Tri-County Health Care (TCHC) is still awaiting our first case of COVID-19 while writing this column. Wadena was one of only a few counties remaining without a documented case until last week. It begs the question: have we truly not had a case or was it not diagnosed due to testing restrictions or false negative results?
Testing has been a hot button issue throughout this COVID-19 crisis, but it is one area that we are gaining ground. Testing availability has continued to increase over the last few weeks at TCHC. Testing was initially very limited due to resources and only included those ill enough to be hospitalized, sick health care workers and those living in congregate living situations. That has gradually expanded to include those who are at higher risk and have had symptoms suggestive of COVID-19.
Over the last few weeks, we have been able to secure more testing options and availability has greatly increased. At this point, we are able to test people who are symptomatic, regardless of risk profile. We anticipate being able to continue to provide testing to our community when patients are ill, and the clinical picture indicates possible COVID-19 infection.
Recently, TCHC has also been able to acquire accessibility to immunoglobulin testing for prior COVID-19 infections. This is a blood sample that checks if the patient has immunoglobulin G (IgG) antibodies to COVID-19. The presence of these antibodies is presumed to reflect prior COVID-19 infection. This test is performed 14 days or more after onset of symptoms, a timeline that reflects when IgG antibodies are expected to be produced by the body. Reliability of testing has been an area of concern for health care providers throughout the country. These tests are new and do not have the data that gets acquired with time. That data is used to perform statistical analyses on tests to tell providers how “good” a test is.
Does the test miss people who actually do have the disease -- a false negative? Does someone who tests positive actually not have the disease -- a false positive? There will eventually be enough data to obtain the necessary information on accuracy of the tests, but at this time there is uncertainty in this area.
Health care providers know that no test is perfect, and COVID-19 testing is no exception. There will certainly be people who tested negative that actually have the infection. There will also be the possibility people who test positive who were not infected.
Uncertainty with testing accuracy is not a new phenomenon. Influenza testing, in particular, is quite inadequate. In fact, often times a patient presenting with influenza-like illness during influenza season is diagnosed without testing. When a test is unreliable, providers base diagnosis and treatment off of clinical information rather than a test result. Time will tell whether COVID-19 testing ultimately is deemed a reliable test, or if it follows a similar path of inadequacy evident in influenza tests.
Lately, there has been talk from state officials of testing large numbers of people in the near future. There are economic and public health reasons for mass testing, and this data will give more accurate rates of infection and mortality. However, from the health care setting, we need to prioritize testing on symptomatic patients. There is cautious optimism of regional testing availability, but until the state has solidified plans for greater testing surveillance, we need to reserve testing for those who are sick.
Currently, ill patients with COVID-19 symptoms can and will be tested. People who are not ill but are questioning infection will not be tested from the health care setting at this time. Testing sites or availability will likely change in the community in the near future, but at this time, testing in the clinics or hospital is only for symptomatic patients.
Negative testing so far may have led some to have a sense of security. The challenges faced with testing availability and reliability of results should be factored into one’s assurances about COVID-19 in our community. There have been a few cases that are highly suspicious of COVID-19, but tested negative. It is very possible that these are false negative tests. We have tested over 100 people at TCHC, and each day feels as though we’re on borrowed time in regards to confirming a positive test in our facilities.
The first confirmed test may finally make this real for some people, but this has been a reality for us on the front lines for weeks. Almost all of us have at least one case that we are convinced was actually positive.
We know it is here in our community, and will be here for some time to come. That is why we at TCHC stress the importance of continuing to practice mitigation strategies that include social distancing, good hand hygiene, avoiding travel whenever possible, wearing a face mask when around others, covering coughs and sneezes and cleaning and disinfecting frequently touched surfaces.