In Lincoln County, Delayed Test Results ‘A Huge Problem’

Even though contact tracing of COVID-19 transmissions has accounted for half of Montana’s positive detections since May, a statewide delay in test results for asymptomatic individuals has rendered the critical public health strategy useless in many counties.

Contact tracing through timely investigations, as well as the investigation of community clusters by public health officials, has contributed significantly to new case findings in Montana, and has bolstered the effectiveness of identifying and containing infected individuals.

The strategy is dependent on timely testing, however, and the recent announcement that a Quest Diagnostics lab in Denver, Colorado, which until last week was conducting the majority of Montana’s asymptomatic tests, had increased its turnaround time from three days to two weeks has stymied officials from conducting effective surveillance testing.

As Montana seeks new partnerships to help clear the backlog of asymptomatic testing, county health departments are overwhelmed by the volume of contact tracing work, with the Flathead City-County Health Department recently shifting its staff to alternating schedules so as to conduct contact tracing seven days a week.

In Lincoln County, Public Health Manager Jennifer McCully said she’s still waiting on the results of more than 1,000 tests from as far back as July 7. With the 14-day window to conduct effective contact tracing now closed, McCully and her staff are exasperated, and have no clue as to the degree of community spread occurring.

What they do know is that Lincoln County now has 34 confirmed active cases.

“It’s a problem,” McCully said. “We haven’t had any tests run for over two weeks, so with our new cluster and all of the new cases we can’t find the source of infection in a lot of cases. A lot of the tests submitted were of close contacts to known cases. If we had rapid turnaround, we could tie it together. But without those results, contact tracing is impossible.”

In May and June, McCully said she was getting test results back in three or four days, and helped the county keep up with contact tracing. When the lag time increased to seven, 10 and finally 14 days, she said the corresponding effectiveness dropped.

“By then it’s too far gone,” she said. “The goal of contact tracing is to wrap your arms around individuals and contain them so the disease doesn’t go any further. And we just can’t do that without getting a clearer picture. In June, we could get tests back in two or three days. But when we get into seven to 14 days, we can’t do anything with that. It’s too late.”

Jim Murphy, head of the state health department’s communicable disease bureau, said the state lab continues to process all of the tests it receives for symptomatic individuals, and is actively working to finalize a partnership with a new lab to conduct the surveillance testing.

“We are confident that we have the ability in-house to handle the needs of symptomatic people and those contacts,” Murphy said. “It’s the asymptomatic screenings with which we need help.”

In tourism communities like Whitefish, which the state identified as a priority for surveillance testing, asymptomatic testing sites were suspended beginning July 17, just as the tourism season got into full swing.

“If availability for processing improves, then asymptomatic testing may resume and we will work to make sure Whitefish is one of the first sites to be operational again,” Whitefish City Manager Dana Smith said.

In Lincoln County, McCully said targeted testing events were routine until the lag time rendered them ineffective, and now her staff is just hoping that community spread is limited.

“We basically have no idea what is going on in our community right now,” McCully said. “That is why the mask mandate is so important right now. We don’t know what is going on.”