How Can I Get a COVID-19 Test?

Montrose County has 5 different ways for the community to obtain COVID-19 testing:
  1. By order by Montrose County Public Health
  2. By order of a healthcare provider licensed to order laboratory diagnostic studies
  3. By order of a long-term care facility medical director following CMS regulations for staff and vendor testing on a frequency determined by CMS dependent on the percent of tests returning positive within that facility’s area
  4. Employer-provided testing through their occupational health department or contract
  5. Direct-to-consumer lab ordering and specimen collection (the consumer orders their own test without a healthcare professional’s direct involvement).

I Don’t Have a Primary Care Provider. Where Can I Find One That Is Accepting New Patients?

Call the Montrose Memorial Hospital Physician Referral line at 970-240-7374 for an up-to-date list of local physicians that are accepting new patients.

Where Can I Get Antibody Testing?

City Market offers COVID-19 antibody testing on walk-in or appointment based system. The cost if $25 each that can be paid in cash or with an health savings account (HSA) or flex spending plan. Unfortunately billing insurance is not available at this time. To schedule an appointment patients can visit www.Kroger.com/antibody

The test takes 1 drop of blood from the patients finger and will have results in 15 minutes. It tests for IgM (short term) and IgG (long term) antibodies.

What is the Testing Policy of Montrose County Public Health?

Public Health carries out testing for suspected and confirmed outbreak sites. Long-term care facilities carry out surveillance testing of their employees and vendors. The medical community carries out testing for non-outbreak illness and exposures that the clinician determines reasonable. Public Health follows up on all positive cases to determine any case links that might suggest an outbreak and to identify close contacts for purpose of education and support in quarantine or isolation efforts.

Montrose County has secured the Event Center for use by Montrose County Public Health and Montrose Memorial Hospital for specimen collection. This allows for a drive through testing option (order required). Several medical offices in town offer on-site specimen collection including send-out and rapid testing options. After December 30, 2020, the Event Center will no longer be available for specimen collection. Decentralization of specimen collection will be key to ensuring access to specimen collection for those who need testing and Montrose County has been working with stakeholders for months to ensure a smooth transition.

Montrose County does not possess a State sponsored specimen collection site and never has. There is not the financial, human capital, clinical, or public health benefit to open access (no order required) specimen collection due to the nature of the diagnostic tests being used, the current public health orders related to isolation and quarantine, and the distraction from the basic public health preventative measures that do not involve testing. A non-test best prevention strategy is the most effective for reducing the negative impact of this pandemic on Montrose. In select populations, a frequently administered surveillance testing program may be appropriate, such as for employees in long-term care settings.

Montrose County continues to promote the basics of prevention and mitigation, which are social distancing, mask use, hand hygiene, isolation of the sick, and quarantine of the exposed to someone who is sick. A test-based mitigation strategy correlates (not causally linked) with a higher case rate, a higher death rate, fewer community outbreaks, and tighter restrictions on social and economic activity. Higher testing frequency does not correlate with fewer hospitalizations. A review of metropolitan areas in Colorado reveals a high testing rate, a high case rate, and high hospital bed occupancy. Conversely, Montrose has a relatively low testing rate, relatively low case rate, and low hospital census. This all may reflect disease prevalence variations across the State.

Limited public health resources, increasingly constrained as the year comes to an end while the pandemic continues, must transition specimen collection and testing to its eventual place in the medical sphere. Never in modern history has mass testing been conducted by public health on such a scale and for such duration. This is not the primary function of public health, but rather the medical community. Montrose County is a partner to our excellent medical community but it is not in the interest of the public to overtake the medical community’s long entrusted role as diagnosticians who use studies when appropriate in the care of their patients. Public Health also does not have the human capital to carry out the level of demand for specimen collection. We must depend on our medical community to support any pandemic response.

