Q&A: Sacramento’s top health official on what’s being done to stop the coronavirus outbreak

Information about the novel coronavirus that has spread around the world and appeared at Sacramento’s doorstep continues to evolve and change.

Sacramento County’s health services director Peter Beilenson is taking charge of the county’s efforts to stem the spread of the virus, also known as COVID-19, which has killed one person in the county and infected at least 16 others.

Why isn’t quarantine automatic for some people anymore? Who’s going to be most affected by the virus? If I have a cough, should I get tested for the virus? Will NBA players jump to the front of the line for testing?

Those are just some of the questions residents have sent to The Sacramento Bee. We asked Beilenson to give us the latest on Sacramento County’s efforts to stem a potential outbreak of the virus. Answers have been lightly edited for length.

How many coronavirus tests have been done?

Full question: There’s been controversy about a lack of testing. You’ve even expressed frustration about limitations you face in getting tests done in Sacramento County. How many tests have you actually done?

Literally I just called the lab director five minutes ago. We do 50 to 60 tests a day, which is about 25 to 30 people because you do two swabs per person. An oropharyngeal and an nasopharyngeal, which is through the mouth and the nose.

We’re been doing 20 to 25 tests a day for about two to three weeks, so approximately a couple hundred tests, which is only for those we triaged to using our testing site: Healthcare workers that have been in contact with a positive test or seniors or people with chronic underlying conditions who have serious symptoms.

Who decides who gets tested?

We put out our laboratory guidance almost every day because it changes from the CDC and the criteria for who we are able to test. Doctors call us and (their patients) have to be approved to get tested at our lab. As new (private) labs have come on, like LabCorp and Quest that are nationally laboratory companies, doctors can prescribe a test for their patients who don’t meet the criteria for our county labs.

The Elk Grove senior facility

Full question: What’s the situation at the assisted living facility in Elk Grove, where one resident died this week from contracting the virus? Are you testing others there?

We do not disclose that (how many are being tested and what the results are). They’ve implemented a variety of strategies that make good sense, eliminating congregate sitting. They do room service to their doors. Everybody wears masks. They’ve set up strict guidelines at the front desk. They aren’t totally quarantined, but they limit the number of visitors that they can have.

They still are obviously a priority. What we did was test going out from the central case (the ill person). I don’t know if they are done yet.

Whether or not they test positive doesn’t matter. Because if they’re showing serious symptoms and are in the hospital or ICU, they’d be getting treatment regardless of what their test showed. The test is confirmatory but it doesn’t define their treatment.

Why tests are important

Full question: Why should people care about the number of tests being done?

The real problem is actually the previous few weeks when we could have used more tests to identify people who are positive so that we could quarantine and trace (people) who had contact with them.

That was why we had the containment strategy initially, but the containment strategy was sort of strangled, if you will, because of the lack of tests.

If it doesn’t matter really for the sickest people, then why does it matter for the unsick? It’s really kind of, I think, some parental reassurance.

But if you are a 34-year-old woman and you have a fever and cough and shortness of breath and you are treating yourself with Advil and doing fine, there is absolutely no reason that you should be tested, nor frankly should you leave your house, because you’ll be exposing yourself to other people.

That said, there are some people who just want to know. There is no good defined reason that you have to know.

Full question: So why does it matter to get everybody tested at the assisted living facility?

I take it a little back. Say you have a bunch of 95-year-old people at an assisted living site and one of them tested positive and died. You might want to follow them more carefully. So if a 90-year-old tests positive but doesn’t have symptoms yet, or shows only mild symptoms, in that case you want to jump on it because a 90-year-old and higher has about a 25 to 30 percent mortality rate, as opposed to the 34-year-old. For the 34-year-old, it does not really matter.

That is why our labs triage out just those who are healthcare workers who have treated someone who tested positive, or seniors or chronic condition people who have serious symptoms.

How long coronavirus tests take

Full question: How long does it take for coronavirus test samples to be run?

Between a little bit less than 24 and 48 hours when it is done at our county facility. It is longer through LabCorp or Quest.

I actually called about LabCorp, this was a couple days ago, I believe they are offering tests now and a swab is sent them, but then, this is as of two days ago this is my most recent information on this, but it has to be sent to North Carolina for confirmation.

For Quest, (swabs) are sent to San Juan Capistrano. But we’ve been trying to call them and we get kind of scrunchy answers. It is not a huge volume yet.

Full question: California Gov. Gavin Newsom has been lambasting the lack of testing supplies for health officials this week. Has Sacramento ever run out of materials?

Over the weekend we ran out of reagent while we were doing a few tests. We did the swabs and took the swabs and the test tubes directly to the (California Department of Public Health) lab in Richmond.

