As questions about COVID-19 abound, public health officials try to provide answers
STEAMBOAT SPRINGS — When it comes to curbing a pandemic, testing is the cornerstone. Without testing, experts say you are flying blind.
“We have a simple message for all countries: test, test, test,” said Dr. Tedros Adhanom Ghebreyesus, head of the World Health Organization, on Monday, March 16.
Now that the virus is here in Colorado and Routt County, the best hope is to identify and isolate cases and slow the spread.
“There is certainly a need to have more testing done, and we are working with our health care partners to make sure they are more widely available,” said Rachel Herlihy, the state epidemiologist for the Colorado Department of Public Health and Environment, during a news conference Wednesday, March 18.
Fighting pandemics requires a comprehensive approach, Tedros said, which includes social distancing.
The restrictions aimed at social distancing placed on the Yampa Valley in recent days are painful and dramatic. Restaurants and bars are facing mass layoffs. Schools are closed for at least two weeks. Government facilities are shuttered to the public.
Steamboat Resort — the community’s winter economic engine — is shut down. People are being asked to stay at home as much as possible.
In a time of great stress, the places many go to relieve that pressure, depression and anxiety are closed: skiing, places of worship, support groups, gyms and yoga classes, restaurants and bars. And people are advised not to gather in groups larger than 10 people.
And no one knows how long this will last.
“If we could do more testing, we would,” said Routt County Pubic Health Officer Dr. Brian Harrington. “Local providers are very frustrated by the testing limitations and criteria restrictions.”
On the state level, Herlihy continues to say in daily press briefings that the state health department is working with commercial labs and the federal government to increase testing capacity.
Currently, people are required to have a referral from a doctor to get a test.
The state lab can only handle so much, Herlihy said, and they are relying on private companies to start bearing more of the load.
“There have been limitations on resources, and that has been challenging to implement the surveillance testing they need to be doing,” she said. “We are working to identify more resources.”
In an ideal world, Harrington said, “We could do full contact testing of any confirmed case, as well as community surveillance testing to determine its prevalence in our community. Aggressive early testing could identify cases early and isolate them. Lacking this more refined public health tool, we have to resort to more of a hammer approach and metaphorically whack it with widespread activity and facility closures.”
But numbers do indicate testing capacity at the federal, state and local levels is ramping up.
On March 16, 25 people in Routt County had been tested. As of Wednesday, March 18, that number had more than doubled to 68.
On March 11, about 300 people had been tested through the state lab, and by Wednesday, the total had risen to 2,328.
There are still only two confirmed cases of COVID-19 in Routt County. Those individuals, both out-of-state-visitors, remain in quarantine. However, on Tuesday, the county was alerted to a group of international visitors to Steamboat testing positive after they returned home to Australia. So far, seven out of the group of 30 have tested positive for the virus.
Because of that, Routt County is now considered an area of community spread, because officials don’t know where the Australians contracted the virus.
“We are prioritizing testing in certain areas in order to better understand where and how much transmission is occurring,” Herlihy said. “It’s critical that we are gathering data in all areas of the state, especially areas where there hasn’t been a lot of testing.”
Where can I get tested?
First, talk to your primary care provider.
On Saturday, March 21, the state health department, in cooperation with Routt County Public Health and the Colorado National Guard, will bring a mobile test collection site to Steamboat, according to county officials. The site will tentatively be open from noon to 5 p.m. at The Meadows parking lot.
People who come to be tested at the state laboratory testing site must bring:
1. An order from their health care provider confirming they meet the testing criteria and need to be tested; and photo identification that matches the name on the provider’s order.
2. Undocumented individuals can use any photo ID; it does not have to be government-issued.
3. Testing is free, and proof of insurance is not required. If the person does not meet the criteria to be tested, they will not be tested. If there are multiple people in one vehicle, each person must have their own doctor’s order.
On Monday, March 16, the state department of health, in partnership with UCHealth, opened a COVID-19 Specimen Collection Center at the intersection of U.S. Highway 40 and Walton Creek Road.
Hours of operation at the UCHealth center will be expanding on Thursday, March 19, to 9 a.m. to noon and 1 to 4 p.m. Monday through Friday. The only patients who will be screened are those with a provider referral after the patient has met screening criteria and has a doctor’s order.
This is not a screening center for the public at large. No medical care is available at this location.
Why aren’t we testing more?
So why has the U.S. only tested about 60,000 people, when South Korea is testing about 10,000 people every day? To date, South Korea has tested over 290,000 people, even though the first case in South Korea was discovered about the same time as in the U.S.
Criteria set by the Centers for Disease Control for who can be tested started out very tight — patients had to meet strict criteria scenarios that involved travel to certain countries and direct contact with another person with COVID-19. Those standards were gradually loosened, and now, testing largely relies on patients getting approval from their personal doctors. But even if they wanted to, doctors can’t test everyone who wants a test.
