Los Angeles County health officials advised doctors to give up on testing patients in the hope of containing the coronavirus outbreak, instructing them to test patients only if a positive result could change how they would be treated.
The guidance, sent by the Los Angeles County Department of Public Health to doctors on Thursday, was prompted by a crush of patients and shortage of tests, and could make it difficult to ever know precisely how many people in L.A. County contracted the virus.
For the record:
6:02 p.m. March 20, 2020The initial version of this story misidentified the source of the letter. It was from the Los Angeles County Department of Public Health, not the Department of Health Services.
The department “is shifting from a strategy of case containment to slowing disease transmission and averting excess morbidity and mortality,” according to the letter. Doctors should test symptomatic patients only when “a diagnostic result will change clinical management or inform public health response.”
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The guidance sets in writing what has been a reality all along. The shortage of tests nationwide has meant that many patients suspected of having COVID-19 have not had the diagnosis confirmed by a laboratory.
Gov. Gavin Newsom has ordered Californians to stay at home. With businesses and popular destinations closed, The Times’ Luis Sinco documented the surreal scenes.
In addition to the lack of tests, public health agencies across the country lack the staff to trace the source of new cases, drastically reducing the chances of isolating people who have been exposed and thereby containing the outbreak.
For years, state and local health officials have been warning that steep cuts to federal grants meant to boost preparedness for a pandemic would mean there wouldn’t be enough equipment and staff on hand to respond in the crucial, early stage. Those fears have come to fruition now, officials said.
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A front-line healthcare provider who was not authorized to speak to the media and requested anonymity said county doctors are interpreting Thursday’s letter and other advice coming from senior L.A. County public health officials to mean they should only test patients who are going to be hospitalized or have something unique about the way they contracted the virus.
They are not planning to test patients who have the symptoms but are otherwise healthy enough to be sent home to self-quarantine — meaning they may never show up in official tallies of people who tested positive.
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Workers at the Ralphs grocery store in Westchester measure out social distancing guidelines for its customers with markers every six feet and limiting the number of customers it allows in to shop. (Jason Armond/Los Angeles Times)
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At Echo Park Lake, friends gather with their dogs and enjoy a Sunday afternoon in the park. Social distancing and home isolation remain in effect due to the coronavirus. (Carolyn Cole/Carolyn Cole/Los Angeles Times)
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During the coronavirus pandemic, people continue to walk and ride their bikes along the path at Junipero Beach in Long Beach. (Francine Orr/Los Angeles Times)
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People run and walk on the Veterans Parkway in Manhattan Beach even with signage saying the space is closed to help minimize the spread of the coronavirus. (Dania Maxwell/Dania Maxwell/Los Angeles Times)
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Jesus Mendoza sells roses on the sidewalk in downtown Los Angeles. Mendoza said his business was overwhelmed by hundred of boxes of roses they could not sell. (Francine Orr/Los Angeles Times)
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Riverside County medical personnel administer a coronavirus test to a driver at a drive-though testing facility at Diamond Stadium in Lake Elsinore. (Gina Ferazzi/Los Angeles Times)
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Drivers line-up to get a coronavirus test administered by Riverside County medical personnel at a drive-though testing facility at Diamond Stadium in Lake Elsinore. Those tested have symptoms or have had a risk of exposure. (Gina Ferazzi/Los Angeles Times)
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Xiao Ping, holding a tray of eggs, looks back at the long line of egg buyers on Saturda morning in Chino. Spooked by coronavirus people from nearby Inland Empire cities started lining up early morning at Maust’s California Poultry in Chino. (Irfan Khan/Los Angeles Times)
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Spooked by coronavirus fears, people from nearby Inland Empire cities lined-up to buy eggs at Maust’s California Poultry in Chino. (Irfan Khan/Los Angeles Times)
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The sparsely trafficked intersection of the 101 and 110 freeways in downtown Los Angeles is seen in a drone image. (Carolyn Cole / Los Angeles Times)
