What the numbers mean: Desire for COVID-19 case counts gets complicated | SteamboatToday.com

What the numbers mean: Desire for COVID-19 case counts gets complicated

Melissa Uchitelle-Rogers, a registered nurse with UCHealth Yampa Valley Medical Center, collects samples Friday from a patient at the UCHealth specimen collection near Walton Creek Road in Steamboat Springs.
John F. Russell

STEAMBOAT SPRINGS — After seeing news reports about new COVID-19 cases at Casey’s Pond and within the Steamboat Springs school system, Routt County Commissioner Tim Corrigan wondered if there was cause for concern.

“Are we in the middle of a big outbreak and we just don’t know about it yet?” Corrigan said. “It was frankly a little bit frustrating to have that much disease prevalence taking place and the public, let alone us, not really finding out about it until seven or eight days later.”

County commissioners have expressed a desire to report new cases more frequently. But getting reliable numbers to then update the county dashboard is not a small task.

“When we get cases we have to adjudicate them and either pass them to another county. It does take a while,” said Roberta Smith, Routt County Public Health director.

To update the dashboard, county health officials need to have accurate and complete case information from the Colorado Electronic Disease Reporting System. This information is then cross-referenced with the county’s own internal tracking of cases.

While data is complied using automated computer scripts, there is normally differences that need to be investigated and rectified before it is ready to be published.

Often times, health officials are aware of and investigating a positive case before it shows up in the state’s reporting system.

“In addition, many of our community partners are doing antigen tests or they are using laboratories that are not connected to the state laboratory system,” said Nicole Harty, county epidemiologist and data manager. “Because of this fact, many of the results are communicated to public health via phone call and then manually entered into (the state’s electronic reporting system).”

Currently, the county’s dashboard is updated on Tuesdays, reflecting cases that were found between the Monday and Sunday of the previous week.

That data is updated again on Fridays to add any cases that may have been found during the same Monday to Sunday span, but test results were unavailable when initially updated.

For example, if a test was conducted on Sunday, the results may not be known until Wednesday. The county dashboard then would not be updated again until that Friday.

While each praised the work county health officials are doing, Corrigan and Commissioner Doug Monger suggested that more frequent updates could inspire people to make smarter decisions to protect themselves and others from the virus.

“Public health is very focused on the work that they are doing to control the spread of the virus and from a professional level, they are doing all of the things that are necessary,” Corrigan said. “But I think there is a point at which the curiosity of our citizens is something that needs to be addressed.”

Corrigan said that it is the responsibility of policymakers like him to work with the health department to get that information to people.

“I think all of us have been lulled into a little bit of a false sense of security because our case load has bubbled along at this lower level for so long that when we receive these weekly updates … (people think) everything is kind of okay,” Corrigan said. “Well, as we just found out everything isn’t so OK.”

How important is the data?

County spokesperson Robin Schepper said they are looking to explore new ways to convince people to follow the county’s five commitments of containment.

“We are in this long-term battle against COVID-19 and we have to practice the five commitments to containment regardless of the case count,” Schepper said.

Health officials have been preaching hand washing, mask wearing and social distancing for months and that message hasn’t changed, Schepper said. What may need to change is who is delivering the message.

“If we could try to get more people from different walks of life,” Schepper said. “People see public health and think ‘government is telling you what to do again.’ … Perhaps we need to try with other people that are well respected in the community and can reach different markets, different target audiences.”

Health officials also have to walk the line of releasing data that informs the public, but is not so specific that those who receive a positive COVID-19 test result become identifiable around town.

“Communicable disease information cannot be released in a manner where it would be identifiable in a community,” Harty said. “Due to our relatively low numbers, this could potentially reveal someone’s identity and break disease reporting privacy rules.”

But, in a form of COVID-shaming, people have been calling the police to report that someone they believe has tested positive and is out in public instead of quarantine.

