Colorado has set a goal of having at least one COVID-19 testing site in each county, and multiple locations in large counties, as the state attempts to ramp up testing capabilities and critical contact tracing before Gov. Jared Polis lifts his stay-at-home order, top health officials said Thursday.
A day after the governor outlined for the first time what the state needs to ease restrictions in the face of the new coronavirus, health officials on Thursday indicated that increasing testing is a top goal — and that Colorado won’t be able to enter the next phase until extensive testing is achieved throughout the state and the positive case count moves from a plateau into a decline.
Several facilities in metro Denver already are increasing testing capabilities and have started offering tests to people who don’t have symptoms and are not health care workers. Officials are hoping to expand these drive-thru sites throughout Colorado.
“We are aware of the need for testing,” Scott Bookman, the state’s COVID-19 incident commander, said on a conference call with reporters. “The governor was very clear: The state won’t reopen until we have the capacity to make everyone safe.”
Local public health departments are working to develop the best method to implement mass testing for their communities, while the state tries to acquire more tests and protection equipment, Bookman said.
“This has been a unique challenge with COVID-19,” he said. “It takes extraordinary (personal protection equipment) demand to do this testing safely. And it’s taken that testing out of traditional places where it’s normally done, and pushed it to local health agencies.”
The next five days will be crucial for the state to understand the trajectory of the virus and inform the decisions Polis will make moving forward, including whether to extend his stay-at-home order past its current expiration date of April 26.
At least 374 people have died from complications of the novel coronavirus in Colorado as total cases topped 8,600 on Thursday, state health officials said.
Nearly 1,700 people have been hospitalized with COVID-19 since the outbreak began last month, but only 859 people were in Colorado hospitals with symptoms of the illness as of Wednesday afternoon, state data shows. At least 239 people between Tuesday and Wednesday either went home or were transferred to a lower level of care, like a rehabilitation facility.
Testing numbers climbed for the third straight day on Wednesday, but the 1,518 tests reported still lagged far below the April 11 peak of 2,687. Polis has said that Colorado has the capacity to conduct 10,000 tests per day, but health departments and hospitals still lack critical personal protection equipment and other materials necessary to safely administer and transport the specimens.
The state’s goal is to have a menu of disease control options that would be able to match what the stay-at-home order has achieved, Rachel Herlihy, Colorado’s state epidemiologist, said on the conference call. That includes extensive contact tracing, aggressive isolation and quarantining, and enough hospital capacity.
“It’s a much more targeted approach,” Lisa Miller, professor of epidemiology at the Colorado School of Public Health, told The Denver Post. “The advantage of testing is that we’ll be able to identify with greater certainty who is infected and who is at risk of transmitting it to other people, and we can quickly make sure those people are isolated so they don’t transmit it to anyone. That’s key.”
Drive-thru testing
Some Denver health care sites have expanded testing in recent days.
AFC Urgent Care offers appointments for drive-thru testing at five of its metro area locations, and plans to expand it around the state, sales manager Stephen Vaulton said. Typically, they get results from LabCorps or Quest in two to four days, he said.
“We’re doing quite a few, as far as several hundred a day,” he said.
Insurance covers the testing. For uninsured people, it can cost $149 to $199, depending on lab fees.
Vaulton said they initially focused on health care workers and first responders, but later decided to test a broader group of people. AFC Urgent Care doesn’t require people getting tested to have symptoms, since some people can spread the disease without getting sick themselves, but asks that those who don’t have reason to believe they were exposed to hold back, he said.
“We are hoping that individuals would use common sense,” he said.
National Jewish Health announced Thursday that it would offer drive-thru testing to people who have a doctor’s referral and make an appointment. It had focused on hospitalized patients and health care workers since March, but capacity has ramped up to handle about 1,000 tests per day. Results typically take one to three days.
The hospital’s commercial lab and research center worked together to create their own tests. Disruptions in the supply chain meant they couldn’t always buy swabs or other equipment, so the labs had to design their own and then test it to prove those parts didn’t change how the test worked, said Tasha Fingerlin, director of the hospital’s Center for Genes, Environment and Health.
“That’s created a lot of work, validating each individual piece,” she said.
National Jewish also developed a blood test to look for antibodies, substances produced by the immune system that show someone was exposed to COVID-19. The hospital started with a commercial testing kit, but made some changes to how it’s used so that it correctly finds more positive cases, said Reeti Khare, director of National Jewish’s infectious diseases lab.
Khare cautioned against making decisions based on a positive antibody test. While it seems likely that people who have had COVID-19 will have some immunity, it’s not yet clear how strong that protection is or how long it will last — or the odds that a result could be a false positive. Researchers will use the test results to help answer those questions and others, like how long a person remains infectious, she said.
“We don’t know how to use those results until we have those results,” she said.
Tracing virus’ path
Extensive contact tracing is the other major piece that needs to be completed before statewide restrictions can be relaxed. But that process is labor-intensive and cannot just be implemented at the snap of the governor’s fingers.
Other countries that have successfully contained coronavirus outbreaks through such measures have required between four and 81 contact tracers — people dedicated full-time to figuring out who has been exposed to the coronavirus by an infected person — per every 100,000 people, according to a report from Johns Hopkins University released April 10. That would mean somewhere between 230 and about 4,600 contact tracers could be needed in Colorado to identify and contact potentially infected people in order to contain the outbreak.
Some of those positions already exist at local health departments throughout the state. Metro Denver Partnership for Health has identified 108 ready-to-go workers who are spread throughout health agencies in Boulder, Jefferson, Adams, Arapahoe and Douglas counties, as well as in Denver and Broomfield.
The state is working to hire additional epidemiologists and student epidemiologists to work on contact tracing, Herlihy, said. The Colorado School of Public Health is working with the state to see if students can volunteer to do some of the tracing work as well, Miller said.
The federal government’s top infectious disease expert, Dr. Anthony Fauci, said Tuesday that as a whole, the nation doesn’t have the testing and tracing capacity to reopen widely. The May 1 goal set by President Donald Trump is “a bit overly optimistic” for much of the country, Fauci said. Easing off social distancing restrictions should happen on a rolling basis depending on the situation in various parts of the country, he said.
Updated 5 p.m. April 16, 2020 This story has been updated after Colorado public health officials clarified that meeting the governor’s goal of having a coronavirus testing site in every county is not a prerequisite for lifting the stay-at-home order.
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