“Slow the spread” is a rallying cry for COVID-19. But, when it comes to information about testing for COVID-19, stopping the spread of misinformation is a challenge faced by public health leaders and healthcare providers.
Two experts involved with Yavapai Regional Medical Center’s (YRMC’s) response to COVID-19 recently shared their knowledge about coronavirus testing and related topics. They are:
William Lockwood, MD, Infectious Disease Specialist at YRMC PhysicianCare Pulmonology and Infectious Disease in Prescott
Infectious disease specialists diagnose and treat diseases caused by microorganisms, including viruses and bacteria. Dr. Lockwood has more than 30 years’ experience treating people who suffer from immunodeficiency – when the body’s immune system is unable to fight infectious disease – and hard to diagnose infections.
Rob Barth, III, RN, MSN, MBA, CEN, Director of Emergency Services at YRMC West in Prescott
Mr. Barth’s experience in the nursing profession includes leadership roles in emergency medicine, disaster planning and trauma services. Since 2002, he has also served in the United States Air Force Reserve as the Deputy Commander/Chief Nurse of the 944th Medical Squadron.
- What types of tests are available for COVID-19?
Dr. Lockwood: There are two types of COVID-19 tests that provide us with different information: a diagnostic test and an antibody test.
Let’s start with diagnostic tests. These tests look for the presence of the virus’s genetic material – the DNA – in order to find out if someone has the virus that causes COVID-19. We collect that genetic material with a swab that is placed fairly far up the nasal passage and more recently using a saliva test.
The second kind of test is an antibody test. When you get an infection, your body makes an antibody to that organism. We can check for the presence of an antibody with a blood test. This tells us if someone has had a disease in the past. It also gives us an idea of how immune people are to that particular infection.
There’s still much to learn about antibody testing before it can be an effective tool in the fight against COVID-19.
- What needs to be learned about antibody testing before it can help fight COVID-19?
Dr. Lockwood: The main question being studied is: What does it mean to have immunity to COVID-19?
Sometimes the presence of antibodies means that immunity is full and permanent and a person will never get that disease again. The measles are a good example of this. Once you have the measles, you have full immunity and you will never get them again.
However, there are other illnesses – like chickenpox – where antibodies provide only partial immunity. When you get chickenpox, your body makes some antibodies and develops some immunity. But those antibodies are not 100 percent protective. The virus that causes chickenpox can remain dormant in your body for decades and return as shingles when you’re older.
For this particular coronavirus, we do not know if the antibodies people are making provide full immunity from ever getting coronavirus again or if they give only partial protection. We also don’t know how long those antibodies will last. So, do you have complete protection for two months or three months or four months? Do the antibodies provide complete protection for your lifetime? Or, do coronavirus antibodies give partial protection for six months and then you’re back to being at risk again? We don’t have the answers to those questions yet.
The bottom line is that antibody testing is still being developed so it is not widely available at this time.
- Who can get tested for COVID-19 at YRMC?
Mr. Barth: First, if you’re experiencing severe symptoms, such as difficulty breathing or chest pains, you should call 9-1-1. If you’ve been in contact with someone who has COVID-19, or if you have mild symptoms, you should contact your healthcare provider or the Yavapai County Community Health Services COVID-19 Hotline (928-442-5103).
The Centers for Disease Control and Prevention (CDC) established testing priorities for healthcare settings that YRMC has followed line and verse throughout the pandemic. So, when people arrive at either YRMC campus, we’re screening them for COVID-19 symptoms. We ask if they have a cough, a fever or difficulty breathing. We also take their temperature. If they have a fever or if they respond “yes” to any of the questions, they’re directed to one of our outdoor triage tents for further evaluation and possibly a COVID-19 test.
Our triage tents are designed to reduce the chance of COVID-19 spreading in our hospitals. They keep our patients and staff safe and manage surge in our Emergency Departments.
- How are COVID-19 test kits prioritized for distribution to states and communities?