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School buses sit idle since all schools have been closed in Los Angeles County. The image was taken by drone. (Carolyn Cole / Los Angeles Times)
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In this drone image, the Westfield Topanga mall parking lot sits empty, as new regulations have closed all indoor shopping centers in Canoga Park. (Brian van der Brug / Los Angeles Times)
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Vehicles flow smoothly along Interstate 5 and the 110 Freeway in Los Angeles in this drone image. (Brian van der Brug / Los Angeles Times)
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The city of Santa Monica has closed the Santa Monica Pier, and few people were on the beach Friday. (Carolyn Cole / Los Angeles Times)
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Shops are shuttered on historic Olvera Street in downtown Los Angeles. (Irfan Khan/Los Angeles Times)
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The intersection of the 101 and 110 freeways in downtown Los Angeles. (Carolyn Cole/Los Angeles Times)
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Hollywood Blvd. is devoid of the usual crowds as most shops are closed. (Brian van der Brug/Los Angeles Times)
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Hollywood Blvd. is devoid of the usual crowds as most shops are closed. (Brian van der Brug/Los Angeles Times)
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On the first day of L.A.’s ‘Safer at Home,” most major avenues and streets in downtown Los Angeles have very little traffic. (Irfan Khan/Los Angeles Times)
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Empty streets in downtown Los Angeles. (Irfan Khan/Los Angeles Times)
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The main entrance to Union Station is closed. (Irfan Khan/Los Angeles Times)
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Union Station was restricted to only ticketed passenger and main entrance closed. (Irfan Khan/Los Angeles Times)
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Commuter protect themselves with a face mask while riding a bus at El Monte Metro Station. (Irfan Khan/Los Angeles Times)
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Salvation Army volunteer Christina Cuevas sets up cots for homeless at Westwood Recreation Center in Westwood. (Brian van der Brug/Brian van der Brug/Brian van der Brug/Los Angeles Times)
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Popular shopping destination Rodeo Drive is all but deserted as retail shops are shuttered in Beverly Hills. (Brian van der Brug/Los Angeles Times)
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The Apple store is among all the stores which have closed during the coronavirus outbreak in Newport Beach. (Gina Ferazzi/Los Angeles Times)
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With all the stores closed, Fashion Island is a ghost town except for an occasional customer getting food for take-out Newport Beach. (Gina Ferazzi/Los Angeles Times)
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People walk the beach, but maintain “social distancing” during the coronavirus outbreak at Crystal Cove in Newport Beach. (Gina Ferazzi/Gina Ferazzi/Los Angeles Times)
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During the coronavirus epidemic people continue to walk, ride thier bikes, and play basketball at Junipero Beach in Long Beach. (Francine Orr/Los Angeles Times)
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While county health officials are shifting their testing strategy, they are rapidly increasing other efforts to save lives.
The Los Angeles Department of Health Services, which runs the nation’s second-largest municipal health system, “is mobilizing all of its resources to fight the on-coming wave of COVID-19 cases expected in the coming weeks,” said Dr. Christina Ghaly, DHS Director. “We are ramping up hospital capacity and taking extraordinary measures to increase supplies.”
The letter also says that, with the increasing availability of tests at private labs, the Department of Public Health will focus on testing aimed at detecting and preventing outbreaks in hospitals and “congregate living settings,” such as nursing homes.
Public Health officials did not immediately respond to a request for comment on Thursday.
Jack Dolan is an investigative reporter for the Los Angeles Times. A winner of numerous national awards, he has twice been named a finalist for the Pulitzer Prize.
Brittny Mejia is a Metro reporter covering federal courts for the Los Angeles Times. Previously, she wrote narrative pieces with a strong emphasis on the Latino community and others that make up the diversity of L.A. and California. Mejia was a Pulitzer Prize finalist in 2021 in local reporting for her investigation with colleague Jack Dolan that exposed failures in Los Angeles County’s safety-net healthcare system that resulted in months-long wait times for patients, including some who died before getting appointments with specialists. She joined The Times in 2014.