The most effective public health intervention is prevention followed by mitigation and containment. Continuing to message, model, educate, and enforce the basics will lead to the greatest spread reduction. Testing will complement those efforts to prevent spread into high-risk populations such as long-term care facilities. Testing, when conducted using public resources, should be reserved for someone who a public health official believes presents a public health concern and where the test result will further the aim of mitigation and containment, such as in outbreaks.

A test result in someone with or exposed to another with symptoms of COVID is not released from isolation or quarantine early. The misunderstanding that it does is likely a contributing factor to ongoing spread. The more messaging focuses on testing, as testing is currently available, and away from prevention, the more spread we will have. Testing as is currently available often detects the virus far after one’s peak infectious period. Therefore, it is not a substitute for distance and mask use.

As Montrose County receives doses, it will distribute vaccinations. Testing options will continue to come on-line and become more affordable. At the same time, public funding will dwindle. More community clinics will take on specimen collection which will broaden access. More offices will acquire rapid point-of-care test equipment and higher compliance with isolation instructions will be seen. These efforts, along with increasing vaccination, will continue to mitigate. Likely in the 2nd quarter of 2021, Public Health and the Emergency Operations Center will support a mass vaccination effort and then, once enough of our neighbors have beat this virus or have been vaccinated, we can gradually return to a socially close and maskless society where business is free to fill to their occupancy limit. Eventually, we will close the book on this pandemic. Until then, we must remain diligent, dedicated, and determined.

Our mission from the Emergency Operations Center (EOC) is to Save Lives. Save Jobs. First and foremost, we want people to be safe and not suffer morbidity or mortality from COVID-19. We also must balance the strength of public interventions with the important mission of savings jobs. Testing is not a top-five public health intervention and may encourage some to leave isolation or quarantine prematurely.

Please click here for the Pandemic Response Update for the Montrose County Board of Health, issued November 20th, 2020.

 

What is the History of COVID-19 Testing in Montrose County?

During the early part of the pandemic, local public health was not supplied with test kits. Our local hospital, Montrose Memorial Hospital, was able to convert viral transport media that it had for other laboratory testing and additional supply of that media for COVID-19 testing purposes. At great expense of human and financial capital, the hospital lab personnel separated their media into different kits and made these kits available to clinicians, patients, and public health at no cost. Because the supply was limited, testing criteria were tight. At this time, limited testing was endorsed by all major public health agencies due to the limitations in supply. As the pandemic progressed, the State of Colorado was able to acquire more collection kits with appropriate media and then began to ship those supplies to hospitals and local public health.

Using hospital resources and using Montrose Memorial Hospital lab to process the orders required a provider order. It was a way to be respectful of the limited supply of tests and the limited supply of specimen collectors within the county. Montrose County continues to use Montrose Memorial Hospital’s lab to handle the vast majority of specimens collected within Montrose County. This has served the County well on several fronts.

This allowed for “one source of truth.” This was instrumental to our Emergency Operations Center, Medical Response Team, Hospital Incident Command, and Board of Health for situational awareness that shaped policy discussions early in the pandemic response. Montrose Memorial Hospital recorded all test results into their electronic records system. This allowed for transparency of data when the ill presented to the emergency department anywhere on the Western Slope where, through our regional health information exchange, that clinical team could readily know what testing results were. This prevented unnecessary delays in care, the unnecessary expenditure of limited PPE supplies, and prevented inappropriate exposures to healthcare personnel.

Over the term of the pandemic to date, the local public health agency has become the source of truth as all sources of Montrose County resident specimen collection (within Colorado) can be linked back to our datasets if that data is known to the State surveillance program. However, we have not solved the need for data transparency to our medical teams for all positive results (on an as-needed data query basis through hospital records or the regional health information exchange) unless that test either goes through the State reference lab or Montrose Memorial Hospital.

Using newer State contracted vendors, such as MAKO and Curative Labs does not get that test results back to the health information exchange automatically, at least not currently. That leaves our healthcare professionals working in the dark if a sick patient were to present for acute care. Public Health will submit a file of positives in a secure fashion to the health information exchange so that at the minimum, a patient’s healthcare team can access the test result if and when needed.

