Local testing capacity to meet increased demand

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

STEAMBOAT SPRINGS – As the number of COVID-19 cases rises in Routt County, with numbers far exceeding the spring surge, local testing capacity – at present – is relatively good .

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

The Colorado Department of Public Health and Environment reported 519 cases in Routt County on Sunday, showing the county has been increasing by about 100 cases per week since early November.

Routt County Public Health Director Roberta Smith said community screening days “are pretty busy.”

At the Steamboat Emergency Center, “our testing is at an all time high,” said physician / owner Dr Jesse Sandhu. “We’re pretty much solid every day.”

At the hospital, “we’re really seeing demand growth as the virus rises everywhere,” said James Wirta, laboratory director at UCHealth Yampa Valley Medical Center.

But unlike the spring, Wirta said he kept pace with demand and was able to maintain a constant supply of test materials.

The Routt County Public Health Department recently switched to a new PCR test, called a curative test, according to Smith. This is a self-administered oral swab, and with state support, samples are now being sent to a private lab due to the continuing backlog at the state lab.

PCR test results come back as quickly as 24 hours according to the vendor – a dramatic difference from the July period when a massive backlog forced people to wait up to a week, or even almost two, for the results. results.

While the state labs’ turnaround time had lasted about five to eight days, Smith said, with their new system, the county is able to get results in about 48 hours – sometimes a little longer and sometimes even less.

Results are also reported more effectively via email or text message directly to the patient, Smith said.

Wirta said that YVMC so far maintains the PCR test turnaround time between 24 and 72 hours. Couriers transport their specimens to UCHealth Laboratories in Denver seven days a week, he said. The goal is to continue to increase testing capacity and turnaround time, Wirta said. In August, the UCHealth system was analyzing approximately 1,800 tests per day and now analyzes approximately 3,000 tests per day.

The Steamboat emergency center has contracted with a private lab that guarantees PCR results within 48 hours, Sandhu said.

The turnaround time is a critical component in slowing the spread. When PCR tests take too long to show results, much of the utility in terms of isolating positive cases and tracing contacts is lost.

Testing technology has also improved so that every PCR test does not require what looks like a “brain biopsy.” Both the health department and the emergency center in Steamboat now use saliva PCR tests, and others that still use the nasal swab don’t need to reach this high into the nasal cavity.

ANTIGEN VS. PCR TEST

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

PCR tests detect viral genetic material, said Routt County chief medical officer Dr Brian Harrington, while antigen tests detect protein markers on the virus.

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

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

But there’s a good chance that a negative is a positive.

PCR tests have been criticized for being overly 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 of Steamboat Pilot & Today asking the public health department to publish the cycle threshold (CT value) for each test, which would indicate a more specific amount of the virus. in the body of an individual.

“Given the wide range of serious impacts that these restrictions and quarantines have on individuals, families and the community as a whole, we believe that transparency is essential and that citizens should know the truth about the values of cycle threshold and subsequent accuracy of our COVID tests, ”according to The Letter.

Sandhu said the FDA has instructed labs not to provide this information to patients.

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

Knowing exactly what that degree of specificity means, he said, but at the moment, “we still don’t understand it well enough. … We don’t want people to act on the numbers while we are still studying whether or not the values correlate with the time of infection and how contagious a person is.

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

Because the PCR test is very sensitive, Smith pointed out that people don’t need a negative test to return to work. People who have 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 five to seven days after exposure, she said, which makes it difficult to tell where people are on the infectivity curve if they have contracted the infection. virus.

“The 14 days cover the length of time that you could potentially become contagious,” Smith explained.

Antigen testing represents an increased local testing capacity, Harrington said, but “it should be noted that the positivity rate of our tests is increasing despite the increase in testing. This strongly suggests an increase in the prevalence of the disease in the county. “

Antigen testing is not appropriate if you are asymptomatic and do it before or after travel or before visiting a vulnerable family member, Harrington said.

“Only PCR tests should be used to test a person without symptoms. … If a person has symptoms of COVID and a negative antigen test, they should remain in isolation while awaiting the results of a backup PCR test. Patients with symptoms and a negative rapid antigen test should always undergo a PCR test to confirm that they do not have COVID, ”he added.

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

Zane stressed that “a negative rapid (antigen) test should in no way change your behavior.”

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

However, if you do experience symptoms, the test is good at identifying a positive, and therefore useful in this scenario. Smith said the state has provided antigen testing to the public health department, which is used in targeted screenings, such as in prisons, schools and assisted living centers.

YVMC only uses the PCR test – the “gold standard,” Wirta said. But they have internal capabilities to perform rapid PCR testing, which is performed on a different platform which allows for faster turnaround time but with limited capacity. It is intended only for surgical patients undergoing an aerosol procedure and / or requiring anesthesia, patients in labor, patients admitted to the emergency department or patients directly admitted to hospital.

WHO CAN BE TESTED

Restrictions on who can take a test have tightened somewhat, but anyone who wants to take a test can still take a test, according to the provider.

The health service no longer tests asymptomatic people who have not had close contact with a known case. Smith urges everyone to remember that community testing should be reserved primarily for the uninsured.

“The pandemic has really shown inequalities in health,” Smith said. “Public health is there to help those who have no insurance. It is the community’s safety net for people who do not have access to health resources elsewhere. There are people in the community who need this free service. “

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

At the YVMC, anyone with symptoms can be tested, Wirta said. This can be scheduled either by 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 that people check with their primary care physicians and insurance companies for more information on testing criteria, cost, and insurance coverage.

On other preparedness fronts amid the current outbreak, Harrington told the public health department: “Supplies of PPE (personal protective equipment) are adequate, but PPE stores could be taxed if we maintained high usage levels. Nationally, there are still stories of inadequate supplies. I would hate to test the system too much. Fortunately, local entities have had several months to try to build their stores. “

In terms of public health staffing, Smith said contact tracers were tracking the outbreak.

“It’s a well-oiled machine,” she says. They do an incredible job.

A few other contact tracers were hired and they streamlined the process, Smith described. They have also increased their capacity for Spanish speaking contact tracers.

For those who meet the criteria and do not have insurance, call 970-870-5577 to make a screening appointment with the public health department and watch the video online