Region sees no shortage of COVID-19 tests
Social media and news from the Lower 48 share pictures of empty pharmacy shelves and stories of people waiting in lines for hours just to get a COVID test. President Joe Biden has said that 500 million athome COVID tests would be made available at no cost, but the rollout is expected to be slow.
The Nugget spoke with State Epidemiologist Dr. Joe McLaughlin and State Pharmacist Dr. Coleman Cutchins about the differences between tests, the availability of COVID treatments, and why a proper mask fit is important. The first thing to know, Dr. Cutchins said, is that there are over 600 tests which received an emergency use approval from the Food and Drug Administration. They can be broken down into two categories: molecular tests which are sent to a lab and can take a few days before test results are back, and rapid tests, which can take less than an hour, if given by a provider or at home tests, often the same tests as a provider gives.
With so many types available, it can be difficult to know which is the right one. “The best test,” Dr. McLaughlin said “is the test that you have available to you. If it’s easiest for you to use over the counter athome tests, great, please use them. But if it’s easier for you to go into a testing site and get either a PCR test or another rapid test, great, go ahead and do that, but please, go ahead and get tested as soon as symptoms arise.”
The Omicron variant “hit us really hard and really fast. The entire world, really,” Dr. McLaughlin said. This has led to an increased demand for testing. “We currently aren’t seeing any shortages of lab tests here in Alaska, but there are national shortages of these over-the-counter tests.”
Currently, there is no shortage of test kits in Nome or the region.
“We have a high level of testing in the region,” Norton Sound Health Corporation’s Medical Director Dr. Mark Peterson confirmed. He explained that NSHC will test anyone with symptoms and encourage those who have just come back from travel to get tested. In fact, he said, they’re happy to test anyone who wants to test. Want to test just because? “We have more than adequate testing to make that happen,” he said. Dr. Peterson also strongly encouraged testing at the airport when people get off the plane in Nome.
Dr. Peterson explained the testing situation in the region. It took a year and a half to get, but the NSHC uses a machine called the Roche Cobas 6800, which is “the gold standard,” and can process 200 samples in about three hours. They also use a PCR test from Cepheid. These analyze molecular PCR tests which look for viral material and are all highly sensitive to detecting the SARSCoV-2 virus which causes the COVID-19 disease.
In addition to the hospital in Nome, each of the villages has an Abbott ID NOW, which is a more rapid molecular test. This is not to be confused with the Abbott Binax NOW tests which are sold over the counter, and look for antigens, a protein on the outside of the virus. Antigen tests are also accurate, but the timeframe during which they can be used is shorter than with molecular tests.
The explanations around test accuracy can be difficult to understand, so Dr. McLaughlin clarified: “sensitivity is the ability of the test to detect a positive infection, if a person is in fact infected. The specificity is the ability of the test to rule out infection in a person who is not infected.”
Still confused? “As the sensitivity goes up, the higher the likelihood of a true positive. If the specificity goes up, the higher the likelihood of a true negative.”
Regardless of which test you use, “when you’re positive, you should consider yourself positive,” Dr. Cutchins said.
The December 27, 2021 guidance from the CDC states that “people with COVID-19 should isolate for five days and if they are asymptomatic or their symptoms are resolving (without fever for 24 hours), follow that by five days of wearing a mask when around others to minimize the risk of infecting people they encounter.”
“Mitigation not medication”
The Omicron wave is only just starting in Alaska, and even as early data from around the world suggests that it comes and goes quickly, the next month or two could be rough. The key is preventing infection. “Vaccination is our best tool for treatment in terms of prevention of viruses,” Dr. Cutchins said.
Dr. Cutchins explained why. Previously, there were treatments for people not admitted to the hospital called monoclonal antibodies. Monoclonal antibodies are synthetically produced in human tissue to target something specific. Each monoclonal antibody product is specific to that one target. “Unfortunately, with Omicron having so many mutations, the two most commonly used monoclonal antibody preparations, the two most readily available, are ineffective against Omicron,” he said.
Two new promising drugs – Paxlovid and Molnupiravir – are just
starting to arrive, but they will also be extremely scarce.
But there are mitigation strategies that work. “Being vaccinated, being up to date, having your booster, masking, distancing, testing, staying at home when you’re sick, avoiding gatherings with those outside your household, all of those things work for Omicron,” said Dr. Cutchins.
When it comes to masking, Dr. McLaughlin says that “fit is proportional to filtration. The better fitting mask you have, the better job that mask is going to do at filtering out the virus. Multiple layers are better than a single layer. Start with a surgical mask and then put a well-fitting cloth face covering over that. Or you could choose an N95 or KN95. The better the fit the better filtration. For people who want added protection, more layers are better.”
Dr. Peterson also noted how interesting it was to see how rates of flu have dropped, which shows what wearing masks and washing hands can do to prevent other communicable diseases, too. In addition to getting the initial series of COVID vaccines or a booster, if eligible, all three doctors strongly recommended getting a flu vaccine, as well.