Testing continues to be a critical part of Colorado’s strategy to combat this virus and I’m proud of the incredible work our state lab has done over these past few months to increase capacity…
— from a press release from Governor Jared Polis, July 24, 2020
On Friday, in Part Five of this editorial series, I mentioned that the “public school re-opening” guidance published by the Colorado Department of Education (CDE) relies partly on the idea that ‘symptomatic’ individuals — the ones exhibiting fever, cough, intestinal upset, shortness of breath — can be prevented from spreading the SARS-CoV-2 virus through numerous actions inside and outside the school building: ‘cohorting’ class groups, requiring masks for adults and students age 11 and up, maintaining social distancing, and so on. You can download CDE’s 18-page guidance PDF here.
One issue that we haven’t yet discussed fully is the fact that perhaps 80% of infected children present as ‘asymptomatic’ — showing no noticeable symptoms. (See this article in the journal, Nature, June 2020.) Also, about 40% of infected adults present as ‘asymptomatic’.
For the vast majority of children, it seems, there’s only one way to know who is infected and who is not. Testing. Same for almost half of adults.
From a press release sent out by San Juan Basin Public Health (SJBPH) on Friday, July 24:
“Testing with timely results is the most important tool to contain disease,” said [Liane Jollon, SJBPH Executive Director]. “Prioritization will ensure that testing and rapid results are available for people with symptoms and people suspected of exposure, enabling SJBPH to quickly identify cases and contain disease outbreaks. We continue to encourage anyone in the high-priority category to seek testing when developing symptoms or when notified of a likely exposure by a public health agency.”
Some recent studies suggest another piece to the COVID puzzle. Studies published in the journals Nature Medicine and Eurosurveillance that tracked infections in Asia and Europe found that about half of the new cases of COVID-19 (44%, 48%, and 62% in respective studies) resulted from contact with a pre-symptomatic individual — that is, a person who would later develop symptoms, after the virus had been transmitted to others.
Based on these findings, the authors of one of the studies recommended that “disease control measures should be adjusted to account for probable substantial pre-symptomatic transmission.” I understand that recommendation to mean, essentially, “Assume everyone is infected, and protect yourself and your family on that basis.”
Maybe, especially in the US? Where we are having a devil of a time testing individuals in a timely manner?
Here’s more from that July 24 press release from SJBPH, the agency that’s been tracking the virus in Archuleta and La Plata Counties. The press release is titled, “Mercy Community Testing Site Reduces Hours, Tests”:
Mercy Regional Medical Center (MRMC) will reduce hours and number of COVID-19 diagnostic tests available at its free community testing site as of Monday, July 27. New hours and days will be Monday through Thursday 8am to noon, and Saturday 8am to noon, limited to no more than 50 tests a day.
Unfortunately, due to limited local availability of testing, and in addition to previously reported laboratory capacity and supply constraints around the state, San Juan Basin Public Health (SJBPH) and MRMC will need to temporarily prioritize use of this free public resource. This prioritization does not affect testing for COVID-19 for patients being hospitalized and refers only to the community testing operated by MRMC and supported by SJBPH.
SJBPH is requesting that individuals who live and work in La Plata and Archuleta counties refer to the following prioritization when considering if they should be tested at this free community testing site:
High priority: people with COVID-19 symptoms and those notified of an exposure by SJBPH or another public health agency.
Medium priority: people with no symptoms or identified exposure but who live or work with high risk populations such as:
- Residents or employees of congregate living or work settings (dorms, long-term care facilities, detention facilities)
- People experiencing homelessness
- Employees of high-risk workplaces monitored by public health
- Health care workers, first responders, and law enforcement
At this time, all others without a known exposure seeking assurance that they do not have the virus, including those instructed to get a test by an employer or educational facility and those testing for travel-related reasons, cannot be considered a priority for free community testing. Tests for these individuals remain available by appointment through private testing providers.
Unfortunately, the reduction in test availability at MRMC means La Plata County is unable to meet nationwide standards for testing capacity to most effectively control spread of infection…
As infection rate spikes again across much of the US, we once again find ourselves able to provide testing only for ‘symptomatic’ individuals. But most children carrying the virus are asymptomatic. And the disease is spread largely by individuals before they even develop any symptoms.
And school personnel and students are not listed as “high” or even “medium priority” individuals, according to SJBPH.
Last week, a federal judge in Detroit, Michigan ordered the public schools there to either shut down their summer school program, or provide COVID testing for all of the 600 students attending the program. The ruling resulted from a lawsuit filed by a Detroit activist group calling themselves “By Any Means Necessary.” BAMN.
Some of the BAMN members had been arrested for attempting to prevent school buses from picking up ‘as-yet-untested’ summer school students.
A sign of things to come?