Dr. Lockwood: Initially, that was done through the federal government and state health departments. At that time, there was very limited testing. Everybody was waiting. Now, private companies are involved so test kits are much more available than they were.
YRMC didn’t get more test kits in the beginning because we weren’t in a surge area. Arizona was not at the top of the list. When the private companies got more involved, that’s when the testing kits became more available.
Now, the challenge is keeping up with the number of tests that need to be processed. It’s not so much having the swabs – which was a problem before – now it’s the volume of the tests to run at the labs.
Mr. Barth: Yavapai County is very fortunate. We haven’t seen the surge here like other places around the state and country.
YRMC has done a really good job with our inventory of COVID-19 test kits. We are in much better place than we were, but we’re still not in an ideal place to test asymptomatic people. And if you look at the CDC website, widespread community testing is listed on about the fourth tier as a non-priority.
- Is widespread testing an effective strategy for managing COVID-19 in a community?
Dr. Lockwood: The answer to that is “yes” and “no.” Let’s say you could swab everybody on one day and get their results just as quickly. You might be able to say, for example, we have 50 people out there with the virus. Those 50 people need to go into isolation and that’s how you would address the virus in your community.
The problem is, that is not an available test scenario for any community. We cannot get the results of all of those tests back fast enough for any one community.
And, a test is only an indicator of where a person is on that particular day at that particular time. If you test someone on Tuesday and they’re negative, they may have acquired the virus by Friday.
So, widespread testing would give you only limited information and it can’t be done fast enough to interrupt the entire chain of transmission.
- What happens to your COVID-19 test after you undergo it at YRMC?
Dr. Lockwood: After you’re tested for COVID-19, the test kit goes to the YRMC Clinical Laboratory where it’s registered for tracking and then sent to a Mayo Clinic Reference Laboratory. YRMC transports tests to the Mayo Clinic Reference Lab daily.
YRMC has partnered with the Mayo Clinic Reference Lab for several years. Because of our partnership, we’re able work with the Mayo Clinic Reference Lab as our best source for these tests.
After the test kit arrives at the Mayo Clinic Reference Lab, its tested and the results are shared with YRMC via a secure computer. The patient’s physician is then notified of the test results. This process takes 12 to 48 hours, depending on the number of tests being processed on that particular day.
- Will there be a COVID-19 vaccine available in the future?
Dr. Lockwood: A vaccine could potentially be a wonderful tool to stop the COVID-19 outbreak. The challenges we face with viruses and vaccines are the myriad steps before a vaccine can become available.
First, you have to decide how the vaccine is going to be put together. There are several paths for developing a vaccine and you need to figure out which will work best. After that, the vaccine is developed in the laboratory where it undergoes many safety tests.
Once it’s ready, the vaccine is tested on a small group of healthy volunteers to ensure there are no major side effects. Next, the vaccine is tested on a larger pool of volunteers to learn how much material the vaccine needs to make it effective. This is followed by more testing to determine the effectiveness of the vaccine and how long it will offer protection.
While all of this is going on, you have to plan for how the vaccine will be manufactured and then distributed.
So, when people say it’s going to be a year, 18 months, two years before a COVID-19 vaccine is available, they are probably very correct. It’s a great way of stopping an outbreak, but it takes time to develop.
- What is the best strategy for managing COVID-19 today?
Dr. Lockwood: Social distancing is currently the best strategy for managing COVID-19. In other words, stay at least six feet away from other people. If you have been exposed to COVID-19 or you’re having symptoms, you should quarantine yourself in your home and stay out of public areas where you could transmit it.
Of course, you should contact your healthcare provider or the Yavapai County Community Health Services COVID-19 Hotline. (The hotline is available between 8:00 am and 5:00 pm, Monday – Friday by calling 928-442-5103.)
For the most accurate and up-to-date COVID-19 information, Dr. Lockwood and Mr. Barth recommend the following resources: