Skyline Happenings

Ed note: Gov. Jay Inslee appears to be moving in the right direction in wanting more testing done in long term care facilities. One time testing is only a start. Testing really needs to be done at least weekly to have a meaningful impact. Hopefully we can get there, but there appears to still be a number of questions about availability. The 5 minute test being done in the White House isn’t very accurate (many false negative tests). Fortunate our UW Virus Lab is quite reliable.

From Fox Q13 SEATTLE — Gov. Jay Inslee plans to order widespread testing at all skilled nursing facilities across the state.

The state revealed last week that 61 percent of COVID-19 deaths in Washington are linked to long-term care facilities. The governor has now tasked the Department of Health to come up with a plan to test every resident and staff member in nursing home facilities.

On Wednesday, public health officials told local health departments that it amounts to about 37,000 tests. Expanding widespread testing to all long-term care facilities would about double the tests needed, according to Dr. James Lewis, clinical lead for Public Health — Seattle & King County.

The news of the forthcoming directive from the governor has local health departments trying to figure out how they can achieve such testing volumes.

“It’s not an easy task, it’s actually a monumental task with many challenges and barriers involved,” said Ingrid Ulrey, policy director and lead for King County’s long-term care facility response. “But we’ve made good progress toward it in King County. Depending on what comes out with the governor’s directive, people are going to need the time and the supplies necessary to get this done.”

In King County, 44 of 52 nursing homes have been fully tested at least once. About 70 percent of all skilled nursing facilities in the county have had at least one positive COVID-19 case.

“For it to be as useful as it can be, you really need to do ongoing testing on a regular basis, whether that be some period of days, a week or two weeks” Lewis said. “But really going beyond two weeks becomes less useful so you really need to be able to do testing on a frequent basis. In order for that to be realistic, we’re going to have to have much better access to test kits and [personal protective equipment].”

The governor has not finalized, published or issued any directive, according to his communications director, Tara Lee. She said testing supplies capacity is a factor in the state’s ability to test all residents and staff in long-term care facilities and said the governor, along with DOH, the Department of Social and Health Services, long-term care associations and public health officials will work together to finalize a plan.

The state has plenty of testing capacity but is still working to procure more testing supplies. In the first week of May, the entire state administered around 33,000 COVID-19 tests, fewer than what it would take to test staff and residents at skilled nursing facilities one time.

From the New England Journal of Medicine: “With reports of transmission of SARS-CoV-2 from humans to domestic cats¹ and to tigers and lions at the Bronx Zoo,⁴ coupled with our data showing the ease of transmission between domestic cats, there is a public health need to recognize and further investigate the potential chain of human–cat–human transmission. This is of particular importance given the potential for SARS-CoV-2 transmission between family members in households with cats while living under “shelter-in-place” orders. In 2016, an H7N2 influenza outbreak in New York City cat shelters⁵ highlighted the public health implications of cat-to-human transmission to workers in animal shelters. Moreover, cats may be a silent intermediate host of SARS-CoV-2, because infected cats may not show any appreciable symptoms that might be recognized by their owners. The Centers for Disease Control and Prevention has issued guidelines for pet owners regarding SARS-CoV-2 (www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/animals.html. opens in new tab). Given the need to stop the coronavirus disease 2019 pandemic through various mechanisms, including breaking transmission chains, a better understanding of the role cats may play in the transmission of SARS-CoV-2 to humans is needed.“

From Bill Gates Blog. Thanks to Steve L. for sending this in.

In any fight, it’s important to know your enemy. Unfortunately, in our battle against COVID-19, there’s a lot that we still don’t know.

How many people are infected with the virus, including those without symptoms?

Is it seasonal or weather dependent?

And how will we know when it might be safe to get back to work and send kids back to school?

These are important questions. More testing, of course, will help us answer them. But with tests in short supply in many parts of the world, including the U.S., it is impossible to test everyone—at least for now.

That’s why I’m excited about a new disease surveillance program in the Seattle area to detect cases of COVID-19 and help guide public health responses. Not only will it help improve our understanding of the outbreak in Seattle, it will also provide valuable information about the virus for other communities around the world.

The greater Seattle Coronavirus Assessment Network—or SCAN—is a first-of-its-kind disease surveillance platform for COVID-19 that allows participants to use a self-swab test to collect their own nasal samples and send them to a lab without leaving home. As a surveillance program, SCAN’s goal isn’t to test every person or serve as a replacement for medical care. Instead, SCAN is testing a sample of people in the Seattle region, including those who are healthy as well as those who are feeling sick. The test results and other data (like a person’s age, gender, race, zip code, and any underlying health conditions) are used by researchers, data modelers, and public health officials to paint a clearer picture of how COVID-19 is moving through the community, who is at greatest risk, and whether physical distancing measures are working.

