Wyoming native DeAnn Cougler lives in Munich, Germany and frequently returns to her home state to visit friends and family and conduct field research for her doctorate studies in philosophy. She’s studying cultural factors that impede economic diversification in coal and energy communities in transition.
She made sure to get tested for COVID-19 right before returning to Wyoming this summer (she tested negative), and has followed recommended hygiene and social distancing practices since she arrived in Casper, she said.
“I’ve been super careful here,” Cougler said. “Every time we meet people, we do it outside and sit apart from each other.”
She’s alarmed at the lack of mask-wearing in indoor public spaces in Casper, she said. Cougler plans to visit her father in Sheridan soon, and said she’s considering getting tested again; her father’s health puts him at higher risk if he contracts COVID-19.
“I’ll be darned if he gets it from me,” Cougler said.
But she doesn’t have a primary care doctor in Wyoming who can recommend her for a test. Some people in Cougler’s same predicament have fibbed to healthcare providers about experiencing COVID-19 symptoms in order to get a test with intentions of protecting others.
Cougler is among a growing number of people who want to get tested as a precaution before traveling, visiting an elderly parent or attending a gathering — even though they aren’t exhibiting symptoms of the virus.
But in a state experiencing a surge in new COVID-19 cases and ever-changing response developments, it can be difficult to discern the best path forward. It is ethical to get tested if you aren’t experiencing symptoms? Does that risk wasting resources that are still considered limited? What kind of tests are out there? And how is the state aiming to contain outbreaks in high-risk facilities?
WyoFile asked healthcare officials and providers about the latest in what’s available, what’s new and what residents should know about COVID-19 testing in Wyoming.
Should you get tested?
If you suspect you may be symptomatic for COVID-19, believe you’ve had close contact with someone who has the disease, or otherwise feel you need to be tested, you should call your healthcare provider or local county health office. Be sure to call first, do not show up unannounced, said Andy Dunn, MD, chief of staff and director of primary care at Wyoming Medical Center in Casper.
It’s critical to have a conversation with a healthcare provider. Aside from COVID-19-related symptoms, a healthcare provider will ask about potential exposure.
Dunn said he’s often discovered that a patient has potentially been exposed to the novel coronavirus through work, has attended a get-together without masks and social distancing or has recently traveled to a COVID-19 hotspot like Arizona. But even if none of those risk factors for exposure apply, there’s really no disqualifier when it comes to who can get tested, Dunn said. Recommendations are based on myriad factors.
“We do test quite frequently because it’s the right thing to do, especially when you’re talking about mitigation and surveillance and contact tracing,” Dunn said.
When the pandemic struck Wyoming in March, people who wanted to know their status but weren’t suffering COVID-19 symptoms were mostly not eligible for testing — except in the cases of some frontline essential workers in health or public safety. Testing was withheld even for those who displayed symptoms but were not considered severely sick or at high risk to suffer life-threatening conditions. Many testing supplies were severely limited then, and healthcare facilities were not geared up to respond with widespread testing.
“That is not the case anymore. Our testing capabilities have expanded greatly,” Wyoming State Health Officer Dr. Alexia Harrist told WyoFile.
In the past few months, state and county health facilities have scaled up, acquiring more testing materials, adding new testing contract services and expanding hours and staffing.
The state lab has a testing capacity of about 750 per day, but has augmented staff by 20-30 people to process up to 1,000 in a day when needed, said Department of Health spokeswoman Kim Deti. The vast majority of samples run by the lab have been analyzed within 24 hours of receipt, Deti said.
In addition to tests run through the state lab, clinics, urgent care facilities and other providers in some regions of the state offer tests analyzed by commercial labs — some without a referral. Wind River Cares Family and Community Healthcare, an enterprise of the Northern Arapaho Tribe, offered testing to all Wind River Indian Reservation residents starting in April. The Teton County Health Department held a mass testing event on May 28. Urgent care clinics in Laramie, Afton, Jackson and Rock Springs and elsewhere have provided walk-in testing at times. Availability of such services, however, varies widely from community to community and even day-to-day within a community. Out-of-pocket costs for patients are also wide-ranging.
Wyoming still doesn’t have the capacity to test every resident and visitor in the state. However, the state and county coronavirus response network is able to manage testing for the increasing number of tests ordered by healthcare providers, according to Harrist.
As of Monday, the Wyoming Public Health Laboratory had processed 28,636 COVID-19 tests, and another 27,466 tests had been conducted via commercial labs and reported to the state, according to the Department of Health’s website. Gov. Mark Gordon has approved and distributed $30 million in CARES Act funding to expand COVID-19 testing capabilities across the state.
With expanding testing capabilities, healthcare providers are recommending tests for a broader array of patients than they did when the pandemic first struck, Harrist said.
“We have been offering testing to anybody who is symptomatic consistent with COVID-19 and anybody who is a close contact that we identify through our contact investigations,” Harrist said. “We ask that if people do have symptoms that could be COVID-19 [related] or if they’re identified as a close contact, we really recommend that they talk to their provider about getting tested.”
It’s still true that for those displaying typical COVID-19 related symptoms — fever, coughing, shortness of breath, muscle pain — who don’t have underlying health conditions that put them at higher risk, a healthcare provider might not recommend a COVID-19 test, Wyoming Medical Center’s Dunn said. They may advise a patient to presume they have the virus and quarantine accordingly.
“We’re starting to learn more about COVID,” Dunn said, and identify “some really key symptoms that we’re starting to see endemically in Wyoming. We can tell people are positive even before we get the results now — we’re starting to get better at figuring out the symptomology.”
