County, health officials: Get tested if symptoms match COVID-19 or if exposed

Since the arrival of COVID-19, it's been hard to ignore that information pertaining to this respiratory illness caused by the coronavirus changes quickly and constantly.

Lately, that has absolutely been true about testing. Local county and hospital officials have the same advice when it comes to testing: Get tested if you have symptoms of the disease and consult the Centers for Disease Control and Minnesota Department of Health websites if you have questions.

"I think most health care organizations follow the current CDC and Minnesota Department of Health guidelines for testing," said Peter Henry, physician and chief medical officer for Essentia Health. "We recognize a lot of people won't necessarily go to those sites to look at that, but in general, anyone who is symptomatic, with some of the typical symptoms of COVID-19, should get tested."

"One of the big initiatives with the rollback here in Minnesota and the new governor's orders is that they have come up with additional guidelines on testing and emphasizing the importance of anyone that has been in contact with an individual that is positive," said Michelle Moritz, Crow Wing County public health supervisor. "They are doing testing for those individuals as well as anyone that has symptoms."

Symptoms include shortness of breath, fever, chills, headaches, muscle pain, sore throat and loss of taste and smell. That final symptom has proven to be a dependable symptom for diagnosis. As Moritz said, guidelines currently request that individuals be proactive in testing if they have had prolonged contact with someone who has tested positive for COVID-19.

"Typically that would be higher contact, so that's greater than a total of 15 minutes in a 24-hour period of time within six feet of someone who has tested positive within the last 10 days," Henry said.

That 15 minutes doesn't have to be all at once.

"That 15 minutes can be over a period of 24 hours," Moritz said. "You could spend a solid 15 minutes or more with somebody or you could spend five minutes here, five minutes there, and you're still spending time with the person and sharing the same air. That's when we're concerned about exposure."

Moritz recommended that in the case of exposure, the test should not be immediate, but should be five to seven days following exposure, though the person in question should quarantine during that time period and possibly after the test results come back, even if they test negative.

Those guidelines also go for those who have been in a situation in which they haven't necessarily been following guidelines, such as anyone who has been in a large gathering where they may not be following social distancing guidelines or wearing a mask. However, Henry said prevention is an even better policy.

"The most important thing is to avoid large gatherings and limit your celebrations to immediate household family members," Henry said. "We recognize that this is a significant sacrifice, but it's a minimal price to pay with the potential of being able to all be there when you celebrate Christmas. Wear your mask, (practice) hand hygiene, keep your hands off your mask except when removing it and putting it on, and you should practice hand hygiene both before and after those things. Staying six feet apart from people becomes especially important when you're eating and drinking, especially in work spaces or public spaces."

Henry stressed that following masking, hygiene, social distancing and, when relevant, quarantine guidelines is vital, especially among younger individuals. Given the number of people who can be contagious without showing symptoms, not following guidelines can make people unknowingly dangerous to those around them.

"Those people that are asymptomatic, oftentimes the younger you are, can become super spreaders very early in the disease," Henry said. "They can have very high viral loads and transmit the disease to a huge number of individuals. Because they don't have symptoms, they don't consider themselves contagious and we let our guards down."

Testing options have grown over time. In the beginning, people were most familiar with something called nasal pharyngeal tests, which resemble the influenza test in which a doctor inserts a long swab into the far back of your nasal passage. Many consider this test very uncomfortable, but now there are more options depending on your health care provider.

Essentia Health, for example, offers both a saliva test and a nasal test with a sample collected more toward the front of the nasal passage where discomfort is uncommon. Nasal pharyngeal tests aren't completely ruled out, however. These tests, especially the saliva test, have limitations.

"The difficult part of the saliva test is the only test we can do with that at the current time is for SARS (COVID-19)," Henry said. "So there are certain instances where a health care provider or physician may request that you have a nasal specimen or a nasal pharyngeal specimen because that allows them to test for other potential respiratory germs or pathogens."

Even among the different types of specimen collection, there are different ways doctors can analyze a test as well. Nasal swabs, for example, may be used for antigen testing, though Henry said those tests, often called rapid tests, should be reserved for those who have classic symptoms. In people without symptoms, the rapid tests may show false negatives.

"Which means the test says you don't have the disease when you do have the disease," Henry said. "Depending on where you are in the illness, that can be up to as high as 15% of people. These places where they are giving rapid tests or offering antigen tests, those should be for people who are symptomatic. They really are not designed for asymptomatic people."

The alternative to the antigen test is the polymerase chain reaction test, which can be done as both a nasal or saliva test. The PCR test is also much more accurate during the earlier stages. The chances of a false negative are 2% or less with this test if done by a qualified lab.

"It's really considered the gold standard," Henry said. "It does not have the issues of false negatives that antigen testing does."

These, generally, are the tests offered recently with in-home test kits, which Henry said are also of high quality, but require more time for mailing. The only down side of the PCR test is that it takes longer to test, typically several days, during which time the person who took the test is required to self quarantine. Otherwise the test results are virtually meaningless. If they are exposed between the time they took the test and the time the test comes back, then they could still be positive, but have no way of knowing.

There are also essential workers in high contact careers who are advised to take the test even without symptoms. This can include grocery store workers, among others.

"Those who work at a place that remains open during the dial back are recommended to get tested during that four-week period of time," Moritz said. "Even if that person doesn't have symptoms and has not been exposed, they are encouraging essential workers and critical infrastructure individuals be tested at least once before Dec. 18 and, if possible, to get tested right away, and then again at the end of that four-week period of time. It's to quickly identify individuals in critical infrastructure - essential personnel and staff - and quickly identify them to get them out of the workplace and avoid exposure of other critical, essential workers."

Moritz also recommends that people follow the approved guidelines and cooperate with contact tracing.

"I'm encouraging people to stay home and follow isolation and quarantine recommendations and be super vigilant for getting tested and answering their phones when public health calls for tracing," Moritz said. "Crow Wing is doing our own for our residents. The numbers have been pretty high with how many calls we need to make each day because of the number of positive tests. It's great when we can catch people on their first call. My staff are here to answer questions and help guide people through this illness. We appreciate that people have been cooperative with us for those interviews."

Essentia Health patients are able to participate in patient initiated testing. Those with an Essentia My Health account can use that account to schedule a time to test at the local test site.

Home test kits can be requested through the Minnesota Department of Health. Information can be found at https://www.health.state.mn.us/diseases/coronavirus/testsites/athome.html. Those who decide to take the home test are, again, instructed to follow instructions carefully and self quarantine until results are available.

Josh Stevenson, Cass County administrator, directed people with questions to the Minnesota Department of Health and Centers for Disease Control websites for questions regarding testing at https://www.health.state.mn.us/diseases/coronavirus/testsites/index.html and https://www.cdc.gov/coronavirus/2019-ncov/testing/index.html.

Travis Grimler may be reached at 218-855-5853 or travis.grimler@pineandlakes.com. Follow him on Facebook and on Twitter at www.twitter.com/@PEJ_Travis.