“In a nutshell, there is very little capacity at the state or federal level to run tests,” Harrington said. “A primary reason the testing criteria are so restrictive is because the capacity to run tests is so limited. The criteria thus prioritizes the most important groups to get tested.”
Herlihy said those prioritized groups include people who are very sick, people with chronic medical conditions, people 60 and older, health care workers and others on the frontline of the response to the coronavirus outbreak.
Routt County Public Health Officer Dr. Brian Harrington gives the following advice:
• If sick, stay at home and isolate yourself from others. Do not work.
• If sick and you have a known contact with a positive COVID-19 case, call your provider or a nurse help line to discuss whether you merit testing.
• If sick and you are a high-risk person, call your provider or a nurse help line to discuss whether you merit testing.
• If sick and have concerning symptoms like shortness of breath, call your provider or a nurse help line to discuss whether you merit.
• No one can just walk up to a test collection center. They will need a provider’s test order, which requires them to first be screened by a provider. This screening can occur over the phone.
• If you are sick and want to get a test, do not just walk into an emergency room or clinical facility. Call the facility first or a nurse help line. Please be considerate of other people in the community, especially our most vulnerable, and avoid exposing them to your illness whether or not it might be COVID-19. This is about all of us.
Social media has been flooded with personal stories about sick people trying to get tests only to be denied, often by multiple doctors and locations.
The issue most certainly isn’t one of demand.
On March 12, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told a U.S. House of Representatives committee that the U.S. health system just isn’t designed for universal testing.
“The system is not geared to what we need right now — what you’re asking for,” Fauci said. “That is a failing. It’s a failing. Let’s admit it. … The idea of anybody getting (a test) easily the way people in other countries are doing it, we’re not set up for that. Do I think we should be? Yes. We’re not.”
There are ongoing investigations as to why the Centers for Disease Control took so long to mass-produce tests. A week after the CDC said they were going to ship out test kits to public labs, they announced there was a problem with the kits. The agency also placed the severe restrictions on who could get tested. There also has been much scrutiny on the Trump Administration’s 2018 decision to disband and not replace the executive branch team responsible for coordinating a response to a pandemic.
There’s another critical side to the need for more testing, Harrington noted.
“Not only does disease testing help us with medical and outbreak management, but it can help society to function,” Harrington said. “In our current state of limited information and high concern, knowing a person is negative for the disease could help employees, employers and the general public have better confidence in returning to work and public interaction.”
Asked how long it will take to see whether these drastic social distancing measures are working, Fauci estimated several weeks or maybe longer at a White House press briefing on Tuesday, March 17.
“We have also seen a rapid escalation in social distancing measures, like closing schools and cancelling sporting events and other gatherings, but we have not seen an urgent enough escalation in testing, isolation and contact tracing, which is the backbone of the response,” Tedros said of global health efforts. “Social distancing measures can help to reduce transmission and enable health systems to cope. … But the most effective way to prevent infections and save lives is breaking the chains of transmission. And to do that, you must test and isolate.
“You cannot fight a fire blindfolded,” he added. “And we cannot stop this pandemic if we don’t know who is infected.”
However at this time, because of the limited resources, local and state officials are advising people experiencing flu-like symptoms to stay home and contact their primary care provider if they are concerned they have been exposed. And there is no guarantee you will be able to get tested.
Harrington said there is a point when it simply becomes accepted that a virus exists through the community, and there isn’t a need to confirm that.
Testing is finally starting to increase, which most likely means cases will increase simply as a function of more testing.
Before immediately heading to the hospital, people who are exhibiting symptoms of COVID-19 have several resources, including:
- The Colorado Department of Public Health and Environment is providing a phone line to answer questions from the public about COVID-19. Call CO-Help at 303-389-1687 or 877-462-2911 or email firstname.lastname@example.org for answers in English and Spanish, Mandarin and more.
- UCHealth Yampa Valley Medical Center offers Ask-A-Nurse, a 24/7 call line staffed by registered nurses who can assess symptoms and provide advice on seeking care. In Routt County, Ask-A-Nurse can be reached by calling 970-871-7878.
- Virtual Visits can be done from the comfort of your home and only require a computer or tablet with a working webcam, speakers and microphone, or a smartphone.
- If patients are experiencing severe symptoms or having difficulty breathing, they should visit the hospital’s emergency department.
Take precautions in everyday life:
- Frequently and thoroughly wash hands with soap and water for at least 20 seconds. If soap and water are not available, use hand sanitizer with at least 60% alcohol.
- Cover coughs and sneezes with a tissue, then throw the tissue in the trash, or use your inner elbow or sleeve.
- Avoid touching your eyes, nose and mouth with unwashed hands.
- Stay home if you’re sick and keep your children home if they are sick.
- Clean surfaces in your home and personal items such as cell phones, using regular household products.
- Be calm but be prepared.
- Employees at businesses and customers are required to wear a mask, according to a statewide public health order.
- Limit distance between non-household members to 6 feet when indoors and outdoors.
- The maximum group size for indoor activities is 10.
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