Steamboat Springs Police Department officers have fielded a handful of such calls. When someone calls to report seeing someone out and about who recently tested positive for COVID-19, officers try to make contact with the person, verify if they had tested positive and then would investigate any contact they may have had.

Officers have yet to come in contact with someone that has tested positive in response to any of these calls.

How the county reports new cases has evolved since the onset of the pandemic in March.

Early on, new case information was not automated, so a nurse had to call around to each clinic that was conducting tests to learn how many tests were administered and what the results were — a cumbersome task, especially for a health department that was still being staffed.

“We didn’t hardly have a public health department until June of last year, slowly building it up. Then of course COVID hit and, just like everyone else, we were scrambling to respond,” Corrigan said.

Frequent updates required county officials to include how many tests were still pending which eventually became too difficult to keep track of accurately. Sometimes the county would report a case that the Colorado Department of Public Health & Environment would later decide belonged to a different jurisdiction.

This led to county officials removing cases from the total case count, which sometimes drew suspicion from the public.

“That became a challenge where the numbers would change by one or two or three, and our armchair epidemiologists, I think, thought that we were trying to manipulate data,” Schepper said. “But we have no control of what Colorado would deem a Routt County case versus somebody else’s case.”

Discrepancies in the reporting structure still exist as state officials count cases based on when the results of a test are received, where the county tracks them by the day the test was taken.

“We strive to provide the most accurate data to inform the community,” Harty said. “We still need to be intentional in our actions and heed the county’s five commitments campaign.”

Want to get tested for COVID-19? Here’s when, where, how and why.

Should I get tested?

Sure, why not? Diagnostic testing is widely available and insurance companies are required by law to cover it. Cases are increasing locally, across the state, and across the country. And epidemiologists only predict it will get worse with cold weather and as people spend more time indoors. Everyone is sick of it, but now — as much as ever — it is time to remain vigilant in order to protect the most vulnerable in the community, keep our local health care resources from being overwhelmed, and keep our schools, businesses, and public places as open as possible.

If you don’t have insurance, make an appointment through the Routt County Public Health Department, or at the South Routt Medical Center in Oak Creek.

If you are exhibiting symptoms, you should definitely get tested, and self-quarantine until you receive your results. COVID-19 is a respiratory disease. Its primary objective is to attack the lungs. However the symptoms can vary widely, and it can be difficult to distinguish COVID-19 from influenza or the common cold. One of the most distinguishing symptoms is the loss of taste or smell. If you have questions or concerns, call your health care provider.

Symptoms may appear two to 14 days after exposure to the virus. People with these symptoms may have COVID-19:

  • Fever or chills
  • Cough
  • Shortness of breath or difficulty breathing
  • Fatigue
  • Muscle or body aches
  • Headache
  • New loss of taste or smell
  • Sore throat
  • Congestion or runny nose
  • Nausea or vomiting
  • Diarrhea

Look for emergency warning signs for COVID-19. If someone is showing any of these signs, seek emergency medical care immediately:

  • Trouble breathing
  • Persistent pain or pressure in the chest
  • New confusion
  • Inability to wake or stay awake
  • Bluish lips or face

(Source: Centers for Disease Control and Prevention)

If you have been in close contact with a positive case, you should get tested.

The Centers for Disease Control and Prevention just redefined their definition of “close contact.” Previously, it had been based on being within 6 feet of an infected person for at least 15 consecutive minutes. The CDC now defines close contact as someone who was within 6 feet of a positive case for a total of 15 minutes or more over a 24-hour period — meaning that could be intermittently for just a minute or two at time.

If you don’t have any symptoms, you could be one of the approximately one quarter of people who get COVID-19 but are asymptomatic. Testing, while slightly uncomfortable, cannot hurt.  If you are exposed to numerous different people on a daily basis, it cannot hurt to get tested. And, the county likes to maintain a good number of people who are getting testing on a weekly basis — it is better for a more accurate picture of disease prevalence. Also, the more people who get tested — the lower the county’s positivity rate. However in terms of categorizing disease spread, the Colorado Department of Public Health and Environment relies more on the number of positive cases per 100,000 people.

