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BOONE — As N.C. leaders have announced plans to increase COVID-19 testing statewide as part of a phased reopening plan, AppHealthCare has again shifted its guidance on whether people should seek testing if they experience symptoms.

“Based on the latest recommendations issued by the N.C. Department of Health & Human Services, testing is expected to expand in the coming days and weeks. Our public health strategy has needed to be flexible and responsive, and this expanded testing guidance allows for more testing to occur,” AppHealthCare, the public health department for Watauga, Ashe and Alleghany counties, said in an April 28 statement.

“If you have symptoms consistent with COVID-19, we would recommend you be tested,” AppHealthCare stated.

The Centers for Disease Control & Prevention recently expanded the list of known COVID-19 symptoms to include not only cough, fever and shortness of breath but also chills, repeated shaking with chills, muscle pain, headache, sore throat and new loss of taste or smell.

“If you are sick with a fever, cough or other mild symptoms, call your health care provider or AppHealthCare. Please do not just show up to a health care provider without calling first,” the health department stated on April 28. “This will help your provider prepare should you need to be tested and lessen the potential exposure to others.

AppHealthCare noted that it will serve anyone, regardless of their ability to pay.

The recommendations represent a shift from previous guidance, announced by AppHealthCare on March 24, that focused testing on health care workers and those with urgent medical needs. At that time, AppHealthCare advised that “people with mild symptoms consistent with COVID-19 do NOT need testing and should be instructed to stay at home.”

AppHealthCare leaders said the restricted criteria for testing announced in March was part of a shift in response to mitigate the spread of the virus and was in line with CDC and NCDHHS guidance at that time. The announcement came amid a nationwide shortage of personal protective equipment for health care workers, NCDHHS noted, as well as media reports of continued test kit shortages and test results taking up to seven days or more.

AppHealthCare spokesperson Melissa Bracey confirmed on April 28 that this is new guidance that “reflects a shift in public health strategy to further identify and contain confirmed cases as we begin to reopen in the weeks ahead.” She said the new guidance has been shared with health care providers.

“As we begin to ease restrictions in the coming weeks and months, testing is occurring more so that we can quickly identify cases and isolate them. We have been using a public health strategy called mitigation over the recent weeks, but are now transitioning back to testing more plans for easing restrictions in an incremental way,” said Jennifer Greene, AppHealthCare health director, in an April 29 statement. “Since we will be expanding testing, we will likely identify more cases. We expect our local numbers to increase in the coming weeks, so we urge continued vigilance.”

AppHealthCare announced a fifth confirmed case of COVID-19 in Ashe County on Wednesday, April 29 — a county resident “linked to an ongoing investigation with a known outbreak in a food processing facility in another county” — and a case in Alleghany County in a non-county resident on Tuesday, April 28.

In Watauga County, nine residents and one traveler have tested positive for the virus.

“As we test more, you may hear of additional cases like this. We will continue to keep the community informed,” Greene said. “We encourage the community to continue doing their part to slow the spread of this virus, and we can do so by avoiding gatherings in groups of 10 or more and following all the local and state orders. We can focus on practicing self-care and caring for others during this time when many things in this situation are out of our control.”

Bracey said that as of April 28, AppHealthCare had 96 tests on hand in Watauga County, 77 in Ashe and 71 in Alleghany. Those figures do not include the numbers of tests available for use by other health providers, she said.

“(We) are tracking this daily to rapidly order more tests as needed,” she said.

The numbers of tests conducted to date in northwestern North Carolina counties vary widely.

In Watauga, as of April 29, 319 tests had been conducted to date — 85 by AppHealthCare and 234 by other providers. In Ashe, AppHealthCare had collected a total of five tests and other providers have done 69, for a total of 74. In Alleghany, 28 total tests had been conducted. Deb Gragg of Toe River Health Department said that 79 tests have been conducted in Avery County as of April 29.

But in the foothills counties of Caldwell and Burke, 1,392 tests and 615 tests had been conducted as of April 29, respectively, by health departments and other providers, according to representatives in those counties.

Asked why Watauga had conducted so many fewer tests than Caldwell, Bracey said on April 23 that “it’s difficult to compare county to county due to varying factors, but we can add that now that testing strategies have changed this week to move back toward a greater emphasis on containment, we expect testing numbers to increase.”

“Our strategy recently has been not to test broadly and instead has been to instruct people who have mild symptoms to stay at home and self-isolate and call their doctor if symptoms worsen, which then could lead to someone being tested,” Bracey added. “This strategy has also helped health care providers preserve personal protective equipment. With this strategy, we have expected to see lower numbers of tests.”

How to Protect Yourself & Others

  • Practice social distancing: avoiding gatherings, keep 6 feet or more away from others and remain at home as much as possible.
  • Frequent hand washing for 20 seconds.
  • Stay home when you’re sick.
  • Keep distance from others who are sick.
  • Avoid touching your face.
  • Clean and disinfect high touch surfaces in common areas like doorknobs, remotes, light switches, tables and handles.
  • People at high risk should stay home to the greatest extent possible.
  • Wear cloth face coverings in public settings where other social distancing measures are difficult to maintain.

People at high risk include anyone who:

  • Is 65 years of age or older
  • Lives in a nursing home or long-term care facility
  • Has a high-risk condition that includes: Chronic lung disease or moderate to severe asthma; Heart disease with complications; Compromised immune system; Severe obesity — body mass index (BMI) of 40 or higher; or Other underlying medical conditions, particularly if not well controlled, such as diabetes, renal failure or liver disease

If You Are Sick

  • Symptoms of COVID-19 include fever, cough, shortness of breath or difficulty breathing, chills, repeated shaking with chills, muscle pain, headache, sore throat and new loss of taste or smell.
  • If you become ill, call your health care provider or call AppHealthCare to speak with a public health staff member before going to your provider or the emergency room.
  • If you have a medical emergency, call 911 immediately.

More Information

Centers for Disease Control:

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