From MDP: County transitions to decentralized testing as CARES Act funding is spent

Thank you to Katharhynn Heidelberg with the Montrose Daily Press for the below article. The original can be seen by clicking here.

With its share of CARES Act funding due to be spent up, Montrose County is transitioning COVID-19 testing from a central site at the Event Center to medical clinics.

The goal is not to halt testing, but rather, to expand it, Dr. Joe Adragna, Montrose County pandemic specialist, said.

“We want to remove barriers and we think central testing at one location presents challenges to testing when appropriate,” Adragna said Friday.

Since about May, county public health and its partners have worked to decentralize testing and see more sites opened; many private practices have been offering testing for months and more are on the way.

“That idea of getting it into the medical community supports a number of things. The appropriate location for specimen collection and detection is through your doctor’s office. That’s the norm,” Adragna said.

“Even though these are extraordinary times, the eventual place (for testing) will be through doctors offices. There will not always be county — or public health — run test sites around the country.”

Montrose County works with Montrose Memorial Hospital for specimen collection. In April, it was able to broaden test kit availability to local health clinics in hopes of reducing the turnaround time. Since then, testing has become somewhat quicker, depending on the laboratory used.

For a time, testing was through a drive-up location at the hospital, but this transitioned to the Montrose County Event Center in October. This site is for those with a provider’s order or direct contact exposure to a COVID-positive patient.

“Many practices have been doing testing for many months,” Adragna said, spotlighting River Valley Family Health Center, a federally qualified health care center, and PIC Place, which offers a sliding-fee scale, as does River Valley. Adragna also mentioned Pavilion Family Medicine, the Basin Clinic on the West End and his own practice, Peak Family Medicine.

As of Friday, 18,913 tests of Montrose County residents had been done, although not all of these tests occurred in Montrose County, since there are numerous places outside of the county now where the public might obtain a test. Test numbers are ultimately reported to Montrose County Public Health.

Friday, there were 1,458 confirmed cases in the county — and one more death, bringing the total virus fatalities here to 19.

Between Wednesday and Friday, the county logged 58 more positive cases. The two-week positivity rate is 16.3% and there are 365 active cases, along with 10 hospitalizations that were reported Friday. (Patient census fluctuates frequently in any hospital.)

Montrose County at last report remained at level orange — high risk — on the state’s dial framework for COVID-19.

Within the last month, testing rates have tripled for Montrose County residents. Adragna said the county used to record up to 1,100 tests in a 14-day period and now records about 3,000 in a two-week period.

“We feel really strongly that the county, hospital and local clinics continue to work together,” Montrose County Public Health Director Alli Howe said, referring to expanding test sites. “This is actually a way to get additional options for community members.”

Howe encouraged people to keep up to date as to which clinics have testing available by visiting montrosecountyjic.com. The site also contains statistics and other information for the public.

Testing alone will not turn the tide, Adragna said, reiterating a previous message.

Tests can produce both false positives, which keep people from their work and other necessary activities, and false negatives, which result in spread by asymptomatic individuals. Further, people may obtain a test too soon after exposure for the virus to be detected.

Also, people may assume their symptoms are COVID, and thus, go without treatment for other ailments. Adragna cited both instances of strep throat and a cardiac episode, in which the patients had assumed they had COVID symptoms and so, did not seek medical care as timely as they could have.

The above are some of the reasons why it is important to involve a health care provider and also why decentralizing testing from locations where only tests — not treatments — are given, Adragna said.

By turning to health care providers, people can potentially receive tests, diagnoses, results and treatments at the same place, although some point-of-care COVID testing might not be as sensitive as others — all the more reason to loop in a qualified clinician, Adragna said.

More testing sites will better ensure access, he said. There should be about 15 different specimen collection sites in the county, between what is already here and what is coming, he added. He also said Montrose Memorial Hospital is working with Curative Labs to see about setting up a site in Montrose.

“But most importantly, we need the medical community to help with specimen collection and support people connecting with a health care provider. We find in case after case, had somebody just relied on the test, or in cases where they did, their health care was harmed. Testing is not a cure,” Adragna said.

It is paramount to connect with health care providers for appropriate treatment, Adragna also said: “To simply rely on the test independent of that is harmful.”

Howe also reminded the public that COVID is not the only illness that can strike and that although public health plays a big role in tackling the pandemic, it is not a doctor’s office.

“Having that provider’s eyes on community members is really critical,” she said. “We’re just excited to be able to offer more sites for community members as we move into January 2021.”

The county has lately been connecting practices with different labs, plus more testing capabilities are coming online frequently, including antigen and antibody kits. Some antibody kits can provide results within 20 minutes at a point of care provider.

Montrose County received about $2 million in federal CARES Act funding, which went to support public health efforts, affected businesses, the airport, the hospital and testing. That funding will all be spent by year’s end.

“People are saying we’re stopping testing. That is far from true,” Adragna said. Rather, the county is increasing access to testing at a number of sites across the county, plus ensuring long-term care services, including home health, have access to test kits, he said.

Surveillance testing — automatic testing on a weekly or even more frequent basis — among those who care for high-risk populations, or first responders such as law enforcement, needs to have quick results.

“We’re trying to get faster testing results for surveillance tests. It does not help use to know they have COVID two, three, or four days later,” Adragna said.

The state’s current public health order, though, does not allow for long-term care sites to conduct any test other than the PCR method to satisfy Colorado Department of Public Health and Environment testing requirements, per Adragna.

“Without real-time results, we are not going to keep this out of high risk populations. This is impacting all of us,” he said. “It’s real and we’ve got to do better.”

Montrose County’s good working relationship between local public health, the hospital and the medical community has attracted state notice. “We work in lockstep,” meeting frequently to assess needs and the barriers to addressing them, Adragna said.

People should not hesitate to get a test or help because they are uninsured. River Valley and other sites have options for the uninsured, plus there are traditional plans, sliding fees and Medicaid and Medicare.

“If they do not have the means to pay for that care, there are resources in Montrose that can get them health care,” said Adragna.

A vaccine is close to being fully approved and disbursed in Colorado, however, it can by no means cover everyone. The state hopes to implement phase one of vaccine distribution this winter and to the general population by the end of next summer, although this depends on supply and steady administration of the vaccines around the state.

“With the vaccine arriving in Colorado soon, we are one step closer toward ending the crisis brought on by this once-in-a-century pandemic, but we must redouble our efforts to wear masks and avoid socializing these next few weeks,” said Gov. Jared Polis in a provided statement.

“Our top priority has always been to save the maximum number of lives and to end this crisis as soon as possible.”

Montrose County is on the list for receiving some of the first-phase vaccinations and could start receiving them as soon as next week, now that the FDA cleared the Pfizer vaccine Friday, Adragna said.

However, the vaccine is not a magical potion and the supply is limited, with the first to go to critical health care workers.

“It’s not enough to cover everybody. It might be enough to cover most health care workers who have direct contact with COVID patients. We are far away from mass vaccination,” Adragna said.

Even if there were enough vaccines for all Montrose County residents, they would not instantaneously offer protection, as immunity can take up to six weeks to build in the human body.

In the end, people must continue to do what they can to prevent the disease — mask-wearing, hand hygiene, social distancing, avoiding large gatherings, staying home if sick and quarantining if exposed or if positive for COVID.

“We have to stay focused on prevention methods,” Adragna said.