So for people like Cougler who want to get tested even without symptoms or exposure — is it ethical to request a COVID-19 test?
The answer is yes, Dunn said.
“We do test for those situations, we do test some folks preoperatively who fit a certain risk stratification,” Dunn said. “Instead of using the state test, we might use a contracted PCR lab … and they can bill it to their insurance companies.”
An at-home test?
Increasingly, there are options for people to order at-home COVID-19 testing kits without a healthcare provider’s recommendation.
The U.S. Food and Drug Administration has approved several at-home COVID-19 tests since April, including one by Vault Health, the company that the University of Wyoming has contracted to screen faculty and students planning to return to campus this fall.
The cost for Vault Health’s saliva-based COVID-19 test is $150, according to the company’s website. Others such as LabCorp, Kroger Health and Vitagene also provide home testing for COVID-19 — some of them saliva-based and some requiring a nasal swab.
If a person chooses this route, there are specifics to consider, Dunn said.
Make sure the test you’re purchasing is approved by the FDA, and that it’s a “PCR” test, he said. PCR (polymerase chain reaction) is a 30-plus-year-old lab technique that can be used to detect the presence of the COVID-19 antigen, which provides more definitive evidence of the virus than tests that detect antibodies or a patient’s immune response to the virus.
“You really want your test to go through a PCR system because you get higher specificity,” Dunn said.
Samples analyzed by the state lab are run through a PCR system, according to state health officials.
Effectively collecting a sample is critical in testing for COVID-19, so another major factor to consider is whether you can self-administer an at-home test, particularly a nasal swab.
“The swab goes all the way back, basically until it touches your brain,” Dunn said, adding that he’d recently been tested with a nasal swab. “You’re going to tear up. If the person performing [the swab] or if you’re performing on yourself, if you’re not tearing up, you’re not going back far enough.”
Saliva-based tests — if they are PCR tests — are an increasingly sought-after option, particularly when it comes to compliance, such as the University of Wyoming’s required COVID-19 test for faculty and students.
Spit for higher ed
The first of five principles guiding the University of Wyoming’s plan to resume on-campus life and business this fall is to “keep the virus out to the extent possible.” To help achieve that goal, employees and students are required to get tested seven to 10 days prior to returning to campus.
The university has secured 20,000 COVID-19 saliva test kits via a $3 million contract with Vault Health for its fall semester baseline testing. There’s no charge to employees or students, according to the university. The expense was approved by Gov. Mark Gordon under CARES Act funding for the state.
Employees and students planning to be physically present on campus this fall will receive an email linking to a Vault Health website to set up an account. They will have to submit personal information and answer questions about potential exposure and symptoms, according to university officials and the Vault Heath website. They will receive test kits in the mail to be self administered at home. Each client is required to schedule a Zoom video call with a Vault Health official to guide them through administering the saliva test.
“The results of the test will be provided by the company directly to the student and the employee and to the University via a secure, HIPAA [Health Insurance Portability And Accountability Act] and FERPA [Family Educational Rights and Privacy Act] compliant database,” UW’s plan states.
UW’s plan also spells out quarantine requirements for those who test positive with and without COVID-19 symptoms, and states that “a negative test result will be required before leaving quarantine or isolation.”
Test results should come back 48-72 hours after the sample is mailed, according to UW and Vault Health.
Timing is critical for the university’s baseline testing and screening plan. On-campus life is expected to resume sometime at the end of August. Best practices require that a person practice caution in the time between taking the test, receiving the results and arriving on campus.
“Students, faculty members, and staff who are awaiting test results must self-quarantine and practice social distancing,” the UW plan states.
Even if a person tests negative for COVID-19, the screening may not be effective if university attendees don’t practice good hygiene and social distancing in the days before arriving on campus. To minimize that risk, the university is asking that tests be conducted 7-10 days before arrival.
“It’s most important for the test to be done as close to the start of school as possible, to minimize potential post-test exposure,” UW spokesman Chad Baldwin told WyoFile. “This approach also recognizes that the likelihood of everyone self-quarantining for 14 days before they come to campus is minimal – although I anticipate it’s something we’ll encourage.”
The state’s largest college is not the only institution where widespread testing and surveillance is unfolding. The Wyoming Department of Health acquired access to 50,000 saliva-based COVID-19 tests through testing company Curative.
The department plans to use the tests on high-risk populations such as nursing homes as part of an expanding surveillance program to identify and contain outbreaks.
“We have, of course, focused on the testing of symptomatic individuals and close contacts,” Harrist told WyoFile. “But what we really want to do is expand the surveillance testing that we’re doing; testing designed to identify cases in high-risk situations early so that we can take appropriate infection control measures.”
The state’s 50,000 saliva-based tests will be used to test these high-risk populations. Long-term care and assisted living facilities are the primary focus of the state’s COVID-19 surveillance efforts; “Outbreaks there can have really devastating effects,” Harrist said.
The state is testing 20% of staff and residents every two weeks. If a case is identified in a facility, the state follows up with 100% testing every week until officials are confident there’s no ongoing transmission. Harrist said the state planned to add Wyoming’s prisons to its surveillance program beginning July 13.
The state is continuously examining new testing capabilities by acquiring more supplies, expanding testing resources and possibly contracting for more private testing services, Harrist said.
“We need to be prepared. We don’t know what’s going to happen in this pandemic. We’re seeing our cases go up, and we want to make sure that we continue to have testing available and be able to detect cases early and implement control measures.”