Pitkin County is near the top of a waiting list for a newly announced COVID-19 rapid-testing option that, per corporate proprietor Aytu Bioscience’s promises, will be able to detect antibodies in an individual and deliver real-time results without having to courier swabs to a Front Range lab.
“They released that they had developed a blood test for COVID, and it’s an antibody test,” explained Kim Levin, Pitkin County’s medical officer. “And within an hour, the county here had their name on a queue at the top of the list to get those when they become available. I thought that was really impressive.”
As described, the tests would circumvent at least one of the major obstacles Western Slope communities have so far faced in testing: anxiously waiting for results from the state-run Denver laboratory.
In fact, that lab — operated by the Colorado Department of Public Health and Environment — at its outset could only process 160 tests per day, and it was receiving specimens from counties all over the state, Levin noted. County public health departments had been told results would be returned between 48 and 72 hours, and Pitkin County hastily established a testing site in Aspen Village.
“When we first set off on this epidemic, we worked extremely hard that first week,” Levin said. “I felt it was an unbelievable effort on all parts to be able to set up that test center, and it happened almost overnight. And it functioned, and we relied on a state lab, and — I don’t know how to say it — they ran into difficulty that they did not foresee.”
Rather than a two- or three-day turnaround, some locals found themselves waiting more than a week for their results.
“There were no private sector labs available when we did that two-day test site because we were so early in the game. The CDPHE lab ended up backing up hundreds and hundreds of tests, unfortunately, and we had no control over that,” Levin continued. “We realized that this type of testing is not going to work. It’s not feasible or viable, and it’s not fair to anyone to do a test and not get a result in time. So after we had this experience, we realized this is not a viable option for our community, and we want to set up something that is more efficient and effective and we’re waiting for that product to get in our hands.”
And so, by about 2:30 p.m. on March 12, its second day of operation, the county opted to shutter the local test site. With limited resources — the county currently still only has 400 nasal swabs — the officials had to make “tough decisions,” she said, and the message to the public shifted from one of testing and containment to one of social distancing and mitigation.
That shift away from testing has proven to be a tough pill for the community to swallow, which Pitkin County Manager Jon Peacock acknowledged to the Board of County Commissioners during a work session Tuesday afternoon.
“We hear the community; we read the same reports,” he said. “We know that testing is going to be extremely important for us to implement on a communitywide basis so we can have better mitigation strategies moving forward.”
Testing is again a top priority for the county — but that’s largely because private-sector entry into the testing market has created new possibilities that didn’t exist even a week ago, Levin emphasized.
“The good news is that there's new possibilities coming down the line, and we are actively looking for them every day,” the full-time emergency physician said. “We are limited by what is produced in the private sector at this point. But we don’t know; these products aren’t in anyone’s hands yet. This is an hour-to-hour, day-to-day adventure.”
In fact, even Tuesday, Levin learned that the United States Food and Drug Administration ordered Aytu to relabel its new test. On Monday, the company announced that, having gotten FDA approval, it would begin distributing 100,000 tests nationwide.
“I got an email today saying they have to relabel all their tests, so now they might not be out until later next week,” she said. “This is the flow. Yesterday, we had all this promise that it might happen in a couple of days, and today, it’s totally different. They’re getting FDA approval right now.”
Innovation, flexibility and understanding are the name of the game, Levin reiterated several times. While Aytu’s forthcoming “bedside test” — that is, a test that delivers results within minutes, such as the existing models for flu, strep throat or mononucleosis — is certainly promising, even if Pitkin County receives all 1,000 that have been requested, there will still be logistical hurdles in implementing broader testing.
For instance, like the current swab-based model, a rapid blood test will still require a physician’s order, and those who administer the tests will still require increasingly coveted personal protective equipment, or PPE.
“My name was on all those tests in the drive-by center. This is a medical test, and a doctor has to write an order to do it,” she said. “I was happy to donate my time for that initially, but it was unsustainable. Then we worry about people without doctors in our community [or without insurance], and who’s going to write those orders? Solving that issue is primary to be able to offer it to everybody.”
So far, Aspen Valley Hospital has not seen the surge in patients experienced in other parts of the world, Chief Executive Officer Dave Ressler said Monday.
“We’re still in the calm before the storm, but the preparations continue; the discussions continue,” he said. “Just making sure we’re doing everything we can to be ready. We are tracking it. We can’t show a statistical uptick yet.”
But Levin cautioned that it’s exactly because of social distancing measures and the public health precautions being taken in the county that AVH hasn’t yet seen a strain on services — and even still, that doesn’t mean a surge isn’t on the horizon.
“That’s why all the physicians support the public health orders, because it is truly the only way to save lives, and it is the only way to keep the hospital open and operating,” she said, alluding to a meeting the AVH medical staff held Monday evening to discuss the evolving situation caused by the novel coronavirus disease. “If the spread continues at the rates that we’ve seen at other places, it’s going to be very hard to keep the hospital open because health care workers will be infected.”
It isn’t hyperbole informing her statement, it’s Levin’s own lived experience.
“I just found out I treated a COVID-positive patient last week,” she said. “I can tell you firsthand, it’s scary — and I want the PPE to protect me. It’s not just older people. There's a subset of people that are being affected by this that are younger and healthy.”
Pitkin County Sheriff Joe DiSalvo described PPE as “the new toilet paper” in that it’s becoming increasingly difficult to secure.
“Some of the issues we’re having is there’s not enough PPE to do a drive-through again,” he said. “New York state’s begging for them; California’s begging for them.”
Hopefully, he continued, the Aytu rapid tests would require less follow up than the swab model because results would be delivered onsite.
“You get stuck and you’re negative, you go home. Nobody has to talk to you again,” he said.
Levin noted that even if the rapid testing becomes available sooner than later and works exactly as advertised, there is still a chance of false negatives with an antibody test.
“It takes about three to five days after you start an illness to make antibodies in a person’s body for the blood test,” she said, noting that if someone is tested before that three to five days, the test could return a false negative. “There are nuances to every test in terms of their specificities. It’s really important when you do a test to understand the details of the test. No test is 100 percent, although we wish it could be. And each of these products that are coming out are going to be different.”
Absent an immediately viable test and the resources to implement community-wide testing, Pitkin County Health launched on Wednesday a COVID-19 symptom tracker, available at the county website’s “community engagement” page. Eagle County has already implemented a similar tracker system, which has so far garnered more than 700 responses, and reports the data daily. The CDPHE reports 18 COVID-19 cases in Pitkin County to Eagle’s 96 — but, Levin stressed, that number more accurately reflects the population discrepancies between the two counties than a more robust testing capacity.
“People may look at that and say, ‘They did it and our community didn’t’ — but nobody has their test results back there, either. They’re trickling in,” she said.