It is important to remember, however, that a test is merely a snapshot of a brief moment in time. You could contract COVID-19 on the way home from the testing site. You could have just contracted COVID-19 before you take a test, but it is too early to be detected in a test.

Testing is a crucial part of isolating cases and slowing the spread, but testing does not prevent COVID-19. Social distancing, avoiding large group gatherings —especially indoors — washing hands, and wearing a mask can — though won’t always — prevent you from getting the disease in the first place.

What kind of test should I take?

The PCR test remains the gold standard of testing. Those specimens must be sent to a lab, and typically take around 48 to 72 hours for results. And that is a fluid timeline, and can depend on the volume and backlog at the labs, as well as things like the traffic on the interstate.

Several private medical offices in town offer the antigen test, which returns results in about 15 minutes. If you have a positive result, it is very likely you have COVID-19. But still is best to confirm it with a PCR test. If you test negative, there is still a somewhat decent chance you could be positive, and received a false negative, which is a pretty dangerous “maybe.” If you think you were exposed or are exhibiting symptoms, the PCR test is the most accurate test available at this time.

Some places offer a saliva PCR test in addition to the nasal swab, which is a bit less invasive and uncomfortable. Call your provider or any of the providers in town to find out what kind of tests they offer. Some providers are also offering the antibody test, which detects whether your body has created antibodies in response to the COVID-19 virus. However this does not mean that you didn’t have it six months ago, and it doesn’t mean that you are immune. The data is still out in terms of if and for how long people who contracted the disease are immune — and there are a number of variabilities, such as how many antibodies were created depending on the viral load contracted. There are cases across the globe, including in the Untied States, of people being re-infected. Again, call your provider or any of the providers in town to find out if they are doing antibody testing, and verify whether it is covered by your insurance plan.

Where can I get tested? 

Routt County Public Health Department

During the week of Oct. 26, there are two special mobile public health clinics. On Oct. 28, the clinic will be at the Hayden Rodeo Grounds from 10 a.m. to 12 p.m. On Oct. 29, the clinic will be at the South Medical Center from 12 to 2 p.m.

Because of the election, the Routt County Historic Courthouse will not have testing the week of Oct. 26. Testing will resume on Nov. 4.

At that time, testing will be available at the courthouse at the following times:

  • Mondays 3 to 5 p.m.
  • Tuesdays 12 to 2 p.m.
  • Wednesdays 9 to 11 a.m.
  • Thursdays 12 to 2 p.m.

Friday or Saturday clinics will become available as needed, and Wednesdays will be added in other parts of the county.

There are two options to make an appointment:

When you arrive, call 970-870-5342 to let the nurses know you have arrived. Remain in your car in the designated parking spot and a nurse will come to you.

Online appointments are not available for the special clinics in Hayden and Oak Creek on Oct. 28 and Oct. 29.

South Routt Medical Center

Testing is available in Oak Creek at 11 a.m. Monday to Friday. All you need to do is call ahead for an appointment (970-736-8118). No insurance or payment is required. Call when you arrive, and wait for a nurse to come to your car.

Other places to get tested:

  • UCHealth Yampa Valley Medical Center (970-875-2686)
  • Northwest Colorado Health (970-879-1632)
  • Pediatrics of Steamboat Springs (970-871-1900)
  • Sleeping Bear Pediatrics (970-879-2327)
  • Steamboat Emergency Center (970-846-6230)
  • Steamboat Springs Family Medicine (970-871-1323)
  • Yampa Valley Medical Associates (970-879-3327)

The Routt County Public Health Department provides this list. If your provider is not on this list, call them and ask what kind of tests they offer. It is also a good idea to ask about what kind of turnaround time to expect.

Kari Dequine Harden contributed to this report.

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