The role of testing for COVID-19 is changing
STEAMBOAT SPRINGS — Routt County has four new positive cases of COVID-19, bringing the total to 14.
The new cases include one male in his 20s, two females in their 20s and one female in her 60s. The woman in her 60s is the only person who is not a resident of Routt County. All four people are in isolation as per public health order. As of Wednesday, 123 people had been tested in the county.
Testing capability is increasing, but now that COVID-19 is here, the role of testing is changing.
This week, UCHealth began conducting its own in-house testing of COVID-19 kits. With a massive backlog and testing capabilities maxed out at both the state lab and private labs, this will greatly increase the ability of the UCHealth system — including UCHealth Yampa Valley Medical Center in Steamboat Springs — to turnaround test results.
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The molecular, gold standard polymerase chain reaction, PCR, tests, which detect specific genetic material within the virus, are being run for all UCHealth hospitals at the Molecular Diagnostics and Virology Laboratory at UCHealth University of Colorado Hospital.
Depending on the availability of reagent — the liquid testing agent currently in short supply — UCHealth now will be able to conduct a few hundred tests a day with their industry developed test and 500 or 600 a day through their lab-developed test, which is still in the validation phase, said Dr. Richard Zane, chief of emergency medicine for UCHealth.
The industry test is specifically geared toward one test manufacturer’s machine.
UCHealth will now be capable of getting test results in about 24 hours. Because of the back log, test results have been taking as long as a week, though that has started to improve significantly this week.
This does not necessarily mean a wider range of people can get tested. The criteria for getting a test remain very restrictive.
Health care workers and other front line responders, like firefighters and EMS workers, are currently in the top priority group for testing.
People who are hospitalized also are being prioritized. Again and again, local and state officials say they wish they could test more people, but they are limited by lack of resources and strict criteria.
Other countries did test far more and far earlier. Everyone is looking to South Korea as an example of successfully flattening the curve.
Zane noted it’s “science happening in real time,” and that these tests are far more complex than something like a glucose test. Each unique test and testing machine requires a specific reagent, Zane explained. And all of that takes considerable time to develop. It isn’t “plug n’ play,” he emphasized, and it isn’t like “turning on a switch.”
But why the U.S. wasn’t able to simply copy the test already established by the World Health Organization still remains unclear.
“The WHO test was not available to us,” Zane said.
However, the World Health Organization shipped 1.5 million testing kits manufactured in Germany — where the first COVID-19 test was developed for public use outside China — to 120 countries.
In the event of any new virus, the Centers for Disease Control develops its own test. That is standard practice.
However, the failure of the first CDC test, the massive regulations on testing criteria and on private industry to develop their own tests and other factors along the way set the United States back by weeks — and weeks during which testing mattered most.
“The Centers for Disease Control opted to develop its own test rather than rely on private laboratories or the World Health Organization,” according to a March 20 article in the New York Times. “The outbreak quickly outpaced Mr. Trump’s predictions, and the CDC’s test kits turned out to be flawed.”
The Department of Health and Human Services, which includes the CDC, has begun an internal review to assess its own mistakes.
While cases starting showing up in the South Korea at the same time as the United States, South Korea implemented a system of mass testing and isolating cases early on — something the United States failed to do and is still failing to do.
Knowing that people without any symptoms — or very mild — were spreading the virus, South Korea tested people who weren’t sick, while the United States kept strict criteria in place in terms of who can get tested. South Korea also quickly permitted private sector labs to run the tests, which the United States only did in the past several weeks.
When the U.S. was averaging about a dozen tests per day, South Korea — with a much smaller population — was averaging thousands per day.
The FDA finally approved tests other than the CDC’s on Feb. 29.
According to the Colorado Department of Public Health and Environment, the state is prioritizing building mass testing capability, but right now, it is prioritizing testing health care workers and other front line responders. That capability will take a long time to build, state officials said at a press conference on Tuesday.
Is it too late for mass testing?
“The time has passed for large scale testing,” Zane said.
In Routt County, the virus is here. It is classified as community spread and a positive test result for COVID-19 doesn’t change treatment — there is no cure.
A vast majority of the population can self-resolve the illness at home without medical intervention.
“We are past the point where we can legitimately contain it here in Steamboat,” said Routt County Public Health Officer Dr. Brian Harrington. “It is here, and it is presumably more widespread than we know.”
The county is now more in a mitigation phase, he said.
But there is always a case to be made for testing, Harrington said. Other areas may still have hopes of containment — or if not containment, better tracking before the numbers get too high and present evidence of community spread.
But with limited resources, it must be accepted that not everyone who wants a test can get tested at this time.
“Our prioritization for testing right now is to maintain the health care workforce,” he said.
If they test negative, they can get back to work. If more people could get tested and have that knowledge, Harrington observed, more people could go back to work more quickly across every private and public sector.
Testing is also vital for patients who are hospitalized to determine course of treatment.
And, it can play a role in the future in the event the virus goes through a resurgence, and can be isolated and contained more quickly.
“We still need to monitor it down the road,” Harrington said.
And that is why, right here, right now, the stay-at-home and social distancing measures are so important. They aren’t hopeful guesses — they are evidence based and can save lives by minimizing the spread and ensuring the local health care system can keep up with cases that require hospitalization.
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 email@example.com 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.
- People should wear a mask when going out in public.
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