Additionally, by partnering with Montrose Memorial Hospital, we gained the workforce that the local government did not possess to handle the growing demand for specimen collection and processing. That freed up limited public health resources to focus on preventative measures. Initially, public health had one registered nurse (RN) and a couple of assistants (including a volunteer from the local school district) that would do all specimen collection. This quickly became overwhelming.

The Hospital offered to lend support for collection efforts at no cost to the County but at great cost to themselves. It was fortunate that they did else we could not have sustained with the growing demand. Eventually, the County allocated CARES funding to the support of specimen collection carried out by Hospital specimen collectors. Public Health also trained interested clinics in the County on safe and appropriate specimen collection and the EOC distributed PPE to those clinics for safe specimen collection. This support allowed our RN and her assistants to return to their other public health duties, which did not go away.

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What are the Local Financial Implications of Testing?

  • May be generating around $100,000 in avoidable costs per 1,000 samples (we are currently collecting around 1200 samples per 14 day period) due to false positive and false negative results (22). This could be a cost of $3,096,000 a year in Montrose County.
  • There is a lack of a financially sustainable specimen collection and handling model without tax increases or government service reduction and shifting budgeted expenses. A sizeable payer source runs out at the end of 2020.
  • Even if there were a sustainable financial model for direct-to-consumer COVID specimen collection, local public health lacks the staffing to perform specimen collection and handling to the degree necessary for community screening or large scale testing operations (even current testing levels). Surrounding county public health agencies have either contacted our local public health indicating their inability to sustain an open testing model or they have had to call in State resources to back up testing operations. We need decentralized specimen collection with rapid results. This could be managed by getting all clinics in the county to do specimen collection and would be best if each had in-house POCT options with confirmatory testing as a backup.

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What is the Future of COVID-19 Testing?

The following is simply a potential list of things to come over the 6 months but does not imply a plan, endorsement, or guaranteed path. With an impending vaccination, a depletion of public funding, consumer demand for better access to COVID-19 testing, manufacturer interest in market capture, and CDC’s interest in spread mitigation, the following may occur in the near term:

  • Testing will decentralize. Oral swab collections will soon be the normal means of specimen collection for PCR based testing. This will be performed at most clinics in Montrose, the hospital, and as confirmatory tests for associated healthcare facilities performing surveillance testing.
  • Rapid testing equipment will be implemented in most healthcare facilities. A positive test will be followed by a confirmatory PCR based test.
  • Eventually, vaccinations will start to become available but it will be 5-6 months before the general population is participating in mass vaccination. In the meantime, low cost, low specificity, but adequate sensitivity tests will become market available for employers or individuals to use frequently, maybe even daily, that will cost around $5 per trial. After mass vaccination, this style of testing will no longer be relevant.
  • Contact tracing will become more effective because of faster turnaround times on test results.
  • More widespread detection of cases will force a modification to the existing dial system as case counts increasingly disassociate with healthcare demand.
  • Schools will experience more student absences and if school cohorting rules are not updated to reflect the earlier detection capabilities of more “screening” style community testing using low cost and home-based kits, then the schools will remain in a remote learning scenario.
  • If we could get to daily community screening using a low-cost and self-administered test, then the exposed could avoid quarantine with a daily rapid test resulting in negative until such time that it becomes positive as long as usual public health interventions were maintained and high-risk groups avoided.
  • We will also have better access to treatments, such as Bamlanivimab, for mildly ill individuals who have risk factors. That will help reduce mortality and hospitalizations.
  • Eventually, mass vaccination or herd immunity will stop the pandemic and the virus will settle into one of those known human pathogens that can infect the non-immune. Booster immunizations may be necessary as we learn as a society how long antibodies or memory cell immunity last after immunization or infection

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