Tuesday, March 10, 2020

Alaska COVID 19 Testing - No Positives Because So Few People Are Being Tested? [UPDATE]

Thanks Jacob for your long comment yesterday.  Let me follow up yesterday's post here.

I got an email back from the doctor's office this morning.  Here's the response about testing for COVID 19:
"As for the testing for Covid 19. The recommendations are that you stay home and care for yourself as you would with any illness (such as a cold) if you are experiencing trouble breathing and feel you are in danger I encourage you to go to the emergency department. We are not testing unless you have certain symptoms and a qualifying history which based on your first message regarding Covid 19 you do not have. I encourage you to stay home and take care of yourself as you would for any cold. Let us know if you have any other concerns."
Here's the CDC's March 4 update (I was still in Seattle then) on who should be tested:
As availability of diagnostic testing for COVID-19 increases, clinicians will be able to access laboratory tests for diagnosing COVID-19 through clinical laboratories performing tests authorized by FDA under an Emergency Use Authorization (EUA). Clinicians will also be able to access laboratory testing through public health laboratories in their jurisdictions.
So, limiting testing is due to the lack of enough tests and that should change.
This expands testing to a wider group of symptomatic patients. Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested. Decisions on which patients receive testing should be based on the local epidemiology of COVID-19, as well as the clinical course of illness. Most patients with confirmed COVID-19 have developed fever1 and/or symptoms of acute respiratory illness (e.g., cough, difficulty breathing). Clinicians are strongly encouraged to test for other causes of respiratory illness, including infections such as influenza.
So, I've had fever and cough - but no difficulty breathing.  I'm also in the group at higher risk for severity if I get the illness.
"Epidemiologic factors that may help guide decisions on whether to test include: any persons, including healthcare workers2, who have had close contact3 with a laboratory-confirmed4 COVID-19 patient within 14 days of symptom onset, or a history of travel from affected geographic areas5 (see below) within 14 days of symptom onset.
International Areas with Sustained (Ongoing) Transmission
Last updated February 28, 2020
China (Level 3 Travel Health Notice)
Iran (Level 3 Travel Health Notice)
Italy (Level 3 Travel Health Notice)
Japan (Level 2 Travel Health Notice)
South Korea (Level 3 Travel Health Notice)"
So, you have two routes to a test:
  1. close contact with a lab confirmed COVID-19 patient
  2. travel to one of those countries
But if no one is being tested, we don't know if someone has had close contact with someone with COVID-19 who didn't show any symptoms or hadn't traveled to one of those countries.
And are places like Seattle (which has had the most COVID-19 cases in the US) NOT on the list because they are significantly different from the countries listed?  Or because the CDC does not want to declare places in the US as problem areas?

[UPDATE 8:07pm:  My daughter emailed me an Alaska State directive which gave "travel to an affected area" like Northern Italy "or Kirkland, WA" as an example of a place where someone might have recently traveled.  It also says we need to rule out influenza, so I've sent the link to that State memo back to the doctor's office, pointing out that I have traveled from a place on the list and that BI had two cases verified today.  And asking how I can get tested for influenza.
 I don't think I'd want to be working at the clinic answering all these emails.]

I'd note that my daughter emailed me today to say there were two confirmed cases on Bainbridge Island where I was for about a month.

The Alaska Corona Virus website tells us:
"In Alaska
Updated March 10, 2020; updates made daily by 12:30pm
Confirmed cases
Current: 0
Cumulative since 1/1/2020: 0
Persons Under Investigation (PUI)*
Current: 16 (pending tests)
Cumulative since 1/1/2020: 47 (includes negative and pending tests)"
Presumably, all these people traveled to one of the target nations, since they couldn't have been exposed to someone in Alaska, because no one here has tested positive.

Despite the President's saying everyone who wants testing, can get tested, we know that's not true.  I can't get tested, for example.  I'm sure someone could do an interesting comparison between now and in the 1980s when people could be tested for HIV.  There are great differences between the two diseases.
  • HIV then was a death sentence, while for most people COVID 19 is a minor illness
  • HIV had a huge stigma because of society's discrimination against LGBTQ people
It would seem the lack of testing - which would help identify and isolate the non-symptomatic carriers - is due to the federal lack of response in getting tests set up.  It shouldn't be hard to let private companies offer test kits.  It seems the genetic testing companies already have swap kits ready to get the samples.  But without strict verification in place, we could get lots of false positives and false negatives.  In this case, false negatives wouldn't be so bad.  False positives would

The sooner everyone can get tested, the sooner the asymptomatic carriers can stay home and the spread of the virus can be slowed down.

[Let me also add that I suspect the odds of me having contracted COVID-19 are low.  And if I did, the symptoms seem manageable so far.  And I've been pretty much in isolation since we got back last Wednesday night.]

[My testing saga is updated Thursday - here.]

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