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Local testing capacity meeting increased demand

Editor’s note: The story was updated at 8:33 p.m.

STEAMBOAT SPRINGS — While the number of COVID-19 cases are surging in Routt County, with numbers far surpassing the spring surge, local testing capacity — at this time — is in relatively good shape.

The demand for testing is up significantly, with 2,317 tests administered between Nov. 5 and Nov. 18, according to the Routt County Public Health Department.



As of Sunday, the Colorado Department of Public Health and Environment reported 519 cases in Routt County, showing the county is growing by around 100 cases per week since the beginning of November.

Routt County Director of Public Health Roberta Smith said the community testing days “are pretty packed.”



At The Steamboat Emergency Center, “Our testing has ramped up to an all-time high,” said physician/owner Dr. Jesse Sandhu. “We are pretty much booked solid every day.”

At the hospital, “We are really seeing a growth in demand as the virus goes up everywhere,” said James Wirta, the laboratory manager at UCHealth Yampa Valley Medical Center.

But unlike in the spring, Wirta said they are keeping up with the demand and able to keep a consistent supply of testing materials.

The Routt County Department of Public Health recently switched to a new PCR test, called the Curative test, according to Smith. It is a self-administered oral swab, and with the support of the state, specimens are now being sent to a private lab because of the persistent backlog at the state lab.

Results for the PCR test are coming back as quickly as 24 hours depending on provider — a dramatic difference from the period in July when a massive backlog caused people to wait as much as a week, or even close to two weeks, for results.

While turnaround through the state labs had been around five to eight days, Smith said with their new system, the county is able to get results in about 48 hours — sometimes a little more and sometimes even less.

Results are also being reported more efficiently through an email or text directly to the patient, Smith said.

Wirta said YVMC is thus far keeping the turnaround for PCR tests at 24 to 72 hours. Couriers transport their specimens to the UCHealth labs in Denver seven days a week, he said. The goal has remained to continue to increase testing capacity and turnaround time, Wirta said. In August, the UCHealth system was analyzing about 1,800 tests per day, and now is analyzing about 3,000 tests every day.

The Steamboat Emergency Center has been contracting with a private lab that guarantees PCR results in 48 hours, Sandhu said.

Turnaround time is a critical piece of slowing the spread. When PCR tests take too long to yield results, much of the usefulness in terms of isolating positive cases and contact tracing is lost.

Testing technology has also improved so that every PCR test does not require what feels like a “brain biopsy.” The health department and Steamboat Emergency Center are now both using saliva PCR testing, and others who do still use the nasal swab are not needing to reach quite as high up into the nasal cavity.

ANTIGEN VS. PCR TESTING

The rapid 15-minute antigen test is now widely available, but doctors and public health experts say it is important to know when to best use and interpret the different types of tests.

PCR tests detect the viral genetic material, Routt County Chief Medical Officer Dr. Brian Harrington said, while antigen tests detect protein markers on the virus.

Or as Dr. Richard Zane, UCHealth chief innovation officer and professor and chair of emergency medicine at the University of Colorado School of Medicine explained, the PCR looks for the actual virus, while the antigen test looks for a piece of the virus. And it’s not always a simple matter of yes or no testing, Zane said.

If you test positive on an antigen test for COVID-19, “positives are for the most part positives,” Zane said.

But there’s a decent chance a negative could be a positive.

PCR tests have been criticized for being too sensitive — detecting the virus long after someone is contagious — while antigen tests are criticized for not being sensitive enough and having a relatively high rate of false negatives.

On November 20, hundreds of people signed a letter to the editor in Steamboat Pilot & Today asking the public health department to release the cycle threshold (CT value) of each test, which would indicate a more specific amount of virus in an individual’s body.

“Considering the wide range of serious impacts these restrictions and quarantines have on individuals, families and the community at large, we think transparency is critical, and citizens should know the truth regarding the cycle threshold values and subsequent accuracy of our COVID tests,” according to the letter.

Sandhu said the FDA has requested labs do not provide that information to patients.

That is because “they don’t want people to act on those numbers,” Sandhu said. “They don’t want people to make clinical decisions themselves.”

