While the COVID-19 crisis continues to strain resources at health care facilities throughout Mississippi, policy changes in the way the state lab is handling testing has caused widespread confusion about the accuracy of the case numbers being reported – especially here in the Pine Belt where delayed, conflicting and often incomplete information is being provided to the public.
One source in local government described the local reporting process as “a noble effort, but wildly inaccurate.”
As of Tuesday, the Mississippi State Department of Health reported 1,073 total confirmed cases in the state – including 27 in Forrest County and six in Lamar County.
There have been 22 statewide deaths attributed to the virus so far, but none locally.
The number of total confirmed cases per 100,000 residents is higher in Mississippi than many nearby states, except for Louisiana, which has the third-highest average rate in the country behind New York and New Jersey.
With the number of cases continuing to climb nationwide, testing kits are now in short supply, and the labs responsible for providing test results are backlogged with untested samples.
According to data posted on a joint website hosted by Forrest General Hospital and Hattiesburg Clinic, there were 464 pending tests as of 4 p.m. on Tuesday, March 30; however, those numbers are not exclusive to Forrest County and instead include data from Forrest Health’s 19-county service area.
No local numbers have been provided by hospital officials in more than a week after The PineBelt NEWS questioned conflicting numbers being distributed by Forrest General and Hattiesburg Clinic.
Merit Health Wesley, which also is conducting tests for the coronavirus, has not publicly released any testing data, but a spokesperson for the hospital told The PineBelt NEWS on Wednesday they are providing those numbers directly to city officials.
Forrest Health officials have acknowledged that testing remains difficult due to an insufficient supply of testing kits, but new kits from different companies are expected to be available soon.
The hospital is also anticipating the ability to do on-site tests within the next 3-4 weeks.
When asked if he had confidence in local testing results – both pending and confirmed – Hattiesburg Mayor Toby Barker acknowledged there have been a lot of moving parts and that “trying to combine effort and reporting methodologies was bound to create some growing pains,” but said he believes the local medical community leadership is doing everything they can to report accurate numbers and fix them when errors are spotted.
“We have seen unbelievable cooperation and teamwork from both hospitals and our clinic,” said Barker. “Establishing a specialized Cough and Fever Clinic to screen and test within 72 hours of the first case was a great testament to innovative work from both Forrest General Hospital and Hattiesburg Clinic; so was the implementation of curbside testing some 10 days later.”
At the Cough & Fever Clinic, a COVID-19 testing site operated by both Forrest General and Hattiesburg Clinic, tests have been sent to the Mississippi State Department of Health lab in Jackson, but also to private labs to be processed, according to Kristy Gould, chief corporate planning and development officer at Hattiesburg Clinic.
“Our goal is to work with the medical laboratories to get results back as quickly and efficiently as we can so we can communicate those results to the concerned patients who have been tested,” said Gould.
Two sources who work in administrative positions at regional medical centers in south Mississippi told The PineBelt NEWS that the turnaround time for test results is “four days at best” and “five to six days on average ... despite reports otherwise from the state lab.”
According to the sources, who reached out to The PineBelt NEWS on condition of anonymity, said private labs are “not taking on a substantial amount of testing ... but even the people involved couldn’t verify how much.”
As of last week, the state health department lab is working from 6 a.m. until 9 p.m. on weekdays and 12-4 p.m. on weekends. The sources said the state lab is “looking into an evening shift” and that private labs “are not going to be able to take up the slack.”
On Tuesday, March 24, the state lab sent a memo to all hospitals, physicians, and health care providers across the state informing them that testing will no longer be available for outpatient services such as the Cough & Fever Clinic in Hattiesburg.
The state lab will only process results from hospital inpatient care, emergency rooms, nursing homes and health care workers, according to the memo.
All outpatient tests must now go through private labs, “which we have almost no information on and are backlogged as well,” said the sources.
The state lab backlog causes a unique set of challenges for hospitals, according to the sources.
