For this doctor, moving forward means more testing

As health professionals survey the landscape now that COVID-19 hospitalizations are trending down, many see what must happen next before any kind of new normalcy can return: a lot more testing.

“Three things have to happen,” said Lawrence Shulman, chief medical officer for ProHealth, which operates a walk-in clinic and a COVID-19 testing site in Riverhead. “We have to test for the virus itself. This will make sure people who are positive are not going to places where they will infect other people. 

“This has to be combined with antibody testing,” he said, which will show if a person has been exposed to the coronavirus. “And the third point is contact tracing, to see who has been exposed by an infected person.”

As experts regionally and statewide have said, this kind of aggressive testing must occur before schools can reopen and businesses can operate on a normal schedule with normal customer capacities.

Numbers released Friday by Gov. Andrew Cuomo showed that 216 persons had died of the virus on Thursday, a rate that has been falling in recent weeks, as have hospitalizations. According to Northwell Health, its 19 hospitals had 1,203 COVID-19 inpatients as of Friday, down 64% from a month ago.

Meanwhile, because demand has fallen, Stony Brook University closed the satellite testing facility it set up in a parking lot at the university. Overall since it opened last month, the facility tested 2,600 people.

ProHealth’s Riverhead facility remains open for testing. Dr. Shulman said an average of about 1,000 persons a week have been tested at ProHealth’s 29 urgent care centers, including Riverhead, which opened on March 31. At all the urgent care sites, he said, approximately 37,000 tests have been performed.

In theory, he said, anyone should be able to get a COVID-19 test, as that will help with contact tracing if someone tests positive. But, he cautioned, just having the test and finding you are negative does not give that person much information except, perhaps, peace of mind. It’s those who test positive that, with contact tracing, allows experts to keep track of where the virus is and how concentrated.

“The caveat is: What do you do with the results?” Dr. Shulman said. “We are open to ProHealth patients and non-patients with symptoms or without symptoms.”

He said he recently saw a family of five who all had COVID-19 symptoms. Nasal swabs confirmed they were all negative. However, antibody testing showed they were positive, meaning they had been exposed to the virus and now have some level of immunity. 

“But what do they do now with that information?” he said. “Can they go out to dinner, if restaurants were open? They could still touch a doorknob that someone with the virus touched, and they can still transfer that virus to someone else.”

Moving forward, Dr. Shulman said his best guess for how to proceed back to a new normal is social distancing, which, for schools, will mean fewer students in classrooms. How to do that, he said, will be difficult and will likely involve rethinking class schedules to reduce the numbers of students in the building at any one time.

“The good point is that school age kids are well protected,” he said. “Under the age of 50, the mortality rate is very low. But you worry about the teachers and administrators and janitors, as they will be older and could have underlying issues like diabetes.”