Carmel, IN goes with proactive Covid-19 testing

While a proactive COVID-19 testing strategy is out-of-reach for much of the U.S., one large town in Indiana is hoping to show the public health benefits of screening for the disease early and often.
Last week, the city of Carmel, Indiana — just north of Indianapolis, with about 100,000 residents — started weekly screening all of its first responders and some city employees, as well as staff and residents of its nursing homes.

Mayor James Brainard said he hopes to next expand the program to all city employees and their dependents, and eventually to all city residents.
“We’re doing this to slow the spread. Ideally, the U.S. would have been able to do this weeks ago,” Brainard told MedPage Today. “We’ll find out who has it, quarantine them, and test their contacts, so that our hospitals and medical personnel do not become overwhelmed.”
As of Monday afternoon, 315 workers had been tested; the city has thus far sidelined four police officers who’ve been infected.
Angela Caliendo, MD, PhD, of Brown University in Rhode Island, said during an Infectious Diseases Society of America press briefing on Tuesday morning, that early testing could work in certain parts of the country.
“There are areas of the country that have not been hit yet, so we might be able to impact the epidemiology of this infection or their curve more effectively than we have in places like New York, Louisiana, and Detroit,” Caliendo said during the briefing. “If we have adequate testing, we could consider areas of the country that can implement a strategy of more broad testing than those hit early. The testing done in South Korea was very important in controlling their outbreak.”

Carmel entrepreneur Zak Khan, who grew up in the city and has a history of philanthropy there, pitched Brainard the idea of proactive testing, which was sanctioned by local medical experts, Brainard said. Khan owns a network of surgery centers, many of which have been temporarily closed due to elective surgery cancellations. He also owns a laboratory, Aria Diagnostics, which purchased a COVID-19 PCR testing unit from Thermo Fisher. That lab has set up drive-through testing for the program.
Khan’s lab charges about $150 per test, covered by Carmel’s self-insured health policy. Brainard anticipates a total cost of $500,000 to $600,000 for the first phase of the project. Ultimately, he’d like to test all 700 city employees, and eventually their total network of 1,800, which includes dependents, and eventually screen the entire city.
Khan said one challenge has been procuring test kits; none were available from the company’s regular supply chains, so he had to assemble his own kit and get FDA approval.

“It forces labs like us to be more entrepreneurial in putting it together,” Khan told MedPage Today.
He now buys sterile swabs and viral transport media separately. Since the typical Amies solution that’s used isn’t available, he’s found other types of viral transport media that can be substituted. While Amies is better for a full pathogen panel, there’s less concern about that since testing is now “laser-focused on COVID,” he said.
Reagents for the Thermo Fisher test have also been a challenge, one that he says may be a bigger roadblock than test kits, though his team is actively seeking out supply, he said.
While the machine can yield results within four hours, the volume of testing and the need to confirm positives extends that time; Khan tells customers to expect a result within 48 hours. He also partners with Indiana University Health which has access to rapid testing if needed.

For instance, if a firefighter is potentially exposed, he can be told quickly whether or not he has to quarantine. Quarantine costs the city because it requires paying time-and-a-half to another employee to cover that shift. If a test quickly comes back negative, Khan said, that firefighter can continue his shift.
Khan said his lab is working with another town in Indiana, and with a home health agency in Texas, on early testing and hopes to expand to others as well.
“We can beat this thing back,” Khan said. “If testing starts with first responders, then moves to healthcare providers, and then the rest of the community, Mayor Brainard’s vision will make Carmel’s line flat.”
Beth Rupp, MD, of Indiana University Health, who isn’t involved in the Carmel testing project, said it could help prevent spread of disease, but cautioned that Carmel’s situation is unique.

“If they have the resources to do that, I think it’s a really interesting idea,” she said, noting that Carmel is a wealthier city than many in Indiana. “A lot of people don’t have the resources to be able to carry that out.”
Rupp added that the “whole testing situation has been such a frustration to all of us in healthcare. I would love it if more testing were available for everyone everywhere.”
Khan expressed similar frustration that the current strategy in the U.S. “is based on a scarcity of tests. I want to make it based on, how do we flatten the curve? Basing it on not having availability of kits is an awful way of practicing medicine.”
https://www.medpagetoday.com/infectiousdisease/covid19/85834