Labs backed up with COVID-19 testing

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Labs backed up with COVID-19 testing

The public is struggling to understand the details surrounding protocols for COVID-19 testing and those standards have been changing almost daily.

People want to know why more people aren’t being tested for the virus, where they should go if they think they have symptoms and a host of other questions they want answered to have some small peace of mind during such an uncertain time.

In a press conference Monday, Gov. Roy Cooper and Mandy Cohen, secretary of N.C.’s Health and Human Services, tried to explain why the testing process has been slowed down.

Cooper said the state laboratory currently has enough testing kits to test 150 people, but the state is still waiting for supplies from the Centers for Disease Control and Prevention that are needed to extract DNA from each of the test specimens.

“We’ve been working proactively to prepare for COVID-19 in North Carolina since January and our state lab started testing early last week,” Cohen said. “We made plans based on assurances from the CDC, but we, like many states, haven’t received the supplies to run the tests we need.”

The state is also looking for alternative ways to speed up the testing process, including agreements with UNC and Duke so their labs can begin testing next week. However, the universities’ efforts to test will also be hampered by the shortage of supplies from CDC. Cohen said N.C. has also been in direct contact with the manufacturers to get more testing kits.

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“The manufacturer is sending more directly to the state to test 500 people. It’s still less than needed to test everyone to meet the new CDC testing recommendations, but it’s an improvement,” she said. “We will continue to work with the CDC to get more.”

When asked if he had faith in the CDC and the federal government to come through on its promise, Gov. Cooper said, “We have a great working relationship with the CDC, but with this particular issue we haven’t gotten what we need. That’s why we’ve approached private labs and suppliers directly.”

While the state and university labs may be hung up by the CDC, Cohen said private labs like Labcorp, based in Burlington, wouldn’t be impacted because they have their own supplier.

“They will help with the volume (of testing) but it will take time to ramp up,” Cohen said.

Labcorp’s turnaround time on test results is currently three to four days. Cohen said the state lab’s turnaround time right now is 24 hours, but local officials said Friday that they’ve been waiting up to a week to get test results back from Raleigh.

“We’ve done 45 tests so far in Haywood County — eight have been negative and we’re waiting on the balance,” Public Health Director Patrick Johnson said last Friday. “Four to five days is the best we’re seeing in getting results.”

By Tuesday morning, that number increased to 75 specimens being collected in Haywood and a total of 24 negative test results.

“To date there have been no positives. We should expect to have our first case in Haywood County soon. The Haywood County Health Department will enforce isolation, perform contact tracing and follow-up for each positive COVID case in order to protect the health of our residents,” Johnson said in an update email Tuesday.

A majority of the testing for coronavirus in WNC is being done by private physician offices and local hospitals. Then those specimens are being sent to the state lab for analysis. Anyone being tested for COVID-19 has to isolate themselves at home while awaiting the results from the lab.

As testing is in high demand and labs are overwhelmed, protocols for testing continue to develop.

“The testing criteria has changed over time as we have moved through various stages of managing this pandemic. Most recently the criteria for testing was fever and respiratory symptoms such as cough and shortness of breath in a person that had a negative flu test and no other cause was identified. Or a person could be tested if they had contact to a confirmed case,” said Amber Frost with Swain County Public Health. “Since the United States, including N.C., now has confirmed community transmission (not just travel-related) we are moving toward a model that is more focused on self-isolation of all sick individuals rather than testing.”

Unless someone is experiencing respiratory issues that require emergency care, the recommendation is for people with symptoms to stay isolated at home.

“All persons with fever and respiratory symptoms, including those with laboratory-confirmed COVID-19, should isolate themselves. This isolation should be for at least seven days since symptom onset and at least 72 hours after symptom resolution (absence of fever without the use of fever-reducing medication and improvement in respiratory symptoms),” Frost said.

Dr. Mark Jaben, medical director for Haywood County Public Health, said right now the limited number of testing supplies are being prioritized for a certain demographic of people. While it’s not an ideal situation, it’s the best they can do under the circumstances.

“If you have a population of people and you don’t know who in the population is ill or infected, we would love to test everyone, but we don’t have the capacity to do that — we can’t get tests quick enough,” he said. “Testing at this point is being directed at a certain slice of people — those who have trouble breathing and people who need to be in the hospital because of respiratory conditions.”

That’s why it’s so important for those who feel mildly ill to isolate themselves at home regardless of whether they can access a COVID-19 test or not. Call your primary doctor if you have questions and they will instruct you about getting tested if they feel it’s necessary.

“Most testing is being done through local doctor’s offices and hospitals. Physicians are using their clinical judgement regarding whether or not a test is needed,” Frost said.

“The real takeaway message here is if you’ve got a fever and cough, isolate at home. If you have trouble breathing and need further screening evaluation, that’s going to be at the hospital,” Jaben said. “The trigger point is shortness of breath. In the sense, we’re in a rationing world now where we don’t have access to everything we need — that’s something we’ll have to be adapted to. We’re trying to do the best and the most we can do.”

Johnson said Haywood Emergency Management Services is working to develop a central online location where the community can go to get accurate and updated information about the virus, testing and other pressing questions. Until then, people are being advised to visit https://www.haywoodcountync.gov/684/coronavirus-Covid-19-Information.

Jackson County said the health department had three collection kits from the N.C. State Laboratory for Public Health with the option to request more when/if needed. As of March 16, Melissa McKnight with Jackson Public Health said they would only consider testing someone if they have a fever or lower respiratory symptoms and have had close contact with a confirmed COVID-19 case within the past 14 days or they have a fever and lower respiratory symptoms and a negative rapid flu test and no other more likely diagnosis.

As of March 22, Macon Public Health reported nine tests have been completed in Macon with seven negative test results and two pending results. If a private lab test is confirmed positive, the health department would be notified.

Hospitals in the region are also working to keep up with the changing protocols. As of Tuesday’s presstime, Haywood Regional Medical Center had not evaluated or treated any patients with COVID-19, according to the hospital’s website.

“At this time, tests for COVID-19 require a provider order. Visiting a provider does not necessarily mean you need testing or that you will receive testing. Your provider will work with Haywood County Health and Human Services Agency to follow all appropriate guidelines from the Centers for Disease Control and Prevention (CDC) and North Carolina Department of Health and Human Services to determine if testing is recommended based on your symptoms and recent travel history,” according to the hospital website.

Duke LifePoint hospitals — HRMC, Harris Regional Hospital and Swain Community Hospital — have taken measures to prepare in accordance with CDC guidelines. Patients in the ER and inpatient units are screened based on their recent travel history; personal protective equipment is available, including face masks and eye protection; and hygiene products are easily accessible throughout the facility. The hospitals have also implemented a “zero visitor” policy until further notice to protect staff and patients, though some exceptions may be allowed.

For more updates, visit MyHaywoodRegional.com and MyHarrisRegional.com.

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