Thread by @chitra_mdmba

We are not ready to reopen.

Last week, approx 4 days after interacting with a patient, I found out that she had tested COVID positive.

I had been wearing only a surgical mask and gloves to examine her for a potential post-birth complication. She was not masked. 1/

She had presented 3 weeks earlier for an obstetric complaint and had a sore throat. She lives in a crowded home with a dozen others. One had had a cough for 2wks. But due to a lack of qualifying symptoms or a lack of testing or both, she was not tested at that time. 2/

In the interim, she made numerous visits to our clinic, had reported to Labor & Delivery and had a scheduled cesarean. No one was wearing an N95.

On her day of discharge, she reported a family member at home had tested positive. A rapid PCR was sent and returned positive. 3/

I'm grateful that my health system leaders notified me and those exposed right away. They are hard at work on revamping our systems on L&D in terms of universal masking and universal testing.

But the obvious question would be, how soon could I be be tested? 4/

I live with my husband (ER doc), son (10 mos), and elderly parents with comorbidities that make them high risk.

Testing is not just for my own health, but informs how I need to interact with my family and community.

Plus, I was scheduled to staff L&D the next day. 5/

First stop, Employee Health. Protocols dictated no testing unless I was symptomatic.

Next stop, my health plan, Kaiser. Phone visit w a nice doc in 2hrs. No symptoms, no testing.

Both sheepishly greenlit me to work the next day, admitting how counterintuitive it seemed. 6/

I understand the need to ration testing to those who have symptoms and are highest risk of transmitting.

But if an exposed frontline healthcare worker cannot access testing and is permitted to continue exposing others, without any attempts to trace my contacts, we are lost. 7/

And I needed to know to keep my family safe.

So I did what I've been doing for the entirety of the pandemic: contacted my underground network of trusted frontline healthcare colleagues to access the latest practices/guidelines where larger systems like government have failed. 8/

Several suggested I fabricate a minor symptom (runny nose) and access an @sfgov testing site, powered by @color. I signed up online for a drive thru appt the next day. The process while unpleasant (wow that swab) was smooth and I got my result in 2 days via text.

Negative. 9/

In the days since, the @sfgov test sites no longer require frontline healthcare workers be symptomatic to get tested.

But we are a far cry from the kind of openly accessible, serially available testing that would allow us to feel confident resuming business as usual. 10/

What's clear is how little we know about the extent of community transmission - due to the utter failure of a fundamental public health function, which is reliable testing/tracking.

I personally will not be the first out the gate if SIP is lifted given what I know now. 11/

The scarcity of testing is an issue of equity, disproportionate disease burden, delays in care.

Not all are privileged enough to make up a symptom or navigate multiple channels to access testing.

Fingers crossed I'm not re-exposed. And govt learns how to test at scale. 12/