Health

As COVID test sites reach capacity, Washington state leaders urge restraint and judgment

As Thanksgiving draws closer, COVID-19 infections are surging and virus testing is hitting capacity, leaving health experts and elected officials imploring the public to stay home, stay safe and save the testing for people who are symptomatic or had contact with someone who has the virus.

“We’re asking people to forego their holiday plans, to stay away from their friends and family and, right now, to reserve the test for people who have symptoms,” or who have been in close contact with people who do, said Dr. Charissa Fotinos, Washington state’s COVID testing lead at a briefing this week. She discouraged those who don’t meet those criteria from getting tested if the sole purpose is a “safety check” to accommodate travel and social gatherings.

Infection numbers are hitting new highs, with King County reporting a daily average of 581 new cases, a rate 200% higher than the previous peak. The cases are overwhelming contact tracing and containment efforts. Hospitalization rates are up 50% each week over last two weeks, and hospital systems are activating emergency responses to meet the demand, officials said Friday.

Gov. Jay Inslee has for weeks cautioned against gathering for Thanksgiving, and recently issued a ban on indoor gatherings with people outside your household in most cases.

But the limited federal leadership has led to some confusing messaging, including an email sent Tuesday to Seattle residents from a national company that’s coordinating the city’s drive-thru testing. The email from Solv read: “Gathering for Thanksgiving? Get a COVID test as soon as possible for extra peace of mind and your family’s safety.”

The company halted the communication to Solv subscribers before it reached its entire database, following the company’s realization that the message didn’t match guidelines that vary among cities and states nationwide.

“We did not intend to send anything that is counter to public health guidance,” said CEO Heather Fernandez.

It was only on Thursday that the U.S. Centers for Disease Control and Prevention issued a warning against travel and holiday celebrations outside of a person’s household. Inslee’s ban on gatherings makes an exception for people who quarantine for 14 days or if someone quarantines for seven days and then receives a negative COVID-19 test within 48 hours of gathering, which seems to leave the door cracked for ‘safety check’ testing.

While testing locations struggle to keep up with the Thanksgiving spike in demand, there are efforts underway to expand the availability of testing before and around the December holidays.

On Friday, Seattle Mayor Jenny Durkan announced a partnership with private testing provider Curative to open two, free mobile testing kiosks by early December in the Northgate or Lake City neighborhoods and the Central District or Capitol Hill neighborhoods. The plan is to add at least five additional kiosks, which can conduct 500 tests daily, by mid December. The kiosks will be located on city property in high density, underserved areas.

“We want to make testing as easy as possible for the residents of Seattle,” Durkan said.

The direction not to test-then-gather (from King County’s top public health official) is interesting. So many Americans I know have been doing this, but in my Canadian circles it’s unheard of. https://t.co/g4Pd3gdZYZ

— Mara Hansen Staples (@marakatherine1) November 20, 2020

The city currently runs four drive-thru testing sites, which are running at capacity and experiencing wait times of up to two hours, even for those with an appointment, officials said. People with symptoms or who’ve had contact with someone who has tested positive are given priority in scheduling.

In the summer, Seattle was conducting an average of 2,500-3,000 tests per day at its free community sites, but that’s doubled to 5,500-6,000 per day. Tests results are typically available from the lab within 48-72 hours, but people are advised to check for results the day after testing, officials said.

When the Curative kiosks are added to the drive-thru sites, the city should have a capacity for 9,000 tests daily. People will make test appointments online, and at the kiosk, people will take their own sample by coughing three times, swabbing their mouths and putting the swab into a capped vial that will be sent to a lab for testing. Results should be available 24-48 hours later by email or text message.

Also on Friday, the county opened its fifth drive-thru location at Highline College in the county’s south end where infection rates are at the highest levels in the area — three times higher than Seattle. King County, which also encompasses tech hubs in Bellevue and Redmond, will add another site in early December, said Dr. Mark Del Beccaro, COVID testing strategy lead at Public Health – Seattle & King County.

The county has been keeping up with demand, adding capacity with additional staff and more drive-thru lanes where possible, Del Beccaro said Thursday.

With eight and soon nine locations, Seattle and King County are “doing really well compared to any peer group in terms of availability of these open access testing sites,” he said. “We are doing really well. I’m not sure there’s anybody doing better than that… there are a lot of places that don’t have the organizational ability or resources to do anywhere near that level.”

If COVID cases keep rising rapidly, and with the potential for flu cases to cause COVID-like symptoms, there are worries that testing could become further strained and for shortages in testing reagents and supplies. There’s also concern about funding for testing.

Under most circumstances, health insurance companies are required to cover the cost of the COVID lab tests without any co-pay. But the biggest expense is operating the community testing sites, and those costs are covered by the federal CARES Act. That funding is running out.

“Our huge concern right now, with the lack of bipartisan coordination in the other Washington, is the current round of CARES Act funding for these activities expires on December 30th,” Del Beccaro said. The county is drafting a strategy to temporarily cover the costs if new legislation isn’t passed in time.

Private healthcare providers, hospitals, and long-term care facilities and others are also conducting COVID tests, accounting for about one-quarter of the county’s tests.

Challenge Seattle, an organization of CEOs from many of the state’s largest companies, sent a letter this week to Inslee and state lawmakers calling for more aggressive action on COVID, including increased testing, and offering its support.

Some health experts are hesitant to advise against testing for people without symptoms or a known exposure in case it discourages people who definitely should be checked, and because the disease has become so widespread that unknown exposure is increasingly possible.

“We need to trust the patient and really educate and say testing is one important modality,” said Dr. Caesar Djavaherian, co-founder and medical director of Carbon Health, a tech-enabled healthcare provider, with pop-up testing clinics around the country. Djavaherian shared anecdotal evidence of positive cases where there was no known contact with an infected person.

“We’ve been humbled by the virus left and right,” he said. In Seattle, Carbon Health is currently only screening Alaska Airlines travelers who require testing to fly to Hawaii.

Experts advise that even when someone gets a negative test, it’s only a snapshot of their COVID status at the moment of testing. They could still be infected and contagious.

So when will people have less restricted access to COVID tests, as we wait for widespread vaccinations?

That likely won’t come until rapid testing kits become widely available for home use.

On Tuesday, the U.S. Food and Drug Administration issued its first emergency use authorization for a rapid, home self-test kit. The kit from California-based Lucira Health requires a prescription and is expected to cost $50 or less, according to the New York Times.

Other home tests kits are available, but samples must be sent to a lab for analysis. Carbon Health offers a $185 home test kit. Residents of the greater Seattle area can participate in free at-home testing being conducted through the Seattle Coronavirus Assessment Network.

It’s a start.

“In an ideal world,” said Fotinos, “if we have testing readily available at every corner, we would want everyone to get tested.”

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