Health officials shift to ‘sentinel surveillance’ for COVID-19 as Virginia moves to Phase 3 reopening

Volunteers wait for patients at a walk-up COVID-19 testing site set up by the health department in Richmond. (Ned Oliver/Virginia Mercury)

Virginia’s third phase of reopening will come with a new way of monitoring COVID-19.

The surveillance program, announced at a Thursday news conference, comes amid declining trends in coronavirus statistics and a growing sense that state leaders consider the pandemic in Virginia under control — at least for now. At the same conference, Gov. Ralph Northam announced he would discontinue his twice-weekly briefings, citing a rise in testing and decreasing percentage of results that come back positive.

“Other states are seeing surges now as people move about more, but in Virginia, so far, we are not seeing a surge in cases,” he said. “In fact, our numbers are very good.

“This is entirely thanks to all of you,” he added. “You have helped by staying home, washing your hands and wearing face coverings. We all need to keep doing all of these things because we don’t want our numbers to go up — especially as we ease restrictions next Wednesday.”

Monitoring COVID-19 through increased testing and contact tracing has been cited as a critical part of containing its spread. In July, the state will also launch sentinel surveillance, another way of tracking the disease that’s previously been limited to seasonal influenza. 

Dr. Karen Remley, a former state health commissioner and current head of Virginia’s COVID-19 testing task force, said the surveillance is particularly important when there are fewer cases of the disease and patients — especially those with mild symptoms — might not think to seek out testing. VDH will partner with two outpatient providers, such as doctor’s offices or urgent care clinics, in each health district to test patients for COVID-19. The first five patients who come in with symptoms and agree to participate will have their specimens tested through the state laboratory in Richmond.

The state will test 1,400 specimens a month through the program, according to Remley. Health officials also plan to launch a second sentinel surveillance program for COVID-19 targeted toward “vulnerable populations,” which will direct tests to sites such as prisons, homeless shelters, and low-income housing developments — “anywhere where we’ve identified there’s a higher risk for disease,” Remley said.

The launch of the program doesn’t mean the state is rolling back other COVID-19 testing, Remley said. But limited and “high-quality” data, as the World Health Organization defines sentinel surveillance, gives epidemiologists a cost-effective way to monitor the burden of the disease in a community and look out for new trends and outbreaks.

“It’s a way to make sure, around the state, you’re consistently getting information,” Remley said. “Another early warning. When disease is really here, we know it — everyone’s in the ER, everybody’s sick. This gives us an idea if it’s starting again and where in the state it’s starting.”

So far, the rate of COVID-19 transmission is declining in Virginia, but the state is still averaging roughly 500 new cases a day. Other states, including Texas and Florida, have seen a spike in new cases after lifting restrictions, causing others to pause their own reopening plans.

Northam said Thursday that he would continue to emphasize social distancing and other basic health measures, such as hand-washing and face coverings, even as the state moved into its third stage of reopening. Phase 3 significantly lifts business restrictions and allows for gatherings of up to 250 people (though the governor said he wouldn’t recommend them unless guests are able to stay at least six feet apart).

“I worry every day and I watch the data every day,” Northam added. “We’ll continue to do that, and as I’ve told Virginians, if we see the numbers trending in unfavorable directions, then we’re obviously going to have to make some difficult decisions.”