Kelsey Brunner/The Aspen Times
Testing for any Pitkin County resident with COVID-19 symptoms — even if they’re mild — will begin Friday, as the community moves into a new phase in the battle against the coronavirus, officials said Thursday.
However, a previously planned effort to test 1,000 county residents for COVID-19 antibodies, which would help determine the depth of the community infection, has been put on hold indefinitely amid concerns about the test’s accuracy.
“Before using (the antibody test) we’d like to see more validation from the FDA,” Pitkin County Manager Jon Peacock said Thursday during an online COVID-19 community meeting. “If there’s further validations, we will look at providing it to the community.”
In the meantime, local public health officials plan to put all their energy into what they’re calling a “box it in” strategy to fight the coronavirus. That entails testing people with symptoms, quarantining them until tests results indicate they’re positive or negative and isolating them if they test positive. Then investigators must track down at least 90% of the people the symptomatic person was in contact with, quarantine them and isolate each one if they test positive.
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The strategy is commonly used in public health to contain what are generally small-scale outbreaks of diseases like tuberculosis, hepatitis A or HIV, said Karen Koenemann, county public health director.
But in the case of COVID-19, the strategy was overwhelmed by the number of cases because it is labor intensive and the county, state and country did not have nearly enough people to do the monitoring and legwork inherent in the plan, she said. In order to do effective contact-tracing in the case of the coronavirus, public health departments need about one investigator for every 1,000 residents, Koenemann has said.
That means Pitkin County — with about 18,000 residents — will need about 18 people to get the job done. Peacock has said the county will retrain employees currently idled by the coronavirus limitations and hire others as contact investigators. The infrastructure and staffing levels should be in place and ready to go by next week, Koenemann said.
“We’ve been building an army of contact tracers,” she said during Thursday’s community meeting.
Aspen Valley Hospital also has been busy preparing to implement the strategy and has reached a point where transmission levels appear to be decreasing, said Dave Ressler, hospital CEO.
First, hospital officials have stockpiled personal protective equipment, which is necessary to collect the virus samples, he said. In addition, the staff is now mostly healthy, with only five hospital workers out with COVID-like symptoms as of Thursday, down from about 20 two weeks ago, he said. In addition, zero patients with COVID symptoms have appeared at the hospital in the past 24 hours, Ressler said Thursday.
“We’ve been conserving our resources for this day,” he said. “This plan has true merit.”
Pitkin County has had 57 positive cases since March 8 and two deaths, according to the state’s database. Aspen Valley Hospital has had 12 patients admitted and/or transferred and tested positive for the virus, per Pitkin County’s update through Wednesday.
The test associated with the box-it-in strategy is known as a PCR test, which tells health care officials if a patient actively has the virus, and is generally collected using a nasal swab. By contrast, the antibody test indicates that a person has had the disease and is detected through a blood sample.
Ressler said that any Pitkin County resident with COVID-19 symptoms — dry cough, fever, body aches, shortness of breath, fatigue are common — should contact their primary care physician. If the doctor agrees that the symptoms could be COVID-related, they will make an appointment at AVH’s respiratory tent in the hospital parking lot where patients will be tested by medical personnel, he said.
Those without a primary care doctor can call AVH’s primary care clinic, which will schedule an appointment at the respiratory tent if necessary, Ressler said. COVID-19 tests can only be done with a physician’s order.
People who can’t afford the test should not worry, Ressler said.
“We will not let cost be a barrier,” he said. “We want you to be tested.”
For others, the cost of the test is generally covered by insurance, he said.
The samples will be collected at AVH, Koenemann said, but analyzed at the state health department’s lab in Denver or at a private lab. Capacity to analyze the COVID-19 tests in Colorado has increased — in the beginning weeks of the outbreak the state lab was overwhelmed — so that results arrive in about 72 hours, she said.
The improved turnaround time makes the strategy feasible, Koenemann said.
The box-it-in strategy will be necessary to keep in place until a COVID-19 vaccine comes online, she said. That isn’t likely to happen for another 12 to 18 months, meaning Pitkin County’s strategy is built for the long haul, Peacock said.
And while it will cost between $1 million and $1.5 million to implement, it is the safest and best way to open up Pitkin County and Aspen’s social and economic life, he said.
“It’s an investment we need to figure out,” Peacock said. “It’s an investment we need to make.”
In a few weeks, unemployment in Pitkin County has gone from around 3% to just under 15%, or about 1,700 people. As of Thursday, the county had given out more than $1.3 million in emergency assistance funds benefiting about 2,000 residents.
Both numbers are expected to rise in the coming weeks, he said.
“This is our path forward,” he said. “It’s a long road ahead, but the road is visible. We are committed to beating this virus.”
Koenemann said COVID-19 will be present in our lives in the form of the box-it-in strategy, social distancing and related protocols including hand-washing, face masks and symptom screening for months, if not more than a year. Public health officials will gradually unwind restrictive public health orders, assess the corresponding uptick, or lack thereof, in COVID-19 cases and make adjustments if necessary, then continue the process until some semblance of our previous lives is reached, she said.
“We certainly can have people sit in a restaurant eventually,” Koenemann said. “People will be able to go to the gym eventually.”
But until a vaccine comes along, normal life is a thing of the past and the future.
“This will become the background of how we function,” Koenemann said. “This will be the new norm.”
