A COVID-19 Testing Explainer

As Montana experiences an uptick in COVID-19, including 69 new positive cases from June 19-21, health officials anticipate the numbers will continue increasing as the state reopens and tourists arrive, which they say underscores the importance of avoiding complacency and routinely taking precautionary measures, including wearing masks in public, washing hands and limiting the scope of close social interactions.

“We’re going to need to be really diligent, otherwise we’re going to have a lot of cases and a whole lot of contacts in a really fast time,” Flathead City-County Health Officer Hillary Hanson said on June 17, the same day that four new positive cases were reported in the county.

The Montana Department of Public Health and Human Services (DPHHS) announced on June 18 the launch of a statewide ad campaign designed to guard against complacency and “remind Montanans to continue taking the right steps to fight the spread of COVID-19.”

Tracking Nonresident Cases

Gov. Steve Bullock said the state will begin including nonresident visitors who test positive in Montana in its online case tracker, although not in the cumulative total, in accordance with federal guidelines, which call for counting nonresident cases in their state-of-residence figures. Bullock said on June 17 that five nonresidents had tested positive in Montana since the out-of-state quarantine was lifted on June 1.

Meanwhile, residents who test positive while visiting another county will continue to be added to their home county’s tally, not the county where they test positive.

The Flathead City-County Health Department started listing active nonresident positive cases last week on its online COVID-19 dashboard, although once the cases are no longer active, they won’t be added to the county’s total.

“We want to give people the opportunity to be as informed as possible,” Hanson said. “We know that as we enter into our peak tourism season, our county could see an influx of out-of-state visitors. We wanted to make this information more accessible to community members and business owners alike.”

Hanson said the department weighs public usefulness and patient confidentiality when releasing information about positive cases, including not identifying a nonresident’s home state.

“We think it’s important for the public to see active cases in our community, but it doesn’t provide a benefit to say what state they’re from, and if anything it provides information that could identify the person,” she said.

Isolation and Contact Tracing

The process for addressing a positive out-of-state visitor case is the same as for a resident case. Infected nonresidents are required to isolate wherever they’re staying for 14 days, even if they had planned to return home during that period. “Isolate” is the term used for people who have tested positive, while “quarantine” is used for people who aren’t ill.

Health workers check in with them daily, going over signs and symptoms. Hanson said her department could call on law enforcement if the person isn’t abiding by the isolation requirement, but that hasn’t been necessary so far.

Health department contact tracers investigate and determine the person’s contacts. The tracers interview the contacts and can help arrange for them to get tested. Contacts who require quarantine must do so for 14 days from the date of last exposure.

Hanson noted that the department’s contact tracers are accustomed to the duty, as they regularly do it for other diseases, including sexually transmitted diseases, salmonella and more. Thus far, staff has been able to handle the contact tracing, but Hanson said “if we need to ramp up, we have plans to do so.” Bullock has also said the Montana National Guard is available if necessary to help communities with contact tracing.

Health officials use federal guidelines for “close contact” to determine who must quarantine; contacts who had been within six feet of an infected person and spent at least 15 minutes with the infected person meet the criteria for quarantine.

“We’re seeing a high number of close contacts,” Hanson said. “We really want to remind people that with businesses open and with people attending events and doing different things, you still need to be diligent about those public-health measures that limit risk.”

Defining and Limiting Community Spread

Better testing capacity allows health officials to more quickly identify individual cases and clusters, helping to prevent and mitigate community spread and outbreaks. Local health officials define community spread as at least five positive cases for which no source can be identified, meaning neither a travel history nor exposure to an infected person.

The Flathead City-County Health Department announced on June 19 that it had found evidence of community spread in the county, with five cases that couldn’t be “directly traced back to a known exposure with a positive case or related to travel.”

In addition to wearing masks in public when social distancing isn’t possible, frequently washing hands and staying home when sick, Hanson said people can limit risk by taking steps such as only dining with family members when eating out at restaurants.

“What we’re really concerned about with COVID are those vulnerable populations,” she said. “We want everybody to do their parts to keep our community healthy and our businesses open.”

Basics of Getting Tested

Increased testing means that anybody in Flathead County with a sign or symptom of COVID-19 can now get tested, and also that tests can be administered to asymptomatic close contacts. Hanson pointed out that earlier in the pandemic, health officials even had to prioritize testing among symptomatic people.

“Now, if you have any sign or symptom, go get tested,” Hanson said.

People who believe they have symptoms can call their primary-care provider or visit one of Kalispell Regional Healthcare’s four screening facilities in Kalispell, Columbia Falls, Eureka and West Glacier. More information, including hours of operation and phone numbers for a 24-hour call center, is available at krh.org/covid-19 under “Screening Clinics.”

