CDC widens coronavirus screening scope; state may test next week

Always Investigating

The Centers for Disease Control has widened its definition of a “Person Under Investigation” for COVID-19 to include travelers from other areas besides China. This after the state changed its own procedures to stop doctors from filling out PUI forms and taking samples until the state is called for approval first.  

Local doctors tell Always Investigating they will push for testing if they feel it’s necessary, even after the state changed the protocol. The state says they could be testing locally as soon as next week.

The CDC and Hawaii Department of Health are making a significant expansion to their COVID-19 lookout for sick people with travel connections beyond just China. It’s a change to what defines a PUI or Person Under Investigation

“CDC has updated their PUI definition to actually align with where Hawaii was already starting to lean forward,” explained state epidemiologist Dr. Sarah Park, “to account for travelers from these other areas, as well as, I might add, to account for someone with a particularly severe respiratory illness, hospitalized, who may not have even a known travel connection.”

Always Investigating was first to report Hawaii doctors had submitted eight PUI forms and testable specimens, but the state discarded them all and said none met the threshold to send to the CDC on the mainland for COVID-19 testing. Dr. Alan Wu’s patient, at Doctors of Waikiki, was among them.

“I’m a little surprised, but I also was notified about the discarding of the sample, so they did notify us and told us that after investigation they did not feel that there was a need,” Wu said.

KHON2 asked Wu: What about your patient alarmed you enough to fill out that PUI form?

“My patient did travel from China, did travel from the city of Wuhan, but they were also in Wuhan and other cities in China for about 3 weeks before they got here,” Wu said. “They presented with upper-respiratory symptoms, runny nose and fever, and we were concerned enough due to the exposure risk and the travel history. We did fill out the form. We did swab him.”

Wu says the state reviewed the case and it was determined to be a low risk

“We went ahead and treated them with antibiotics and the patient recovered fully,” Wu said. “There are still follow-ups here, and there are no symptoms currently.”

The traveler remains stuck in Hawaii.

“Due to the travel restriction, they are here in Hawaii and they have been here now over a month and a half without any symptoms,” Wu said. “They’re doing fine.”

The state’s COVID-19 protocol until just yesterday was for doctors to isolate the patient, take specimens, fill out the PUI form, fax it in and then call the state to make sure it arrived. The state told Always Investigating Wednesday it was reversing that: The doctor must now call the Department of Health investigators first. If the state says a patient meets criteria to test, they will authorize the doctor then to fill out PUI form, and the doctor will collect and submit specimens to the State Laboratories Division.

“It is a collaboration with our clinical partners,” Park explains, “so  they would consult us and we would discuss with them and review who of those individuals should be tested.”

KHON2 asked Wu: “Despite the state wanting to have that first approval and that final say, are you confident that a doctor would be heard if he or she pushed and said ‘I want this person tested?’”

“I’m pretty sure if I insisted on pushing a test to be done, I will get my point across,” Wu said, “and I will work with them to make sure that they will run my test. We have to get a bigger number of case studies to determine how much farther we need to push our state to go to run our test.”

Testing so far has not taken place in Hawaii, nor of any Hawaii samples by the CDC on the mainland. Hawaii is among just a handful of states that have submitted no samples to the CDC while awaiting our own functional test kits.

The state DOH today said they have the three components of the test kit in Hawaii but that there was a concern about one of the components. They say the CDC gave the state’s laboratory the green light to start the verification process.

“I’m even happier to say that when we do make that decision (to test) we will have hopefully by next week the capacity to do the test in our state,” Park said.

Meanwhile doctors say they’ll continue to work hand in hand with the state using whatever officials say is the latest in an ever evolving protocol.

“They’re our body of government for the health of the entire state and I will leave it up to them as the subject matter expert to determine that,” Wu said. “I think it’s wise to give them a call and go through the questionnaires and determine whether or not this patient needs further testing because they deal with a lot more cases than each individual local doctor does.”

As of today the state of Hawaii still has no confirmed cases, no persons under investigation, and no tests submitted. There are 80 people self-monitoring under Department of Health supervision. Of those, 73 are on Oahu, 5 are on Hawaii Island, 1 is on Maui, and 1 is on Kauai. Under self-monitoring, “individuals voluntarily remain at home and refrain from work, school, gathering places, and public transit. They communicate daily with Department of Health staff,” according to the DOH.

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