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
