Testing key to keeping the novel coronavirus in check in Montana

By 
Deb Hill
News-Argus Managing Editor
Tuesday, June 9, 2020
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Ashley Ausman of the DPHHS State Public Health Laboratory prepares samples for RNA extraction while working to conduct COVID-19 testing. RNA isolation from samples is one step in the process that takes several hours to produce a final result.     
Photo courtesy of Jon Ebelt, DPHHS

As Montana enters the second week of Phase 2 reopening, testing is seen as one of, if not the primary, tool to allow the state to stay on top of COVID-19. As of Tuesday morning, over 53,000 coronavirus tests had been run, with 471 of those from Fergus County residents.
“We are seeing more testing of asymptomatic people,” said Julie Rooney, public health nurse with the Central Montana Health District. “In our area this is mostly in nursing homes and assisted living facilities, and for people who are going into a medical facility for some type of procedure. They are required to get tested before they can have their procedure.”
All of this is part of the state’s efforts to try and catch COVID-19 outbreaks as they are happening.
“If we get a positive test, then we can do the contact tracing to find out who they may have been in contact with. That’s how we contain it, by testing and contact tracing,” Rooney said.
In Central Montana, she said, anyone can get tested but it will require a medical provider’s approval.

“In some places there is drive-through testing, “ Rooney said, “but due to the low number of cases in Central Montana we don’t have that level of aggressive testing here, because we haven’t needed it.”

Number of cases varies widely across the state
So far the six-county area covered by the Health District has seen only five cases of COVID-19.
However other areas of the state have not been so lucky. Gallatin County, for example, has seen the most cases of any Montana county, 168, in people ranging in age from under 10 years old to almost 90. After Governor Bullock enacted a “stay at home” directive in March, Gallatin County’s case numbers dropped to zero, but there has been a small spike in cases in the past couple of weeks.
Tracy Knoedler, director of human services with the Gallatin County Health Department, said the county is now seeing community spread of COVID-19.
“Community spread is when we cannot identify where someone got infected,” she said. “Lots of our original cases we could trace back to travel, but with recent cases we have not been able to identify the source. That means the disease is out there in the community, possibly being transmitted by those with no symptoms or only mild symptoms. In those cases, the individual does not even know they are sick and should get tested.”
Knoedler said health department personnel in Gallatin County are being “hyper vigilant” and keeping a close eye on the progression of the disease.
“We are doing testing of asymptomatic people, and some targeted testing if we think there might be a case, for example, at a business. We’ll test all the employees to try and keep it from spreading,” she said.
Even with community spread, testing is still useful, Knoedler said. And she feels the state is in a much better position with regard to testing now than just a few months ago.
“If you go back to February, when we had our first potential case, you could not get a test unless you talked to the CDC, and then you had to send the test to the CDC and it took five days to get results back,” Knoedler recalled. “Now we have tests available locally and they are run daily at the state lab. This is helping us track and stay on top of [COVID-19] cases.”

State lab in charge of Montana’s testing program
Dr. Ron Paul, chief of the Laboratory Services Bureau of the Department of Public Health and Human Services, oversees the state’s public health lab, which is responsible for running tests for the novel coronavirus. Currently the lab is reporting the results of over 1,500 tests per day, every day including weekends.
“We have a really amazing staff of lab scientists and supervisors working for public health. Everything we do here is geared for public health,” Paul said.
Normally the public health lab techs are busy testing for things like influenza, pertussis, measles, mumps and HIV. The lab also conducts newborn screening tests. Until early March, the novel coronavirus was not on the agenda.
All that changed on March 2.
“We had to get testing up and running quickly. During normal times we work five days a week, one shift. Things are a little different now -- we are working every day. We have some temporary help for administrative tasks, and one or two former employees have come back to help us in their spare time, but most of the work is being done by the people we already had on staff. They are very, very dedicated,” Paul said.
COVID testing took over a second lab, once dedicated to environmental testing.
“We’ve built in some redundancy with our equipment that allows us to run three different COVID-19 assays. Having multiple pieces of equipment that can perform the assays or the PCR [genetic] testing is essential because equipment can break down,” Paul explained.
Still, he credits the employees as the reason Montana’s testing program is working so well.
“We are doing the majority of COVID-19 tests here, between 700 and 1,000 per day. The rest we send out to other labs, but we are doing all the tests from symptomatic patients because those results are needed immediately,” Paul said. “Every time we think we can’t get through the next level of testing, we all pull together and we do it. We couldn’t anticipate the massive volume of tests, but somehow we’ve been able to adapt. While we hope this doesn’t go on for an extended time, we will keep going as long as is needed to keep the spread of the disease low.”

Preventing coronavirus spread still important
While Montana is in the process of opening back up, the coronavirus has not gone away, as the new cluster of cases in Gallatin County show.
Still, the Health District’s Rooney is all in favor of the re-opening, if done carefully.
“We are in a much better place than we were in March,” she said. “We have more testing ability, our health care facilities are better equipped to handle COVID cases as they have more protective gear and policies in place for how to deal with these patients. We have to go back to something closer to normal.”
However, Rooney hopes people don’t forget the basics: frequent hand washing, social distancing, wearing masks when social distancing cannot be maintained and staying home when sick.
“If we all do this, a lot of communicable disease would be stopped in its tracks,” she said. “Our flu numbers dropped like a rock when the ‘stay at home’ orders started. The same principal will work for flu, pertussis [whooping cough] or COVID-19.”
As for what the future holds with regard to coronavirus, Rooney said she will not be surprised to see Fergus County get some cases eventually. However she and other public health officials expect a vaccine will be available, perhaps as soon as next year.
“We are planning now for how we would do mass vaccinations, once a vaccine is available,” she explained.
Until then, she said, anyone with COVID-like symptoms should immediately talk to their health care provider about getting tested.
“Time is of the essence when it comes to containing this disease,” she said. “The earlier we get on top of it, the better we can contain an outbreak.”
Rooney said anyone concerned about possible COVID-19 cases in Central Montana can call her at 535-3983.

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