The nation’s second-largest municipal health system has told its staff that it is essentially abandoning hope of containing the coronavirus outbreak and instructed doctors not to bother testing symptomatic patients if a positive result won’t change how they would be treated.

The guidance, sent by the Los Angeles County Department of Health Services to its doctors on Thursday, was prompted by a crush of patients and shortage of tests, and could make it difficult to ever know precisely how many people in L.A. County contracted the virus.

The department “is shifting from a strategy of case containment to slowing disease transmission and averting excess morbidity and mortality,” according to the letter. Doctors should test symptomatic patients only when “a diagnostic result will change clinical management or inform public health response.”

The guidance sets in writing what has been a reality all along. The shortage of tests nationwide has meant that many patients suspected of having COVID-19 have not had the diagnosis confirmed by a laboratory.

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