Amid nationwide testing shortages and backlogs, one county in our region is offering COVID-19 tests to everyone. A local couple is bankrolling the effort. And it’s not the usual nostril swab. It’s a blood test.
Normally this time of year, real estate agent Teddy Errico would be helping prospective buyers find ski resort getaways. But instead, on a chilly afternoon in Telluride, Colorado, he found himself washing his hands outside a middle school gym.
“Entrez vous,” said a door attendant in a fake French accent, opening the door for Errico to step inside, where benches were doused in enough bleach to stain people’s pants.
“How are you for blood draws? First stick they usually get you?” asked one of the staff as Errico progressed to the blood draw station.
While tests have been rationed in most of the country, San Miguel County is offering a free COVID-19 test to anyone who wants one. First, they tested all the first responders and their families (all of them came back negative). Then they tested teachers and their families. Then people over age 60. And then everyone else.
As of Tuesday, the San Miguel public health department said it had collected blood from more than 4,800 residents, which is more than half the county’s inhabitants.
According to a spokesperson with the county, if someone tests positive it will be assumed that they’re potentially infectious and they’ll be asked to self-isolate for two weeks. In addition, they might be offered a nasal swab test to see if they're actively fighting the virus. People who test negative will get a second round of blood testing a couple weeks after the first, to rule out the possibility that they were too early on in a COVID-19 infection for the test to detect their immune response the first time around. (As an FAQ page from the company providing the tests, United Biomedical, explains, if someone’s blood was taken within 10 days of getting infected with the virus, they might show up as a “negative.”)
Dr. Ajay Sethi is an infectious disease epidemiologist at the University of Wisconsin, Madison. He said results from San Miguel County could prove to be really useful.
“It's an opportunity to get really meaningful data that we’re sorely lacking,” said Sethi.
The usual nose-or-throat swab only picks up if someone is actively ill with COVID-19. A blood test, on the other hand, looks for antibodies. It asks if the immune system has ever encountered the virus before, so it also picks up on people who may have gotten the virus and then recovered, without ever knowing it.
“If there's high uptake for this antibody test,” said Sethi, “We can get a complete picture of how many people are infected in the community, but maybe never needed medical attention -- maybe never even thought to call their doctor.”
And that, he said, could help get a better understanding of how the virus spreads within a community. Sethi has been working on trying to predict when certain hospitals might get flooded with cases.
“In order to forecast where it might go in the future, we’d certainly want to know where most of that transmission is occurring,” he said. “Right now we just don't know, since we're only testing people who are symptomatic and [at] higher risk for severe disease.”
As the Washington Post has reported, a number of health policy experts have said this kind of testing could be the key to “reopen society,” because people deemed recovered are possibly immune so could go back to regular life.
“It’s important to find people who have recovered and who are unlikely to be reinfected, so they can go out and be the buffers for the rest of us,” Charles Cairns, dean of the Drexel University College of Medicine, told Science News. And Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said in late March, “I’d be willing to bet anything that people who recover are really protected against re-infection.”
It’s a little early for that conclusion, according to Dr. Lee Riley, a professor of epidemiology and infectious diseases at University of California, Berkeley School of Public Health.
“Just because you mount an antibody doesn’t necessarily mean you’re protected,” said Riley, who focuses on outbreaks of disease in urban slums, and served in the CDC’s Epidemic Intelligence Service.
He agrees, however, that antibody testing an entire county could be useful in a big-picture kind of way.
“If this is a part of a study, I think it’s worthwhile because that contributes to the knowledge that we need,” he said. Knowledge like: Who really is immune, and for how long? And how fatal is the new coronavirus, if you count all the people who got it rather than just the people who got really sick?
But the testing in San Miguel County isn’t designed as an academic study. And it’s unclear how much, if any, of the data will become available to researchers and the public.
“Right now we’re trying to control new infections and deaths,” said Riley, and putting money and manpower toward blood testing could sap those efforts.
“I think people should be aware that when you do this kind of mass testing you may be taking away the resources from where they’re really needed,” he said, noting that the typical nose-or-throat test is more useful at showing who is actively ill and therefore likely contagious. Indeed, for San Miguel residents whose blood tests positive, the county said it plans to follow up with a nasal swab test, also known as PCR.
Still, even if there were unlimited resources to offer everyone blood tests, not everyone would get it. Even in San Miguel County.
Temojai Inhofe lives in Norwood, a less affluent part of the county (while Telluride puts on Shakespeare in the Park, Norwood’s hosting a rodeo). And while Inhofe said she’s excited about getting herself and her daughter tested, she feared that others in her community may not have the opportunity.
“You have to sign up online. You have to have technology to get the alert that your testing day is today. Or the phone call. Or the email,” said Inhofe. “If you don’t have the luxury of having internet at home, you’re not going to be in the loop necessarily.”
And because of the state-wide stay-at-home order, she says word of mouth isn’t as useful because people aren’t, say, chatting at the grocery store. (A spokesperson with the county said people can register on site, and that flyers advertising the testing have been posted in a number of public places).
“I think there is great potential that the less fortunate and the poorer of our community will be left out because they won’t know,” said Inhofe.
Some countries are working to make antibody testing widely available. In Germany, an epidemiologist told the publication Der Spiegel that, with the help of antibody testing, immune individuals could potentially be issued a certificate allowing them to return to regular life. And in the UK, health officials have promised that do-it-yourself blood tests will be available soon at drugstores and by mail. Supposedly, they’re as easy as a finger prick, with results you can see for yourself in just 15 minutes.
In San Miguel County, it could take more than a week for residents to get their results, since blood samples will be mailed to a lab in New York, where, as a press release put it, “there may be some delay due to the area being especially hard hit by COVID-19.” Back in March, the state health department collected nasal swab samples from 100 people in the county. Two weeks later, results came back showing that three residents had tested positive. As of April 1, the county said it was still waiting on results for 11 people.
This story was produced by the Mountain West News Bureau, a collaboration between Wyoming Public Media, Boise State Public Radio in Idaho, KUNR in Nevada, the O’Connor Center for the Rocky Mountain West in Montana, KUNC in Colorado, KUNM in New Mexico and support from affiliate stations across the region. Funding for the Mountain West News Bureau is provided in part by the Corporation for Public Broadcasting.
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