Doctors: COVID-19 blood antibody test won't help us now

  • COVID-19, courtesy Centers for Disease Control
    COVID-19, courtesy Centers for Disease Control
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After listening to recommendations from medical experts, Ouray County Commissioners decided not to pursue a request from an anonymous citizen who offered to put a deposit on COVID-19 antibody tests but asked the county to set up a payment plan to cover more than $200,000 to test all residents.
Commissioners and health officials consulted with Dr. Drew Yeowell, the county’s EMS medical director who is also an 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 if the county undertook the same testing being performed in San Miguel County, which is being performed by a biomedical company owned by Telluride residents. The test was provided to the county for free and requires two separate blood draws from participants, and has a goal of collecting data about antibodies and exposure to the COVID-19 coronavirus. While this 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.
The anonymous citizen asked the county to commit to testing all county residents and offered to put a deposit on 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 Health Department Director Tanner 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 County 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 professionals 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 available 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.
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 on Wednesday, Gates said the clinic has not used up its supply yet but may have more demand soon from college students returning home to Ouray County from schools that have closed elsewhere.
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.
Yeowell said Montrose Memorial Hospital is working on using tests that hopefully can be processed more quickly than the ones processed through the state lab, which were taking as long as 10 days for results.
At this time, the hospital is switching to a test that could produce results in 24 to 72 hours.
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 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, Ouray County doesn’t have any confirmed cases, but all the surrounding counties have positive cases. Health officials warn the absence of positive tests doesn’t mean it’s not here.
In a meeting Wednesday, health officials advised they believe the region is roughly a month away from the “peak” of the virus here, and medical professionals are preparing for a potential surge of critically ill patients who are more vulnerable because of their age or other medical conditions. Yeowell said medical professionals are expecting another peak in the fall, potentially, and that 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.
Colorado Gov. Jared Polis issued an order for everyone in the state to stay home beginning this morning, lasting until April 11, with some exemptions. You can read that order and answers to questions about that order here: https://covid19.colorado.gov/stay-home-except-essential-needs.