One of the biggest questions puzzling public health officials is exactly how many people are infected with the virus. Think about the pandemic like an iceberg, says Dr. Jay Shendure, scientific director of the Brotman Baty Institute, one of SCAN’s lead partners. With ongoing COVID-19 medical testing, which has been largely focused on people with symptoms, we have been able to see the tip of the iceberg. Just below the surface, however, there is the part of the iceberg we don’t see—the unknown number of people who are infected but experience mild symptoms or no symptoms at all. Dr. Shendure compares SCAN to “a set of sonar pings where we’re skimming over the water and pinging to see what lurks beneath.”

I want to be clear that SCAN does not replace the widespread testing that is still needed in communities. But it has the potential to become an important tool for health officials seeking insights about the spread and behavior of the virus. Early results from SCAN found many cases of COVID-19 in Seattle that might otherwise have gone undetected among individuals who had experienced some symptoms (fever, cough, or shortness of breath) but had not yet sought medical care. As SCAN gathers more test results in the weeks ahead, researchers expect the new data to provide a better sense of the number of infections and serve as one source to help answer other questions, like when physical distancing measures can be relaxed.

SCAN is a partnership between Public Health—Seattle & King County, the Brotman Baty Institute, University of Washington Medicine, Fred Hutchinson Cancer Research Center, and Seattle Children’s Hospital. It relies on data modeling support from the Institute for Disease Modeling (IDM) and receives support from my private office, Gates Ventures, and our foundation.

SCAN is an outgrowth of a research study started before COVID-19. It’s been clear for years that there was a lot the scientific community didn’t understand about respiratory viruses, such as how they spread through a community, and the best ways to stop them. So, in 2018, my office teamed up with the Brotman Baty Institute and other partners to launch a study of respiratory illnesses, including the seasonal flu. That effort, the Seattle Flu Study, aimed to recruit 10,000 volunteers in Seattle who showed cold symptoms to provide a simple nasal swab at kiosks set up in health centers and through at-home tests.

One of the early discoveries of the study was the impact of high-intensity physical distancing measures on reducing the flu. In the winter of 2019, a major snowstorm in Washington state led to week-long school and workplace closures. Analyzing the data from that flu season, researchers found that the snowstorm’s dramatic disruption of social contact led to a drop in the transmission of the flu and other respiratory illnesses.

The Flu Study team hoped that these and other findings would help researchers develop tools to curb and even prevent the spread of the flu—and maybe one day help public health officials prepare for a future pandemic.

That day arrived sooner than anyone ever imagined with COVID-19.

In late January 2020, the first confirmed case of the novel coronavirus appeared in the U.S., just outside Seattle. The patient had visited Wuhan, China, the origin of the outbreak. 

Several weeks later, the Seattle Flu Study team started picking up signs of the coronavirus’s genetic signature in their flu study survey samples. In February, they identified the first known case of transmission in the U.S.—a teenager living outside Seattle who had not traveled to China and had no link to anyone with the virus. The Flu Study team sequenced its genome, and quickly realized that the virus had been spreading undetected for weeks.

This finding and the discovery of dozens more coronavirus cases suddenly put the Seattle Flu Study at the center of the area’s response to the coronavirus. We were fortunate to have this existing surveillance platform and an experienced team to quickly shift their focus to the outbreak. In March, we formed the new SCAN partnership with King County’s public health agency to track the spread of COVID-19.

One of the innovations of SCAN is an easy-to-use, at-home, self-swab test kit. The key advantage of this at-home testing approach is that people don’t need to go to a clinic, where they risk exposing themselves or others to infection. People interested in participating in SCAN can enroll online, and, once approved, they get a test delivered directly to their home. After individuals complete the nasal swab test, a courier service picks it up from their home and returns it to SCAN for processing. Anyone who has a positive result gets contacted by a public health worker who provides guidance on how to care for themselves and their families. And all participants can check their results online.

SCAN is currently testing 300 people per day, but actively working to test more. Those test results are then analyzed by disease modelers to map virus transmission chains. By examining the genetic signature of an infection, they can determine whether it represents a new introduction to the region or is part of a local transmission. They can also use the data to estimate disease prevalence and build models to look at how the virus is responding to certain measures—like school closures and physical distancing. You can learn more about their work on Nextstrain and the Institute for Disease Modeling’s research site.

As the SCAN team collects more data, I’m looking forward to learning more about their insights into many of the questions we have about this pandemic and how we can prevent the next one.

Thanks to Marilyn W. for sending along this article by Dr. Bromage. It’s the best summary I’ve seen about what the risks of exposure are in this current pandemic. Basically it’s about the dose of viral particles and the time of exposure. It’s highly unlikely to acquire an infection outside just passing someone on the sidewalk (unless they cough or sneeze in your direction). He points out the problems we’re going to face in states that are opening up too quickly. Most importantly he emphasizes the practical ways to keep safe.