Two people call their local clinic. One is a 70-year-old man in an assisted living facility, the other a hale and hearty 25-year-old woman.
Both have a fever and a cough and want to be tested for the coronavirus. Only the man will receive a test. The hypothetical situation indicates the state of coronavirus testing in Wyoming and across the country, how providers have to triage the tests they administer according to guidelines that prioritize at-risk patients and health care workers.
“We would love to be able to test everybody with safe, easy, low-cost, highly accurate tests,” Dr. Jim Little Jr. said. “But because it is limited, right now we are limiting tests to the highest-risk patients.”
Little runs St. John’s Family Health and Urgent Care, a clinic in the Smith’s Plaza on the south end of town. He and his staff find themselves telling symptomatic patients who don’t fit the guidelines to simply self-isolate under the assumption they have COVID-19, the disease caused by the coronavirus.
In spite of the lack of testing the state Health Department reported Tuesday that 739 tests had been run by public and private labs in Wyoming, with 37 positive cases. As of Monday morning, St. John’s Health had submitted 86 tests. Testing has found three positive cases in Teton County
Lack of testing capacity has been a theme of the United States’ response to the outbreak. The New York Times reported South Korea and the U.S. had their first cases of COVID-19 on the same day in late January.
Following the first case the Centers for Disease Control and Prevention lab in Atlanta was the sole U.S. testing facility for five weeks. In that same time, South Korea approved several commercial tests and established drive-thru testing facilities.
By March 17, the day of the Times’ report, South Korea had tested more than 290,000 people, the U.S. 60,000. The same dearth of testing has held true in Wyoming.
“We know that we are undersampling,” Little said. “We are trying to do the best we can to get accurate information about how widespread it is.”
The Wyoming Department of Health has been increasing its test processing capabilities from 10 per day in early March to 50 per day March 16 and 80 to 100 a day as of Monday, according to state epidemiologist Dr. Alexia Harrist.
Local providers still say the turnaround time for tests sent to the state lab can be five to seven days.
“My focus on testing has been to move away from reliance on state testing to private sector testing,” St. John’s Health CEO Dr. Paul Beaupre said.
A swell of companies have come forward with tests, but even some commercial labs St. John’s has worked with have run into problems, Little said, with wait times longer than seven days. A new test approved Saturday by the Food and Drug Administration promises results in less than an hour.
St. John’s has ordered a machine that in coming weeks should have a similar capability. As of now it can test for more than 20 viral infections, giving providers and patients more information, and Beaupre said he hoped it would have a test for the coronavirus in two weeks.
Without good numbers it is difficult to gauge how well measures like social distancing are working. Little pointed to Vo, Italy, which tested all 3,000 of its residents. That allowed officials to quarantine anyone who tested positive and essentially halt the spread of the virus through targeted measures.
Another consequence of poor data is that providers have less information on when a surge of patients might come. Surge capability refers to a hospital’s ability to take on lots of patients, particularly sick ones, and many rural hospitals face the prospect of being overwhelmed if the COVID-19 outbreak escalates.
Beaupre said St. John’s has the necessary supplies to deal with a surge. The hospital has 14 ventilators and has ordered 30 disposable ones. The machines are only one piece of the equation, because staff is needed to manage them, and if people are pulled from other posts, St. John’s can staff about 30 ventilators.
Though the hospital has only six beds in the intensive care unit, areas like the recovery room, the pre-operation room and the tent that was recently erected on the campus can be retrofitted for up to 28 more ICU beds, for a total of 34.
“I really don’t want people to be afraid that we are going to run out of resources,” Beaupre said.
In addition to beds, personal protective equipment will be necessary if St. John’s sees a surge in patients. Beaupre said at current usage levels the hospital has up to three months of supplies. The state of Wyoming has activated the National Stockpile, so outside resources are available as well.
In the face of a lack of testing, providers still feel ready if a surge occurs. Little, the urgent care doctor, said Jackson is prepared in part because it’s a tourism economy, which means the hospital has a capacity for a much larger population.
“Our hospital is built for surge capacity in the summer,” he said. “Right now, since it’s offseason, we have lots of capacity.”