Testing lab at capacity, Alluvion suspending drive through clinic for asymptomatic people; CCHD explains contact tracing

Alluvion Health is shifting testing operations since they were notified July 15 that the state public health lab is at capacity due to the volume of testing.

State officials asked Alluvion to shift their priority to only test those who are symptomatic or have been identified as direct contacts from the health department, according to Alluvion’s Tanya Houston.
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Alluvion is looking for another lab or option, but in the meantime, is discontinuing open testing at the drive through site.

Houston said they’re handing out fliers to anyone coming through the drive through today, July 16, stating that if they still wish to be tested today, it will be 3-4 weeks until they get their results.
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“This is a constantly evolving situation and information is changing rapidly,” Houston said in an email to The Electric. “This is not just the scenario in Cascade County, and will be reflected statewide as all testing agencies work to adjust.”

Alluvion is continuing onsite testing at assisted living facilities and for other high risk populations as directed by the state, Houston said.
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Great Falls Clinic is currently only testing symptomatic people and/or patients checking in for surgery or admitted to the inpatient unit.

A spokesperson for GFC said, “our in-house testing is extremely limited due to allocation of supplies.When we test in-house for inpatient admits, surgeries or symptomatic patients, the turnaround is within a few hours. This will change once we run out of supplies and we have to go through the state.”

Benefis Health System has also stopped testing asymptomatic patients and has also shifted testing focus to those identified as high risk or symptomatic.

In an email to The Electric, a Benefis spokesperson said, “s we continue to see many new daily COVID-19 cases throughout Montana, the demand for testing has increased beyond capacity. State officials have notified Benefis that the state lab’s waiting period is now three to four weeks for results on tests for asymptomatic patients, and the wait is even longer for larger labs outside of Montana. Subsequently, state officials have directed us to stop testing asymptomatic people at this time and focus our testing only on those with symptoms.”

Until July 16, Alluvion was offering the drive through test to anyone, regardless of whether they had symptoms.

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Houston said they could mark certain priority groups if the individual is a first responder, medical provider, or fell within another specific group.

During the open drive through testing, Houston said some people coming through weekly or biweekly for testing.

Houston said Alluvion has conducted 7,293 total tests from 6,101 unique individuals, and of those, there were 36 total positive tests. The positives were from all of Alluvion’s testing operations, and not all were individuals from Cascade County as they’ve had some from out of state.

Contact tracing

The Cascade County City-County Health Department is responsible for contact tracing communicable diseases and is currently monitoring about 100 people who are either active cases or people identified as close contacts.

A close contact is defined as a person who was within six feet of a positive person for 15 minutes or more.

According to CCHD, the state lab prioritizes testing for people who are contacts of known cases. With those tests, they typically see results within 2 or 3 days, CCHD told The Electric.

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Katie Brewer, CCHD’s prevention services manager, said someone who tests positive is initially notified by the health provider that conducted the test. The heathcare provider also lets a patient know that the health department will contact them.

Brewer said that once CCHD is notified of a positive case, the public health nurses or CCHD staff will give that person a call and have a conversation to determine their onset of symptoms and then go back 48 hours to see who they’ve been around.

Brewer said they talk about CCHD’s role and figuring out where they were exposed and then working to mitigate further exposure.
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A positive person will give names to CCHD nurses and staff but that information is protected by CCHD, Brewer said.

CCHD then contacts those known contacts and let’s them know they’ve been exposed to COVID-19 and that they must quarantine for 14 days. CCHD calls positive cases and contacts daily to monitor symptoms and sometimes gather more information through conversation if a person remembers other details.

“Finding out you have COVID is quite stressful,” Brewer said.
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She said they understand that it can be a shock and it’s also hard to remember every detail of who they were around, what they did and where they were, so that’s part of building relationships to have conversations and work through it.

Trisha Gardner, county health officer, said if they hear things from other people, they can go back and talk some more, or sometimes people remember a detail and get in touch.

That’s common contact tracing for all communicable diseases, not just COVID, Gardner and Brewer said.
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Gardner said they ask probing questions, “trying to get them thinking through their day.”

Every case is a little different and Brewer said they’ve had some with very few contacts, some with more than 30.

Gardner said they haven’t had anyone who knew they were sick or symptomatic who was going out in public, knowingly exposing others.

Brewer said it’s difficult, because it’s allergy symptoms and some thought it was allergies.

“Some feel like a bus hit them, others had a sniffle and thought it was the cotton,” Brewer said.
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The number of people being monitored fluctuates daily as people come off quarantine, but then new contacts come on, Gardner said.

Gardner said that there are provisions in state law that allow for health orders for isolation and quarantine and if they aren’t followed, a person can face fines and potential jail time.

Brewer said they’ve been fortunate and most in Cascade County have been very cooperative with contact tracing and following the orders to quarantine or isolate.

Isolate is the term used for someone who has tested positive, according to public health officials, and quarantine is for those who are identified as contacts but not symptomatic or tested positive.

CCHD has two full time nurses, one part time nurse and other staff helping with contact tracing and monitoring.

One nurse is handling other communicable diseases, such as sexually transmitted infections, one nurse is taking the lead on COVID.

The department still has vacancies for public health nurses, which are posted on the county website.

Garnder said anything told to CCHD staff during contact tracing is kept confidential and the department will write letters for employers if needed, or do what they can to assist a person to make the process easier.

“They’re an essential piece to us stopping this spread,” Gardner said. “They’re critical to us. We rely on their honesty so they have to be able to trust us. Our mission is to get the disease as contained as possible and in order to do that we need people to talk to us.”

Brewer said there’s no judgement or fingerpointing from CCHD staff during the process.

“We just want to find the case,” Brewer said. “We want to find the exposure, we want to stop the spread.”

CCHD sends letters to every positive case and contact outlining what isolation and quarantine means with their date of exposure.

Brewer said they’ve been able to find all the contacts that have been reported to them so far.

She said that out of the 60 confirmed cases in the county, as of July 16, there have been 18 that were asymptomatic. Of the total cases, seven were acquired from an asymptomatic case, Brewer said.

Of all the confirmed cases so far in Cascade County, all but one were symptomatic or found through contact tracing. One was a person who traveled out of state so decided to get tested upon return despite being asymptomatic.

She said they haven’t had anyone who was asymptomatic and went through the Alluvion drive through out of simple curiosity test positive for COVID.