On May 5, 2020

Living with Covid-19 amongst us

Rutland Regional, state prepare for reopening with testing for those symptomatic and contact tracing

By Polly Mikula

Since the beginning of April, at least, the state of Vermont and all its regional hospitals and health clinics have had enough Covid-19 tests to test all symptomatic patients for the virus. All it takes to get one is a doctor’s referral and an appointment.

With the availability of testing — about 14,000 tests were given in the state as of April 24— it’s encouraging to see both the number of tests and the confirmed cases from those test decrease, Governor Phil Scott, Health Commissioner Mark Levine and CEO of Rutland Regional Medical Center Claudio Fort have all said.

This shows that “the overall burden of illness is decreasing,” Fort summarized.

Because of available testing and consistent trends showing the virus is no longer spreading exponentially, the governor has decided to relax some of the social mitigation measures he put in place last month.  “We will continue to watch the trends,” he said. “Our decisions will be based on facts and evidence and if we see and uptick in cases, we might have to increase measures once again.”

Fort and Dr. Rick A. Hildebrant, chief medical information officer and medical director for hospital medicine at RRMC participated in a live call-in broadcast about Covid-19 with PEGTV, April 16, where they explained the status of testing locally.

Hildebrant explained, “We have adequate testing available for symptomatic patients, but the testing is really designed for people who have symptoms of Covid. When testing people without symptoms the negative rate is high, even when people actually have the virus. So we do not test those people because it doesn’t give you an accurate result. But if you have symptoms of Covid call your doctor and ask to be tested because there is adequate testing available…. and we’ll hopefully be able to get results in house very soon,” he said.

“PCR-based is the most common type of test for Covid-19. It’s a DNA test. It takes a fair amount of time to validate the test, however, so even when you have the capability to run it you have to be sure that the testing protocol gives you accurate information and test results,” Hildebrant explained of the process. “Our lab has been working very very hard on this to not only acquire the appropriate testing material but to validate the tests themselves and we’re very hopeful that by the end of this month we’ll be able to run tests locally at RRMC… and within 1-2 hours we can find out,” said Hildebrant.

The protocol for people who test positive for Covid-19 is home isolation for most (only severe cases must be hospitalized), then the state department will trace anyone who may have been infected.

Why contact trace?

Public health experts say the epidemiological detective work known as contact tracing can help slow the spread. Center for Disease Control  Director Robert Redfield has said  “very aggressive” contact tracing would be needed to prevent new outbreaks.

Commissioner Levine said testing and contact tracing are currently the only proven methods to box in the virus as the economy slowly begins to open.

On April 20, the Department of Health announced that it will soon have 48 people tracking down individuals who may have been exposed to the virus in Vermont.

Dr. Joshua White, chief medical officer at Gifford Medical Center in Randolph, said that ideally, the U.S. would track down everyone who’s been in contact with someone who tested positive for Covid-19 and get them tested to “put an end to any sort of chain of transmission.”

How it’s done

When someone tests positive for Covid-19 in Vermont, a contact tracer will first reach out to that person’s doctor then call the patient, ask about the onset of symptoms and who else they might have exposed.  The aim is to find out everyone with whom the infected person had prolonged enough contact within the 48 hours before the onset of symptoms to put them at “medium to high risk,” explained Daniel Daltry, program chief of the HIV, STD and Hepatitis C program for Vermont’s Health Department.  The contact tracers will then call those potentially infected people to coach them on what to look out for, how to isolate, and how to get tested if they develop symptoms.

Daltry said the department continually evaluates whether they have adequate staff to conduct contact tracing, with the goal of interviewing people within 24 hours of their positive Covid-19 test result.

Contact-tracing is critical for Vermont to quash outbreaks that will inevitably pop up until a vaccine is developed, White, Levine and Daltry agree.

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