Docs: Don't waste money on blood tests

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After listening to recommendations from medical experts, Ouray Country commissioners decided not to pursue a request from an anonymous citizens who offered to put a payment plan to cover more than $200,000 to test all residents.

Commissioners and health officials consulted with Dr. Drew Yeowell, the country's EMS medical director who is also a Montrose Memorial Hospital emergency room physician, and Dr. Joel Gates, who operates Mountain Medical Center, before making the decision.

Both Yeowell and Gates said they saw little benefit to the community information might be useful in the long run, it won’t provide valuable information to help the community immediately in terms of determining who is sick, he said.

As of Wednesday afternoon, Mountain Medical Center said it had conducted a total of seven tests – more than half of its available supply. Four came back negative. Doctors were waiting on three test results.

Ouray County is just one of 14 counties in the state — there are a total of 64 counties in Colorado — as of Wednesday that had not reported a positive test yet. But health officials have cautioned against reading too much into that figure, nothing the lack of positive test is indicative of the lack of testing in Ouray County, not necessarily the lack of actual infections. Mountain Medical is the only entity in the county to receive tests at this time. Ouray County has ordered 100 tests, according to Health Department Director Tanner Kingery. It’s not known when those tests will arrive or if the quantity ordered will be fulfilled.

Mountain Medical obtained 10 tests after ordering 20, according to Gates. Those tests are the traditional swab tests which indicate whether someone is actively sick with the virus. In a meeting Wednesday, Mountain Medical representative Josie Scoville told county leaders the clinic has used seven tests, and is waiting on results from three of those tests. All the tests so far have been negative.

In the absence of available swab tests, others have pushed for funding an antibody blood test like the one being used by the biomedical company in Telluride.

The anonymous citizen asked the county to commit to testing all county residents and offered to put a deposit the tests, Kingery said, with the understanding the county would ultimately be responsible for the bill. There were several other stipulations to the agreement, including a robust campaign to convince county residents the testing was good for them and to encourage participation, according to Kingery. It wasn’t clear exactly how much money the tests would have cost the county, but Kingery told the group a “partial repayment plan” could be discussed and the person wanted a contract.

“Don’t waste this money on a test that will not help now,” Yeowell said. “It will help with data, it will help with epidemiological data later down the road …It will not help us now.”

Yeowell cited several concerns, including:

- The testing wouldn’t necessarily show who has the virus at the time they take the test. Because the test detects antibodies, it could show a positive result for someone who was exposed earlier, at an undetermined time.

- The testing may result in negative tests for those who have the active disease and are infectious, or for those who have been exposed but don't produce the antibodies.

- The logistics of testing the entire population and having them gather in one place for blood draws may cause more exposure and contagion.

- The amount of personal protective equipment, including gloves and masks, for the tests would deplete already scarce resources. Yeowell said he has been wearing the same mask at Montrose Memorial Hospital for two weeks to conserve supplies.

- The testing process may expose medical personnel to the disease and put them at risk for infection.

- The results may be confusing to the public. In the case of an antibody test, testing negative isn’t necessarily good in this case because it means someone is still vulnerable to contracting the virus. Yeowell cited the potential for these tests providing a false sense of security to people in a time where community spread of the disease is the main concern.

Yeowell told commissioners he absolutely does not recommend using the blood tests at this time.

“It is going to be more of a public danger getting this test than it will be a benefit," he said.

Yeowell said the same testing was offered in Montrose Country for $24 per test, and the county opted not to pursue it for the same concerns he raised during the meeting with Ouray officials.

Yeowell said a small benefit to the blood test for antibodies would be to find out if health care professional had already been exposed and had some immunity built up. Gates cited “peace of mind" as a possible benefit, just so people saw some form of testing was going on and had something instead of nothing.

But, “it won’t change the direction of the medical care that we would advise,” Gates said.

While blood testing might make folks feel like someone is doing something, “The reality is it’s not going to change what our advice is for those patients that turn up positive.”

The only other benefit to the antibody blood test being conducted in San Miguel County at this time is for research, the doctors concurred.

“It is not useful during an active pandemic. It is very useful in analyzing the epidemiological data later,” Yeowell said.

Gates said it’s not clear whether a person could be reinfected if they tested positive on the antibody blood test being used in San Miguel County.

“The science is not great at helping us even know if they would need to use PPE (personal protective equipment) or not,” he said.

After listening to the recommendations from medical professionals and fielding questions, the commissioners agreed to not proceed with the antibody blood tests.

“What I’m hearing you say is basically that from a research standpoint and for information standpoint doing these tests might have benefit for the public in the long term,” said Commission Chairman Don Batchelder. “But you don’t see given the assets we have available how it is going to be beneficial right now."

In the absence of widespread testing, medical professionals are continuing to recommend social distancing, hand washing and taking other precautions to sanitize areas and limit contact with others who may be infected. Yeowell said at this time, it appears a person could shed the virus for four days prior to showing symptoms, so it’s especially important for people to keep their distance as they wouldn’t necessarily know they’re contagious.

Yeowell said Montrose Memorial Hospital has transitioned from the tests processed by the state lab, which were taking as much as two weeks to get results, and is now using an out-of-state lab that provides results in about 48 hours.

Yeowell said this testing at the hospital is available for local medical providers, with patients who are symptomatic and meet criteria for testing, which has relaxed a bit in recent weeks. Anyone seeking testing is still required to obtain a referral from their medical provider, and can make an appointment to be tested at Montrose Memorial Hospital, he said Wednesday.

"It is not a first-come, first-serve. It is not a free for all," he said.

He advised the current estimates for contagion indicate the peak number of cases in the region may not hit for another month, and medical professionals are preparing for a surge of demand at that time.

Though Ouray County responded to an invitation from state emergency officials that it would like to have National Guard testing assistance, County Emergency Manager Glenn Boyd said last week it appears that help isn’t coming. Boyd said the state chose Montrose instead after it went to San Miguel County, for surveillance purposes.

At this time, Montrose Memorial Hospital has prepared a 30-bed COVID-19 unit aside from its eight-bed intensive care unit, according to Yeowell. The hospital is also working on plans to potentially use Columbine Middle School in Montrose for an auxiliary COVID-19 hospital if needed.

“We’re preparing for our surge that we expect over the next two or three weeks,” Yeowell told county leaders on Wednesday.

Yeowell also said the hospital has assembled at least 25 ventilators which could be used for COVID-19 patients.

The hospital is also sourcing an anti-malarial drug that may prove effective in COVID-19 treatment, and so far they have 27 doses, Yeowell said. This drug, chloroquine, is still being studied for its effectiveness in treating coronavirus, but health officials hope to have more doses on-hand in case it proves helpful. The FDA granted emergency approval for its use on COVID-19 earlier this week.

Yeowell said medical professionals are expecting another peak of cases in the fall and social distancing is the "new normal" to help flatten the curve of the peak to allow medical professionals time and resources to respond to those who become critically ill.

Last week, Colorado Gov. Jared Polis issued an order for everyone in the state to stay home until April 11, with some exemptions. These orders also included instructions for playgrounds to be closed, for non-essential workers to stay home and for employers to provide opportunities for their workers to continue working remotely and avoid contact with others.