Testing for COVID-19 has been a closely followed and debated issue during the pandemic. In addition to the impact on each individual’s care, test data is critical to strategic planning and public policy.
As well as informing us, however, testing issues have also created a great deal of confusion and frustration. The terminology and specifics are new to most, and the criteria for and access to testing has fluctuated a great deal in a short period of time. After four months, here’s where we stand:
Summary points
* Testing is now available to anyone with symptoms of COVID-19, however mild;
* Those needing COVID-19 assessment are encouraged to call their family doctor or nurse practitioner's office, call 811, or attend the hospital emergency department (ER);
* Powell River and qathet Region District have had very few confirmed cases of COVID-19 to date, but remain at risk for future outbreaks. Ongoing attention to public health measures is still critically important.
Criteria for testing
Most COVID-19 patients have cold or flu-like symptoms, though onset may be gradual over days. Those with severe symptoms should attend the ER without delay. Common symptoms include fever, fatigue, cough, shortness of breath, muscle aches, sore throat, lack of appetite, and loss of taste or smell. Headaches, confusion, runny nose, nausea, vomiting, diarrhea and rashes are less typical, but may occur.
People without any symptoms (asymptomatic) are not generally tested in BC, except in special circumstances such as a public health investigation of an outbreak. In addition to using limited resources, testing asymptomatic individuals can lead to high rates of false positives (test is positive, but the person doesn’t actually have the virus). An online symptom checker is available at https://bc.thrive.health/covid19/en, or through 811.
Where to get tested
People are encouraged to call their nurse practitioner or family doctor if they feel they may have COVID-19. In addition to reviewing criteria for testing, a primary care provider knows their patient's medical history and can direct them accordingly. Some clinics offer testing on site, including drive-through testing, while others will refer to another office or to the hospital.
Assessment and testing for COVID-19 at Powell River General Hospital is located in the ambulance bay of the ER. There is a separated space for one patient at a time, and it is cleaned after each use. Efforts are being made to reduce wait times, but these do vary.
Those coming to the ER for respiratory symptoms or COVID-19 assessment are encouraged to call ahead (604.485.3211), and will be directed outside to the ambulance entrance where there is a buzzer to advise staff on arrival. Testing is available 24/7, if needed.
People being assessed and tested for COVID-19 will only be brought into the main ER department if they need further investigations or treatment. Dedicated areas are used for this purpose.
Procedure for outpatient testing
Testing for COVID-19 involves essentially a small cotton swab on a plastic stick that is inserted into one’s nose, turned a few times, then removed and placed in a tube. Nasal swabs may make one’s eyes water, but are generally described as uncomfortable rather than painful.
Locally, all COVID-19 swabs are packaged at the hospital and flown to Vancouver once or twice daily for processing. Results are typically by 8 am the day after they are received in Vancouver.
Powell River Hospital has secured a small supply of rapid tests that can identify a COVID-19 result within an hour. Owing to the very limited supply, these are generally reserved for critical situations.
Most people with COVID-19 (over 80 per cent) will be well enough to stay at home during their illness.
After being tested, patients are given instructions and an information sheet on how to self-isolate until test results are available. Staying home when sick is considered by many experts as the single most effective strategy to limit COVID-19 in a community.
Results
To confirm a negative test people may wish to speak with their primary care provider, use myehealth.ca, or call the BCCDC negative results line between 8:30 am and 4:30 pm, seven days per week, at 1.833.707.2792.
Those with positive test results will be notified rapidly by Public Health. In BC thus far, over 98 per cent of positive cases were reached in under 24 hours. The family doctor or nurse practitioner will also receive the result.
If someone tests positive for COVID-19, a public health staff member will call them daily until they are cleared (usually 10 days if minimal symptoms). They will offer direction on self-isolation and help advise how to manage symptoms, including when to seek further care.
The public health team will also take a detailed history to identify who has had close contact with a positive case, including up to 48 hours before that person's symptoms first developed.
Those people identified by public health as having a significant risk of exposure (e.g. sustained close contact, household members, no physical distancing or protective equipment) will be notified as soon as possible, and will be advised to self-isolate (and to test if they develop symptoms). Contact tracing is not generally done for very brief, distanced, or other low risk encounters.
Future plans
Blood testing for immunity (i.e. past infection) is not yet available for routine use. It is still unclear how accurate these tests are, and how long immunity from natural infection can be detected.
As we move into the fall, we expect an increase in respiratory viruses of all types. Detailed plans for additional testing sites have been developed and will be implemented based on capacity and need.
Powell River data
Local medical officer of health Dr. Geoff McKee reported last week that the lower Sunshine Coast has had a total of six cases thus far in the pandemic, and that Powell River region has had fewer than five cases to date (because of the low number and the potential privacy risk for so few cases, the exact number was not given).
Dr. McKee also noted that there were no active cases being followed on the Sunshine Coast. Unfortunately, there could be cases that simply aren’t identified yet, or new cases that may arise at any time. For this reason, regardless of the exact number of confirmed cases, we all need to follow public health recommendations if we hope to protect our community from this virus.
A recent survey completed by the Powell River Division of Family Practice identified that roughly three per cent of people surveyed in our region have been tested for COVID-19. Several barriers to testing were identified by community members, which we are working to address.
Conclusion
While our region has had relatively little COVID-19 activity thus far, global cases continue to rise rapidly. Until there is widespread immunity or a universally effective treatment, we are all vulnerable.
Local physicians will continue to prepare and behave as if there are active cases in the community. Staying home when sick, washing hands, physical distancing with most people, and wearing masks or protective equipment when needed, continue to be the cornerstones of defence for all of us.
In addition public health measures, testing (and contact tracing) is an extremely powerful tool to limit the spread of COVID-19. Anyone who thinks they may have symptoms should call their family doctor or nurse practitioner, call 811, or attend our local emergency department.
Be smart, be safe, and be kind. We are in this together.
~ Powell River Physicians COVID-19 Steering Group
