Dear Community Members,
We want to respond to the questions that many of you have asked about COVID-19
testing in Teton County, WY.
There are two types of COVID-19 testing. The first is active disease testing
and the second is antibody testing. These two types of tests, ideally,
may be used together to develop an overall picture of COVID-19 in our
community. Active disease testing identifies individuals who need to be
isolated or quarantined and can be used with isolation and contact tracing
to control spread of the disease in our community. Information about whether
a patient has COVID-19 also helps healthcare providers make medical decisions
and take other steps to keep patients and healthcare workers safe. We
know for certain that active disease testing is very appropriate and necessary
based on the current phase of the disease curve in Teton County. Because
antibody testing may also provide valuable information, St. John's
has asked a group of local physicians, scientists, and experts to review
and advise us on currently available antibody testing platforms that may
be valuable to our community. St. John's has stated that it will base
decisions about antibody testing for healthcare workers and emergency
responders on the recommendations of this group.
First, it is important to distinguish between active disease testing and
Active Disease Testing is used to identify if a person has COVID-19 on the day the person is tested.
The current COVID-19 case counts being reported across the globe, and
in Teton County, are from this type of testing. This test result will
be negative if a person does not have COVID-19 at the time the test was
taken, even if they have previously had COVID-19. The test is conducted
by taking a nasopharyngeal swab to test a person’s upper respiratory
tract specimen. The swab is then sent to either the Wyoming Public Health
Laboratory or a private lab for testing. All the laboratories used by
Teton County, Wyoming providers are authorized by the Food and Drug Administration
(FDA) under an Emergency Use Authorization (EUA) to conduct Real-Time
reverse transcription polymerase chain reaction (RT-PCR) to test the samples
submitted. Real-Time RT-PCR test is a qualitative test that detects nucleic
acid from SARS-CoV-2 (the virus that causes COVID-19) in the nasopharyngeal
swab submitted by healthcare providers.
Antibody Testing determines if a person has developed antibodies to COVID-19. Antibodies
form in response to being exposed to COVID-19. However, after exposure
to COVID-19, there is a delay in the formation of antibodies in a person.
An antibody test (serology immunoglobulin test) for COVID-19 tests an
individual’s serum, blood, plasma or finger prick sample for the
presence of IgM or IgG. A positive test result would indicate that a person
has previously been exposed to COVID-19 and has developed an immune response.
It is important to note that current antibody testing may not be a reliable
way to identify persons who are currently infected with COVID-19. Positive
antibody tests may be due to present or past infections with a non-SARS-CoV-2
coronavirus due to cross-reactivity with other common non-COVID-19 human
coronaviruses. Similarly, a negative antibody test does not rule out a
SARS-CoV-2 infection because a person could be presymptomatic, in the
early stages of their illness, or immunocompromised. Currently, there
is only one FDA -approved antibody test on the market. Right now, these
tests are not known to confirm immunity, measure the strength of one’s
immunity or determine how long immunity might last. The FDA has also warned
against fraudulent test kits that are being sold. The hope that we hold
for this type of testing is that it may provide a better understanding
of the spread of COVID-19 along with calculating accurate case fatality
rates and developing other important indicators. Antibody testing may
also prove useful for identifying first responders, medical providers
and others who have been exposed and who can safely resume work without
needed to be quarantined or isolated.
To assess testing platforms and the value of antibody testing for Teton
County, Dr. Beaupre has selected a panel of local experts who have backgrounds
in medicine, public health, scientific research, biotechnology, laboratory
science, and biostatistical and epidemiological data. In addition to their
professional qualifications, these individuals have no financial interests
in companies currently offering antibody testing. Dr. Beaupre and Jodie
Pond will participate in the group's sessions but will not participate
in voting on a recommendation. The members of the panel are: Dr. Travis
Riddell, Dr. Marcia Lux, Dr. Jim Little, Dr. Jeff Greenbaum, Dr. Lars
Conway, Dr. Marc Domsky, Matt Lenz, Zach Hall, Laurentius Marais, and
The panel will consider several factors, including: FDA approval status,
technology specifications, published test performance, cost, invasiveness
(blood draw vs. finger stick), impact on personal protective equipment
(PPE) supplies in the community, and results of rigorously designed serology
studies currently underway.
Until there is a reliable antibody test, we feel strongly that we should
continue first and foremost to direct available financial and human resources
into doing more widespread COVID-19 active disease testing so that we
can more quickly stop the spread of COVID-19 in our community.
It is the opinion of the Teton District Health Officer, the CEO of St.
John’s Health, the Director of Teton County Health Department and
other public health experts that antibody testing should not be the focus
of the current effort to control the spread of COVID-19, but that we should
conduct a robust exploration of whether antibody testing may soon be an
important part of our public health response to this disease.
Jodie Pond, MPH
Teton County, Wyoming
Travis Riddell, MD, MPH
County Health Officer
Teton Public Health District, Wyoming
Paul Beaupre, MD
Chief Executive Officer
St. John’s Health
Teton County Hospital District, Wyoming
For more information on Coronavirus from St. John's Health, visit our
dedicated COVID-19 webpage and subscribe below.