Passing the test

The struggle to expand COVID-19 detection as Idaho reopens

By Cameron Rasmusson
Reader Contributor

It’s no mystery how to get Idaho back on its feet in the wake of the COVID-19 pandemic.

From the beginning, public health officials have been beating the same drum: testing, testing, testing. It provides the clearest starting point to determine infection rates in a given area, and it allows for further investigation through contact tracing to provide even more detail about the nature and extent of viral spread. 

Photo courtesy Bonner General Health.

“Without knowing, without testing, it’s like moving blindfolded,” World Health Organization Director-General Tedros Adhanom Ghebreyesus told NPR.

Actually getting testing to the level it needs to be for health officials to make informed decisions is more complicated than it might seem. Health care workers say the supply chain of testing kits has to date been unreliable. Meanwhile, state officials are working to improve supplies in anticipation of ambitious testing goals set by Idaho Gov. Brad Little. 

According to Kristin Carlson, Bonner General Health external marketing specialist, the hospital has tested a total of 563 people as of May 26. To date, health workers have confirmed four cases of COVID-19, none of which are still being monitored. 

The majority of tests are conducted and processed at the BGH lab, with a smaller percentage sent for external processing. 

Bonner General Health has also begun serology testing, which determines whether or not a person has contracted the coronavirus and is producing antibodies. The hospital has conducted 85 of these tests, with 84 negative and one positive. 

Not just anyone can get a test on a whim. Both COVID-19 and antibody testing require an order from a doctor. In the case of COVID-19 testing, the patient must also have symptoms consistent with the viral infection: coughing, breathing difficulty, fever, chills, muscle pain, sore throat and loss of taste or smell. 

It’s important to make sure that tests are put to the best use possible. That’s because there’s no guarantee from week to week how many kits will arrive, Carlson said. Each week, BGH lab managers put in an order for the maximum allowable number of viral tests from medical technology company Becton Dickinson, but it’s anyone’s guess whether or not that request will be fulfilled.

“Some weeks we get our full order, other weeks, only a few,” Carlson said. “This could be due to the manufacturing demands and shortages, or that priority is given to areas with more widespread exposure.”  

Given the circumstances, BGH Lab Manager Cherie Proctor is more or less satisfied with where testing stands. Yet, she also sees a need for greater volume. 

“The biggest issue with testing more people has been a shortage of supplies,” she said. “If I had the ability to test 10,000 people I would be more satisfied, but I think the [doctors ordering the tests] have done a fabulous job screening patients and testing appropriately.” 

In the meantime, curbside COVID-19 testing is available through the BGH Emergency Department, Monday through Friday from 11 a.m.-1 p.m. 

“Based on the availability of COVID-19 testing, it is still the emergency physicians’ discretion whether or not to test an individual,” Carlson said. “We try to test everyone who fits the criteria; however, day-to-day availability of test kits is the determining factor.”  

Testing may become more freely available if state officials are able to successfully implement the governor’s strategy for a dramatic expansion of COVID-19 testing. The plan, announced May 22, aims to facilitate an economic reopening of Idaho while limiting the risk of a secondary outbreak — and another shutdown.  

“A strong economic rebound can only occur with a combination of efforts, and expanded and targeted testing is a big part of our strategy,” Little said. “We have an impressive team of very capable local clinical and laboratory and research experts from across the state helping us navigate this crisis, and I sincerely appreciate their help.”  

The new guidelines categorize candidates for testing in five levels of priority. Priority 1 includes the most at-risk individuals — symptomatic health care workers, hospitalized individuals or nursing home residents, for instance. Priority 5, comprises the lowest-risk category of Idahoans. This includes asymptomatic individuals who have recently used commercial transportation, worked at crowded events or participated in contact sports. 

Testing will need to ramp up dramatically to meet the goals set by the state. According to Boise State Public Radio, 43,000 tests per week are needed for the first two priority groups alone.

Meanwhile, Little said the federal government supplied Idaho with 40,000 tests for the month of May, with another 40,000 expected for June. 

The testing plan arrives as Idaho prepares to enter Stage 3 of the “Idaho Rebounds” phased approach to reopening. Scheduled to be announced by Little on May 28 and begin Saturday, May 30 — assuming Idaho meets guidelines for new cases of COVID-19 — the stage allows for higher-risk businesses like bars to reopen if they meet safety guidelines. Even more relaxed standards will go into effect Saturday, June 13 if new cases trend downward.  

The challenge now facing the state is dramatically ramping up testing to the thousands of tests per week recommended by the governor’s Testing Task Force. To aid in the expansion of COVID-19 testing capability, the U.S. Department of Health and Human Services is sending $56 million to the state, according to a report from the Associated Press. It’s unclear yet exactly how that money will be spent. However, the funds are contingent upon a plan to test 2% of Idaho’s population. 

“The takeaway message from these recommendations is that we will need to build incredible testing capacity plus the ability to respond to all of those results with appropriate clinical and public health follow-up care, if we hope to provide wide-scale and repeated testing for all Idahoans who may need to be tested,” said Dr. Christopher Ball, chief of the Idaho Bureau of Laboratories and co-chair of the Testing Task Force.

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