The health official leading Arizona's new coronavirus response is urging primary care providers not to test most patients for COVID-19, saying the state's "current reality" is that it doesn't have enough supplies to meet testing demand.

In a set of new guidelines issued Wednesday, Health Department Director Dr. Cara Christ said providers "should consider removing this diagnostic 'tool' from their toolbox and managing patients with respiratory conditions as if they have COVID-19."

"Keep working with your commercial vendors for testing, but do not depend on having test results for your management," Christ wrote. "There is no specific treatment or management strategy (for COVID-19), and results should not change clinical management."

Given a shortage of personal protective equipment, Christ also advised health care professionals to move testing outdoors, if possible, and to reuse equipment. Going outdoors could help limit the exposure of staff and other patients, she wrote.

She encouraged doctors to send patients with more severe symptoms to "higher levels of care" but noted: "There may not be testing indicated or available at the higher level of facility, either."

A shift in tone

Christ wrote that she was revising guidance for primary care providers due to their "continued work on the front lines."

"There are concerns that if primary care clinics close, it will overwhelm the emergency rooms and hospitals, and could potentially impact deaths far beyond those from COVID-19," she wrote.

The new recommendations are dramatically different in tone than statements made by Christ just a few weeks ago, when she indicated the state had enough test kits to meet demand.

At the time, Arizona was testing only those who'd traveled to affected areas or had direct exposure to a known case of COVID-19.

The state later expanded its testing criteria to include people showing symptoms and members of high-risk populations and got testing help from private labs. But persistent problems maintaining supplies, from the nasal swabs needed to collect samples to the gowns and masks needed to protect health workers, have slowed the efforts of public and private labs.

"There are shortages, and we need to move towards reuse, extended use, and alternative sources of PPE (personal protective equipment)," Christ wrote.

She suggested providers follow the lead of clinics that have limited visits for patients with respiratory symptoms to one part of the day, saying staff there has been "keeping on gowns and masks while just changing out gloves."

'Several months to go'

Christ's call to pull back on COVID-19 testing comes as many Arizonans were hoping for just the opposite.

For weeks, patients have feared they had the virus but couldn't get confirmation, and thought things might be different once private testing expanded.

Health officials had previously acknowledged supply shortages but, in recent days, touted shipments from the Strategic National Stockpile.

Christ has said the state is doing everything it can to prepare for the expected uptick in cases, which is expected to peak in mid- to late April. In the meantime, medical professionals are asking that Arizonans do their part for the community by allowing priority groups, such as older adults or health care professionals, to access limited testing supplies first.

"COVID-19 is spreading across the world and in our state at a rapid rate," Christ told primary care providers. "We anticipate working together much closer as things continue, and we have several months to go."

Reach the reporter at maria.polletta@arizonarepublic.com or 602-653-6807. Follow her on Twitter @mpolletta.

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