“(Hospitalized) patients with symptoms are in isolation/quarantine until their results come in. This means that full (personal protective equipment) is donned each time the patient is seen by each provider. Since they are in there for up to a week before knowing their results, this is causing a shortage of PPE, and most of the people in isolation are not even COVID positive,” said the sources.
The sources said hospital beds are generally tied up with isolated patients.
“Specifically, dialysis patients cannot do outpatient dialysis if they are tested and awaiting results due to contamination concerns in those clinics. The drain of keeping a dialysis patient inpatient awaiting for results is incredible. (The) vast majority of these patients are COVID negative,” said the sources, who added that “negative results more quickly would save a ton of resources.”
When asked about the existence of the memo and how it may have affected initial reporting data, officials from both Forrest General and Hattiesburg Clinic declined to comment.
Gould said Hattiesburg Clinic was “currently discussing lab testing with other organizations who can provide quality, safe and efficient testing for our patients.”
According to the Forrest General website, “other patients who have symptoms that may be consistent with COVID-19 ... are being sent home for home quarantine, and they can proceed to the Cough & Fever Clinic to be tested for COVID-19.”
However, several patients have reported to The PineBelt NEWS that they have been turned away from the clinic or have not been tested when symptoms are present.
One visitor, who also spoke to The PineBelt NEWS on a condition of anonymity, took her partner to the clinic when he was experiencing a high fever, cough and chest pains.
According to the Forrest General and state health department websites, those are symptoms of COVID-19.
“(He was) tested only for flu,” she said. “(He had) a fever that topped out at 104-plus without fever reducer ... and it hovered at 101-102 with fever reducer.”
She said the Cough & Fever Clinic was “complete chaos” when they visited on March 18, the day the clinic opened, and they waited four hours before being seen.
“There were sick people laying in the grass and on the sidewalk. (It was) one of the craziest things I’ve ever experienced,” she said.
Dr. Bryan Batson, chief of medical informatics at Hattiesburg Clinic, said part of the triage process at the Cough & Fever Clinic is to evaluate patients for other causes of fever and cough, such as strep throat, walking pneumonia and flu.
“People who visit the Cough & Fever Clinic with COVID-19 symptoms such as fever, cough and breathing difficulty will be evaluated ... if no other cause is identified or if the patient has known COVID-19 exposure, they will be tested,” he said. “Testing will be done when appropriate based on clinical criteria and guidance from the (U.S. Centers for Disease Control and Prevention) and the Mississippi State Department of Health.”
According to an email from a Forrest General spokesperson, “there have been hundreds of patients who have called the Cough & Fever Clinic asking if they should be seen here, and they are being advised that if they don’t have (the symptoms), they should call their doctor for further instruction.”
The email said that only one person has been “advised” to visit her primary care provider or immediate care instead of the clinic for an evaluation of “her symptoms ... which did not include cough, fever nor shortness of breath.”
The spokesperson did not provide estimated wait times at the Cough & Fever Clinic or a number of people who have been tested at the clinic.
The spokesperson said the Cough and Fever Clinic was testing an average of 110 people per day, but when asked for additional details about the results, they asked Forrest General no longer be mentioned in any coverage about the clinic and instead directed all inquiries to Hattiesburg Clinic.
According to the hospital’s website, only two groups of patients are being tested through the Forrest General emergency department, including patients who are ill enough to require hospitalization and health care workers who are symptomatic for COVID-19 illness.
Gould acknowledged that “patients did have a longer wait time” the day the clinic opened. She said that patients were directed outside of the clinic – to their vehicles – after the reception area in the clinic “met full capacity under the current 6 feet distancing guidelines.”
“Patients opted to stay outside and enjoy the fresh air,” she said when asked about patients in the grass and on sidewalks.
When asked, Gould did not provide the number of people who have been tested at the clinic but said “there are 2-3 physicians ... and up to 15 staff on site to assist in this effort.”
“It is a critical and busy time in the health care world – and we are working very hard in this rapidly evolving situation as health care professionals to help those who need our medical care,” she said.