Lack of COVID-19 testing capacity a roadblock to staged business reopening says Washoe County Health Officer

Photo: Brian Bahouth/The Ally

During today’s Washoe County Board of Commissioners meeting, Washoe County District Health Officer Kevin Dick gave commissioners an update on the numbers of cases and healthcare resources used in combating the COVID-19 pandemic in Washoe County.

During his remarks, Dick said if the number of active cases begins to decline in the state, there are ways, given the resources, to safely reopen parts of Nevada’s economy.

Dick referred to the “box it in” strategy developed by former CDC director, Dr. Tom Frieden. The protocols are to test widely and isolate infected people identified through that testing. Then, through rigorous contact tracing, find everyone who’s been in contact with an infected person and quarantine all of them for the 14 day incubation period. If they do become symptomatic, people can be isolated to limit the threat of further transmission.

“This framework works in conjunction with gradually opening different types of businesses in a way that we can monitor the number of cases that are occurring in our community through this testing strategy, so that if we do start to see increases and an additional surge developing, we can react to that and slow down the pace of that reopening activity that’s occurring,” Dick told commissioners.

In order to adequately monitor the spread of the novel coronavirus under Dr. Fieden’s guidelines, Kevin Dick cited a Harvard University study that says 152 tests must be conducted per day, per 100,000 population. That translates into roughly 700 tests a day in Washoe County.

“We’re currently at about 240 tests being conducted a day,” Dick said. “So that’s about 52 tests per 100,000.”

The lack of novel coronavirus testing is a well-documented problem throughout the US. Dick said that 4 Abbott Rapid Testing units have been deployed at regional medical centers. He said the devices can give results in fewer than 15 minutes, but they lack the needed test cartridges.

“As that capacity can be increased, the promise of the rapid ID type test is that they can be deployed to point-of-care testing, so as more become available, ideally, they would be distributed out to medical practices throughout our community, and people could get tested in a similar way that they do with flu, with the rapid flu test.”

The other key to reopening Nevada businesses in the context of declining numbers of cases is the workforce needed to conduct case contact investigations. Once a COVID-19 case has been confirmed, that person is quarantined, and investigators, ideally, trace back all the infected person’s contacts over the past 14 days to quarantine them and prevent further infections.

Dick said, based on several studies, the county would need roughly 140 contact tracing workers to safely reopen some Nevada businesses. He did not say how many are currently on the job. He did say the he expects federal funding to help hire more contact tracers, but that money has yet to arrive.

If businesses reopen, even with mandatory masks and social distancing margins, the ability to test and isolate people with COVID-19 is the key to continued commerce and a decline in the numbers of people infected.

“We need to work to strengthen our capability of enforcing that isolation and quarantine to be effective in this moving forward,” Dick said. “Because we won’t have that other layer of protection, that’s the stay at home and social distancing practices, the stringent ones that we have in place.”

Commissioner Kitty Jung said the outlook for more testing capacity remains dismal. She expressed the multi-faceted need for a controlled reopening of public spaces this summer.

“We also need to learn a little bit how to do this without a net because we’ve been told, and every single one of us have tried I’m sure to get a hold of something in that supply chain (testing kit supply chain), and we can’t get it.

“So I don’t want to keep saying, ‘when are we going to get these tests?’ I want to know, what if we don’t get these tests until September?

“My biggest fear is that people are not going to love, support and respect all the social isolation, and just be yahoos and do what they want.

“Where if we can incrementally start recognizing that psychological, spiritual, mental, and physical needs, with the science that is available, so I would like an update on that,” Jung asked.