation plans to enact immediately if it is found in a school.
If prevention precedes testing, then contact tracing is what comes after it in the overall response scheme. What’s the difference between contact tracing and disease investigation?
Disease investigation is interviewing a person who has the disease, and they either could have tested positive or have symptoms or both. In those situations, you’re trying to understand factors that might have contributed to their being infected. You’re giving them instructions for what to do to prevent further transmission of the disease and identifying their close contacts, meaning people they might have exposed to the virus or transmitted the disease to.
Contact tracing picks up on that last step where, once you’ve identified the close contacts, then you’re contacting them and giving them recommendations to prevent them from transmitting it to others, including being in quarantine for 14 days. You’re also letting them know signs and symptoms as well as instruction on what to do if any of those signs appear.
NPR reported this morning that the country has around a tenth of the contact tracing it needs to really control the virus’ spread. What’s our capacity locally?
Because we’ve had such a spike of cases in the last several weeks, much like with lab testing, we have a backlog of investigations to complete, as well, but we have been fortunate to get additional resources to create more positions for both disease investigators and contact tracers. So, we’re constantly bringing on new people to support those efforts.
How many do you have currently?
I don’t have the exact number, because they come from different funding sources, but I’d say, ballpark, several hundred. (The health district spokeswoman confirmed that, between their staff and Deloitte contractors, there are currently 400 disease investigators and contact tracers. Another 100 call-center disease investigators and 80 short-term contact tracers are in the process of coming on board.)
Prevention, testing, contact tracing — what’s the most important piece in tamping down the pandemic?
I think all those efforts individually and collectively are important. One isn’t more important than the other. But, certainly, contact tracing is helpful, because you’re focusing your efforts on people who are at the greatest risk of exposure and therefore infection. So, the more you can focus your efforts on that, making sure all the contacts are notified and go into quarantine, the more effective your strategy will be overall. Because you’re targeting people who are known to be at-risk, it’s a good use of limited resources.
We’ve seen this with contact tracing with other diseases and conditions. Any time we diagnose someone with a sexually transmitted disease, for instance, we work to identify their sexual contacts and make sure they’re notified, and come in for testing, evaluation, and treatment, if needed, because it’s a very targeted way to mitigate the spread.
What’s big-picture takeaway for people here?
Continue to practice good behaviors: social distancing, wearing a mask, staying home if you’re sick, practicing good hand-washing hygiene. If we all employed these simple practices, we could help mitigate the spread. And then — recognizing that, given the current capacity, it may take several days for results to come back, and if you have symptoms you will need to remain isolated during that time — when testing is available, get tested, because the more cases we identify through testing, the more we can implement measures to mitigate the spread.