April 17, 2020 Moonshine Minutes
Hello all. I’m Alex Hoeft, news reporter for Moonshine Ink.
So far the U.S. has tested about 1% of its population for COVID-19 — a total of roughly 3.2 million people. Tahoe Forest Health System, meanwhile, has tested approximately 1.2% of our region’s population.
Across the country, it’s been a question of access to test kits and a race to discover new testing methods.
Today’s Moonshine Minutes center around the latest testing efforts in our region.
As things stand, there are two boxes to tick that’ll get you a test for COVID-19 at the Tahoe Forest Hospital, which is following guidelines from the Centers for Disease Control: either you need hospitalization for possible COVID symptoms, OR you’re a healthcare worker.
Cindy Wilson, director of public health nursing for Nevada County, told us: “I think in an ideal world we would like to know about everybody who actually has it … [But] we have to live with the reality rather than the ideal in this moment because testing is limited and is being prioritized in a way that makes sense with the limited capacity.”
Because we don’t live in that perfect world where anyone who thinks they might have the disease can be tested, the local hospital system is improvising.
Harry Weis, CEO of TFHS, explained his team tracks “rule-out inpatients” — those who did not receive a test or the results of a test yet, but show symptoms consistent with the disease and require hospitalization.
These patients are not considered in the total count of cases for each county until an actual test confirms positivity. As of April 16, the hospital had two inpatients who were officially positive for COVID-19 and four with symptoms consistent with the disease but no positive, considered rule-out patients. As of this broadcast, TFHS is reporting 49 total positive tests administered by their staff, 41 at the Truckee location and 8 taken at the Incline Village facility.
We had the chance to catch up with the hospital’s first overnight rule-out patient, who we’re calling Mary to keep her anonymous. I’m Becca Loux, reporter and editor for the Ink.
Mary shared her timeline of symptoms, testing, and recovery in an interview. After going down “like a ton of bricks” from her COVID-19 symptoms on March 18, Mary experienced the worst chills of her life and other symptoms of a particularly bad flu — pain in her back, scalp … even eyeballs and eye sockets. The next day, March 19, she ended up at TFHS’s drive-thru testing clinic, where they administered a flu test to her.
Mary said: “They got the results back and I was negative for flu A and B. Then I was like, okay, I’ll take my [COVID-19] test now, and they’re like, ‘Yeah, no, you don’t meet the criteria … even though you have a lot of the symptoms, frankly, we don’t have enough tests so you’re not going to get tested.’”
It took a close friend who tested positive and continued symptoms for Mary to finally get tested on March 25. On Friday, March 27, Mary ended up in the hospital with difficulty breathing.
Because she was hospitalized Mary was tested twice more for COVID-19: once the day she arrived, the other, the day she left.
Of the three COVID-19 tests Mary received, the March 25 one she says she never heard back about; the March 27 one tested negative; and only the last one tested positive for the disease, taken the day she left the hospital on March 29.
She said: “I ended up with three tests where other people can’t get any.”
After Mary left the hospital, Nevada County stepped in, as is the protocol for communicable diseases. Cindy Wilson was assigned to Mary and began confirming that Mary had necessary care in place and interviewing her about close contacts she may have infected.
Wilson described that process: “Healthcare providers, hospitals, [or] labs report to us if they have a positive result. Then that person becomes a case and we reach out to them. They are placed in isolation per our health officer’s order and that means they have to stay away from everybody for at least seven days from the time their symptoms started, and at least three days from the time their symptoms resolve.”
There’s no formal system by the hospital to track contacts of confirmed COVID cases. CEO Weis said it’s not feasible given current bandwidth.
Nevada County does keep track but the data isn’t compiled.
Wilson explained it: “If I have a case I’m talking to, I might know that they have seven contacts, and out of those seven contacts, four of them were symptomatic and three of them were not over the course of time they were in quarantine. Another nurse might know that about her cases. But we have not put it together.”
A lack of testing capacity is an issue in our region and everywhere in the country. But innovations are in the works and in fact, at least one is on the ground already in Grass Valley.
Sierra Nevada Memorial Hospital has acquired a rapid COVID-19 test courtesy Abbott Laboratories. This testing takes 5 minutes to confirm a positive test for the disease, and 15 to confirm a negative one.
Said Wilson: “That’s still limited as to how many of those can be done, but at least for the people who are being prioritized, the answer is fairly quick and immediate rather than waiting for three to four days — and if the lab is backlogged, sometimes even longer than that.”
Tahoe Forest Health is currently trying to get a hold of this testing method. Weis is in talks with Sierra Nevada’s CEO to see if they can figure out an equipment swap between the hospitals. He’s also tossed his hat in the ring with the California Hospital Association, the state assembly and senate, and Abbott Labs itself to get rapid testing that way, among a few other options. No luck thus far.
Antibody testing is also a silver lining to the coronavirus pandemic. According to the CDC, antibodies indicate someone has an immune response to COVID-19. Though this testing is in its early stages, Nevada County’s Wilson said this type of testing can play a role in how we re-kickstart the economy.
She told Moonshine: “If somebody has antibodies can we consider them to be immune? That’s a question that still needs to be answered. If they’re considered to be immune, perhaps they can get back to work before somebody who doesn’t have those antibodies. It’s an important piece of research, but at this point I still believe it’s research and not patient care, per se.”
Read the story, Testing Triage for COVID-19 in Tahoe, in its entirety at moonshineink.com. And be sure to subscribe to our email list to keep up with all our online exclusive stories.
Stay healthy, stay sane, and share confirmed information. We’re in this together, and, like our anonymous “Mary,” we’ll come out the other side