Full question: Has Sacramento restocked on reagents?

Yes, we have resupplied.

Roadblocks to testing

Full question: What are other hindrances to testing?

The UC system is trying to do their own testing, and one of the things that the CDC kind of neglected to do was to give positive sera (plural for serum) from a coronavirus positive test, because you need that to run the test.

They are ready with the materials but they don’t have any coronavirus positive samples, so they’ve been working with us today, UC Davis and UC Irvine, to try and give them some of our results. We’ve had some positives, although we’ve only had about 17 or 18. (As of Thursday afternoon, there were 29 positive cases.)

The positive serum actually goes to the CDC for confirmation of our finding. We had sent ours away, so what we’re trying to see is if we can split samples, in other words keep some of the sample that is positive for coronavirus for UC Davis to gin up their machine while sending the other part of the sample to the CDC for confirmation, so we are looking into that.

Full question: What about expanding your testing capabilities?

We would like to expand our testing capabilities. However, we kind of lost the window of opportunity when you want to get a lot of people tested to do the contact tracing and the quarantining, when it would have made more of a difference. Before the things started spreading, that would have been more helpful. It’s helpful to have testing, it is not the be all and end all.

Tests for Kings NBA players

Full question: The NBA shut down their season. Will Kings players get first dibs on tests?

That is not the issue. That is the issue the NBA is giving, but frankly because Newsom’s requirements shut down any gathering with more than 250 people in it, I think it is more about the potential spread of the virus among the spectators.

Coronavirus test policy

Full question: In the ideal situation, what would your testing policy look like?

If we had unlimited tests, that’d be great. I keep going back to this over and over again: It’s quite analogous to the flu season. In fact, we strongly encourage people to test for flu and respiratory syncytial virus, RSV (a virus that mimics the common cold) which often causes kids respiratory infection but often causes adult respiratory infection.

Full question: You mean if you get flu- or cold-like symptons, but don’t qualify for a coronavirus test, there are other tests you can take to sort of rule out coronavirus?

Yes. We encourage (some people) before they get tested for the coronavirus to test for those two things because they are way more common than the coronavirus.

We would be doing more testing. It would mostly be reassurance or defining the populations that are at risk and defining them early on before they develop symptoms.

Full question: If I feel sick tomorrow, and pretty darn sick, do I consider calling my doctor and asking for an RSV or flu test?

I literally just prescribed this for one of our friends, for that situation. He is a 52-year-old guy who had shortness of breath, coughing and no fever, or very mild fever. I recommended he get an RSV and a flu thing first, which turned out positive.

Full question: If you turn out positive for RSV or flu, does that negate the possibility that you have coronavirus too?

Hard question. I don’t think it eliminates that, but the chances of having both would be pretty small.

How serious is coronavirus?

Full question: Some people are saying this is not that serious, and the media is overblowing this. What perspective can you offer as the county health chief?

Our whole message of mitigation that we are harping on is predicated on three points:

Number one, 81 percent of all cases nationally and internationally, are mild or asymptomatic.

Number two, it is clear now after three-plus months experience that kids are affected less by this than by the flu in terms of severity of the illness.

Number three, the two major populations that are severally at risk for this illness, and those are the elderly and those with underlying health conditions.

So our mitigation strategy is specifically focused on reducing the risk to those populations from exposure to the virus from younger people in general and vice versa. For instance, we have recommendations for seniors to not go out into the malls, avoiding the casino trips, making sure we screen people coming into the assisted living places before allowing them in.

So I think we have a very bifurcated message here that is: For most people, this is a mild to moderate illness, but for those who are most at-risk, it can be very serious.

That why we want to encourage people to take the mitigation messages that we have been talking about like staying at home when you are sick, washing your hands, etc. etc.

Details on coronavirus cases

Full question: You announced six new cases in Sacramento County this week, bringing the total to 17 over the past three weeks. Can you give us details about those six?

No, other than they are community spread. We are not talking about individual cases anymore. You want to know if they are of a certain age (group), but it is no, we are not giving those out.

Working from home

Full question: Are we transitioning into a period you guys are telling employers to have employees to work from home?

We are not saying you should or shouldn’t but the guidance that came out from the CDC and CDPH certainly encourages looking at that.

Full question: Bottom line, what’s your prognosis? Where are we going next with the coronavirus?

It seems very likely, because this is analogous to other novel virus, that after a year or so this will be part of the constellation of infectious diseases that go around the world in a seasonal manner. I am not diminishing the seriousness of this illness to some people, or the widespreadedness if you will, but that probably is the most likely thing to happen.

This story was originally published March 15, 2020 at 5:00 AM.