COVID-19 tests lose value when results take too long
STEAMBOAT SPRINGS — A backlog in turning around COVID-19 test results at state and commercial labs in recent weeks is rendering the critical information the tests provide much less valuable.
In Routt County, it is now true that anyone who wants a test can get a test. But it is taking on average a week to get test results back, said Routt County Public Health Medical Officer Dr. Brian Harrington. Thus — the data about what is happening in the community is always about a week behind.
“Our goal — the standard we should be striving for — is to get test results back in 48 hours and that we complete contract tracing within 24 hours,” Harrington said. “If we identify a case quickly, we can prevent them from exposing others to the virus. When we get late test results, it significantly undermines our ability to stop chains of transmission early.”
Now, Routt County is also facing some data reporting backlogs.
There will not be any local COVID-19 test results released this week, according to the Routt County Public Health Department.
The delay in reporting is attributed to limited staffing, according to a Monday news release.
About a week ago, the county’s one full-time public health nurse resigned, and the position remains vacant.
“Since the pandemic, Routt County’s public health nurse calls every clinic that provides COVID-19 tests and tabulates the results of positive cases, negative cases, pending cases and deaths, as well as getting information from the Colorado Department of Public Health and Environment (CDPHE) on Tuesdays and Fridays,” according to the release. “Even though the county will have challenges compiling data, positive cases are still being addressed promptly and contact tracing will continue to be implemented.”
A week prior to the nurse’s resignation, Director of Public Health Director Kari Ladrow announced her resignation, effective Friday. Roberta Smith has since been named interim director.
According to his records, the last date on which a test was collected that resulted in a positive COVID-19 case was July 15, Harrington said. As of Monday, the county’s website reported 204 pending test results.
In a Friday opinion piece in The New York Times, Dr. Elisabeth Rosenthal wrote: “The latest fiasco is perhaps the most Kafka-esque: Tests are now widely available in many places, but results are often taking so long to come back that it is more or less pointless to get tested. … One canon of medical practice is that you order a test only if you can act on the result. And with a turnaround time of a week or two, you cannot. What we have now is often not testing — it’s testing theater.”
Local testing agencies are largely reliant on massive commercial labs, as well as the state lab.
“The crux of it is the PCR reagent,” Harrington said, of what he hears is the primary reason behind the backlog.
In addition, more testing is being conducted across the state and nation — especially in states seeing surges in new cases — and the labs are not meeting the demand,” Harrington said.
Reagent is a chemical cocktail used to detect ribonucleic acid (RNA), Harrington explained, then transcribing to DNA — thus being a critical ingredient in detecting the virus.
“I think this has exposed the problems by not having a nationally-organized testing regime,” Harrington said.
If a person has symptoms for a couple days, then gets tested and doesn’t get results for six or seven days, he said, the window, when isolation would be effective, has been missed.
Ideally, everyone who got a test and had symptoms or reason to believe they’d been exposed would self-quarantine for 10 days, but that isn’t always the reality, Harrington acknowledges. And for people who are asymptomatic or get tested as a part of surveillance testing — a lengthy self-quarantine is even less likely.
“One of the tenants of the whole opening-up machine is that we have robust testing capacity capabilities,” Harrington said. “I would suggest that currently we are not meeting the mark.”
UCHealth, with internal testing capacity, has consistently been producing the fastest results, Harrington said.
At UCHealth Yampa Valley Medical Center, the average turnaround time for COVID-19 test results locally is just under three days, according to Heather Rose, UCHealth manager of community hospital marketing.
“We are currently prioritizing hospitalized patients and those who are symptomatic and need to be admitted to the hospital with the fastest tests,” Rose said. “Results from these rapid tests are available very quickly. Results for those who do not need care in the hospital, including most patients who visit our drive-thru sample collection centers, will be available in about 72 hours.”
Across the UCHealth system, an average of about 1,550 tests have been performed each day, compared to just over 1,000 in June and 760 per day in May, according to Rose.
“These increasing numbers are a result of increased demand as well as UCHealth now providing testing for anyone who needs or wants a test,” Rose said.
At Steamboat Emergency Center, Dr. Jesse Sandhu said turnaround times for test results over the past several weeks, which have taken an average of seven to 10 days, are unacceptable. He said one result took as long as 20 days.
The center recently partnered with a different private lab, which guarantees results in 24 hours from when they receive the test specimens in their labs, leaving a total turnaround of about 48 hours on weekdays and 72 on weekends
“What’s the point of getting a test if you are already past the infection?” Sandhu asked. “We can’t do a test that is not going to give us some sort of value.”
While most people who contract the virus will recover, Sandhu notes there’s value in a negative test, but only if it’s received in a timely fashion.
“It can eliminate inconvenience in people’s lives,” Sandhu said. “They can go back to work, be around family, be around high-risk individuals. And carry on a more normal life and protect other people.”
The state laboratory now has around-the-clock staffing and is averaging about 10,000 tests a day, compared to 2,000 in April. Colorado Gov. Jared Polis announced last week an expansion of public-private partnerships to increase capacity.
Harrington said the positivity rate in Routt County is remaining in the 1% to 3% range, which is low. He said a positivity rate of 10% would trigger concern.
Harrington is also keeping close track of how people are contracting the virus. In June, 10 of the 15 cases had a story — meaning they had travelled somewhere or knew of a close contact that had the virus. Five people had no stories, Harrington said. In July, eight people had stories, and nine did not. Those nine, he said, would represent community spread.
“The numbers are too small to say it’s significant, but it’s something to pay attention to,” he added.
Call 970-870-5577 to set up an appointment to get tested with the Routt County Public Health Department. Testing takes place every Wednesday.
“Patients are encouraged to contact their primary clinic for testing as well,” according to the county’s website. “All local clinical facilities can also obtain COVID-19 testing for patients.”
Call 970-846-6230 to set up a testing appointment at the Steamboat Emergency Center.
At UCHealth Yampa Valley Medical Center, COVID-19 test appointments can be scheduled through My Health Connection via uchealth.org or the UCHealth app by selecting “COVID-19 testing” or calling 970-875-2686. Appointments are available 9 to 11 a.m. Monday to Friday and 1 to 3 p.m. Monday and Tuesday.
Testing appointments also are available at the South Routt Medical Center at 11 a.m. every weekday. For an appointment, call 970-736-8118.
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