Mary Sterhan, executive director of the Flathead Community Health Center, said her clinic can test people who don’t have a primary-care physician or can’t pay for a test. She said expanded testing is a shared priority across the health-care spectrum.

“When you get right down to it, everybody is trying to get more testing done,” she said.

Sterhan said there’s confusion among the public about testing, from types to access, and believes outreach and education will be important as cases ramp up again.

“We’re getting a lot more phone calls and a lot of nervous people now that it’s back in the community, so some clarity around what kind of testing is available is appropriate and important,” she said.

The tests are viral-detection tests that identify if a person is actively infected with the virus. Health officials in Montana don’t currently administer antibody tests, which can show if a person has previously had the virus, although the varying efficacy and wide range of different tests have raised reliability concerns as people across the nation purchase them on the private market to self-administer.

Beyond accuracy questions, Hanson notes that there are still a lot of unknowns with COVID-19, including length of immunity following infection. While the health department doesn’t have an official position on residents securing private antibody tests, she said it’s important to keep those uncertainties in mind.

“Our biggest concern is that people are going to use test results to change their behavior because they think they’re protected in a manner that they really may not be because there are so many unknowns,” she said.

A spokesperson from Bullock’s office said the state is looking at the possibility of offering antibody testing in the “near future,” but noted that there are “a lot of antibody tests out there that are not accurate and we want to make sure we are utilizing machines with validity.”

Community “Snapshot” Testing

Flathead County began offering asymptomatic testing for frontline workers last week. The community “snapshot” testing, which offers an idea of the disease’s presence in an area within a specific time period, kicked off with testing in West Glacier on June 16-17 and in Whitefish on June 18-19.

The free testing is primarily aimed at businesses whose employees have frequent interactions with the public, particularly tourists.

“We’re setting it up to meet the needs of those frontline workers,” said Sterhan with the Flathead Community Health Center, which is coordinating the snapshot testing. “But having said that, we will test anybody who comes by and wants to get tested.”

People are screened at the drive-through test sites, and if they exhibit symptoms, they are referred to a health-care provider or one of KRH’s respiratory clinics. Asymptomatic people are given a nasal swab to self-administer onsite in their car. Then the test kits are sent away for processing, with results returned in a week.

The state of Montana is funding the testing as part of Bullock’s efforts to provide additional resources for destination communities with a lot of tourism. The state initiative said the snapshot testing “aims to develop an early warning system for a COVID-19 outbreak through one of the major risk factors facing the state — travel.”

Interested businesses can contact the health center ahead of time to get information, or employees can drop by the testing sites when they’re open. West Glacier and Whitefish will continue hosting testing sites two days a week, while Sterhan said Columbia Falls and Bigfork will also have sites, perhaps beginning this week.

Both Sterhan and Hanson emphasize that it’s a “snapshot” of the community on a particular day, and people who test negative could test positive a day later. But those glimpses could render valuable indicator information for public health officials.

The sites’ hours are subject to change right now as health officials try to find optimal schedules to accommodate the greatest number of workers. Sterhan said information such as locations, days and hours will be updated on the Flathead Community Health Center’s Facebook page.

Frontline workers include grocery store clerks, bartenders and waitresses, and employees in tourism fields, including outfitters. Sterhan said raft company employees and Glacier National Park staff were among those participating last week.

As chambers of commerce let more businesses know and word of mouth spreads, Sterhan expects the sites’ number of visitors to grow, but said the state has assured community health centers that adequate testing resources are available.

“We’ve been told we have access to the tests, and we’ll just continue to order tests as we need,” she said. “We will continue to do it throughout the summer.”

Improving Capacity on Multiple Fronts

Bullock set a goal of eventually reaching 60,000 tests completed per month in Montana, and recent data suggest the state is working toward that goal. For the week of June 6-12, Montana administered 11,229 tests, a 50% increase over the previous week.

The governor’s efforts to expand testing include both general capacity and targeted testing in places such as nursing homes and on American Indian reservations. The first round of large-scale community testing on reservations wrapped up last week on the Flathead Indian Reservation in one of the state’s largest testing events.

All residents of Lake County and the reservation were invited to the free drive-through testing event, held over four days from June 17-20 in a different town each day. Roughly 2,500 people were tested. Results take about seven days.

Hanson said even as infections rise, it’s important to note that the county and state are vastly better prepared to handle the situation than at the start of the pandemic, not only in terms of testing but also critical factors such as personal protective equipment. The U.S. Army Corps of Engineers also built an alternative care facility at Kalispell Regional Healthcare that can be used in the event of a surge in cases.

“We know that cases are going to continue to increase,” Hanson said. “What we’ll be looking at is, ‘Are we still able to manage the cases?’ We’re far better positioned now than before.”