Knowing precisely what that degree of specificity means may come down the road, he said, but at this time, “We still don’t understand it well enough. … We don’t want people acting on the numbers while we are still studying whether or not the values correlate to the timing of the infection and how infectious someone is.”

Until more data is released on the CT values, it’s too risky to act on assumptions, Sandhu said.

Because the PCR test is very sensitive, Smith emphasized that people do not need a negative test to return to work. People who tested positive once, she said, under current guidelines do not need to be retested for 90 days.

However, a negative test does not release a person from quarantine, Smith said. People tend not to show symptoms until about five to seven days after exposure, she said, making it difficult to tell where people are on the curve of infectiousness if they contracted the virus.

“The 14 days covers the entire time you could potentially become infectious,” Smith explained.

The antigen tests account for an increased local capacity in testing, said Harrington, but “it is worth noting the our test positivity rate is increasing in spite of the increase in testing. This strongly suggests increasing disease prevalence in the county.”

The antigen test is not appropriate if you are asymptomatic and getting the test before or after taking a trip or prior to visiting a vulnerable family member, Harrington said.

“Only PCR tests should be used when testing a person without symptoms. … If a person has COVID symptoms and a negative antigen test, they must still remain in isolation pending the results of a backup PCR tests. Patients with symptoms and a negative rapid antigen test must still get a PCR test to confirm they do not have COVID,” he added.

Sandhu noted that asymptotic people, while still carrying the virus, may not have enough of the virus to show up on an antigen test. A person could be infected, but it is too early to detect the virus with the antigen test, he said.

Zane emphasized that “a negative rapid (antigen) test should not in any way shape or form change your behavior.”

Sandhu said he spends a lot of time educating patients on how to interpret negative antigen test results, telling them not to make any decisions until they get the PCR test.

However, if you are experiencing symptoms, the test is good at identifying a positive, and thus useful in that scenario. Smith said the state has provided antigen tests to the public health department, which are being used in targeted screenings, such as in correction facilities, schools and assisted living centers.

YVMC only uses the PCR test — the “gold standard,” said Wirta. But they have in-house capabilities to perform a rapid PCR test, which is performed on a different platform that allows for a quicker turnaround time but with limited capacity. It is only for surgical patients undergoing an aerosolizing procedure and/or needing anesthesia, labor patients, patients admitted from the emergency department or patients directly admitted to the hospital.

WHO CAN GET TESTED

Restrictions on who can get a test have tightened somewhat, but anyone who wants a test can still get a test, depending on the provider.

The health department is no longer testing asymptomatic people who didn’t have close contact with a known case. Smith urges everyone to remember that community testing should be reserved first for people who are uninsured.

“The pandemic has really shown health inequities,” Smith said. “Public health is here to help those who don’t have insurance. It is the safety net of the community for people who can’t access health resources elsewhere. There are people in the community that do need that free service.”

You can still get be asymptomatic and get tested for travel, Harrington said, but that is no longer available for free through the public health department.

At YVMC, anyone symptomatic can get a test, Wirta said. That can be scheduled either through a primary care provider or by the patient online.

Many private providers now offer both types of tests, as well as antibody tests. It is recommended people check both with their primary care doctors and their insurance companies for more information about the criteria, cost and insurance coverage of testing.

On other preparedness fronts amid the current surge, Harrington said for the public health department, “PPE (personal protective equipment) supplies are adequate, but PPE stores could be taxed if we have sustained high levels of use. Nationally, there are still stories about inadequate supplies. I would hate to test the system too much. Fortunately, local entities have had many months to try and build up their stores.”

In terms of public health staffing, Smith said the contact tracers are keeping up with the surge.

“They are a well-oiled machine,” she said. They are doing such an amazing job.”

A few more contact tracers were hired, and they’ve streamlined the process, Smith described. They’ve also increased their capacity for Spanish-speaking contact tracers.

For those who meet the criteria and don’t have insurance, call 970-870-5577 to make an appointment for testing through the public health department and watch the online video about the new self-administered test. For those who are asymptomatic and/or who have insurance, the current recommendation is to contact a private health care provider.


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