COVID-19 update: NSHC expands testing in Nome and region

As of Tuesday, April 28, there were no new COVID-19 cases in Nome or the region and a total of 345 confirmed cases in Alaska. On Friday, there was no new case reported in Alaska, but since then new cases emerged in Anchorage, Chugiak, Petersburg, North Pole, Eagle River and Wasilla. In their daily situation report, NSHC announced on Monday that efforts are underway to expand testing for anyone who wishes to be tested, symptomatic or not.

According to Medical Director Dr. Mark Peterson, “NSHC is making Coronavirus testing available to anyone in our region who would like to have it done.” This includes the Nome area and all of the region’s villages and is available in Nome Monday through Friday from 10 a.m. to 2 p.m. in the tent in front of the hospital. There is no appointment needed, there are no out-of-pocket cost to any patient and everyone is welcome. “We have already made voluntary testing available to all of our employees, as often as weekly,” Dr. Peterson noted.

 Village residents can be tested as well. Altogether, NSHC has 1,000 kits available and 400 can be analyzed here in Nome.

Dr. Peterson said that evidence shows that a large percentage of patients with COVID-19 have very mild or no symptoms at all. “NSHC plans to test up to 10 percent of the people in our region to see if there are asymptomatic cases here. We encourage anyone would who like to get tested, to stop by for a test. This plan to test up to 10 percent of our population includes our village population as well. Over the next two weeks we will be testing widely in all of the region’s villages,” Dr. Peterson wrote in an email to the Nugget. NSHC’s Reba Lean said that the hospital has received an Abbott ID NOW rapid test machine to conduct analysis of test here in Nome but those tests and others were also sent out to a state lab for analysis to confirm the results. "We did that for a couple of weeks, and there were never any discrepancies, so our testing is now considered confirmed," Lean wrote in an email.
 "We also have the ability to send regional tests to ANMC (which is where all of our pending tests are lately) and to the State Lab as a backup. Our village tests are all sent out of Nome because our local testing unit requires samples within a short timeframe, and getting tests in from the village won’t always meet that timeframe."

When asked about the actual mechanics of the test, Dr. Peterson said that the test is just a quick swab of the nose and added, “We are in discussions with the City of Nome about possibly offering testing at the airport to people coming into town from Anchorage.”

He points to the daily Situation Report as a good source of information of number of tests performed and additional educational material about COVID-19.

When the first patient in Nome tested positive for the coronavirus, the state misidentified the person as a woman when indeed it was a male patient and later corrected the information on its website.

After being notified of the positive test, Public Health contacted the patient to do an in depth interview for source tracing and contact tracing. According to Nome Public Health team leader Deanna Stang the interview can take up to two hours. “We start by asking basic demographic information, employment information, complete a CDC field interview collecting information about symptom onset, symptoms the patient has experienced or still experiencing, travel history, and review of underlying health conditions,” Stang said in an email correspondence with the Nugget.

Since the incubation time for COVID-19 is two to 14 days, the public health nurses ask detailed questions going back 14 days before symptom onset. Stang said that after they completed the interview with the confirmed case they provide education about self-isolating in the home, how to decrease spread of COVID to others in the home, symptom monitoring, what to do if they need to seek medical care or need emergency services.

The infectious period starts two days prior to symptom onset and ends when they meet CDC criteria to discontinue isolation. Without tests, the criteria is that at least three days have passed since the fever broke without the use of fever-reducing medications and improvement in respiratory symptoms (e.g., cough, shortness of breath) and at least seven days have passed since symptoms first appeared.

“You generally need to be in close contact with a sick person to get infected with the virus that causes COVID-19,” Stang said.

Collecting details about who the patient has encountered during the infectious period is called “contact tracing”, Stang said.

Public Health collects contact information for those who have been in close contact with the patient and they are then notified that they have been exposed and receive education about COVID, quarantine and symptom monitoring. “Contacts are asked to take their temperature twice a day if they have a thermometer and monitor for symptom development, and quarantine for 14 days since their last exposure date with the confirmed case. We assess their needs, do they need masks, thermometers, can they safely social distance from others in their home, and provide resources for food service delivery,” Stang said.

Individuals on isolation or quarantine are instructed to only leave the home for medical and is very important that they call ahead before going to the hospital, Stang said. “Public Health contacts the confirmed case and all the contacts daily until they are cleared from isolation or quarantine. We monitor for symptom development and answer any questions they may have.”

 Aggressive source tracing, contact tracing and broadly testing is key to the success in decreasing transmission of COVID, said Stang. “The Public Health team is working seven days a week to ensure that source tracing and contact tracing is being done promptly. Public Health Nurses are working in shifts and providing weekend coverage and covering the whole state for new cases and contact monitoring.” She said that if a region has received multiple positive cases and the Public Health Center has a full case load, the case will be assigned to another Public Center to conduct the investigation.  “EPI and Public Health Nurses are highly trained in conducting investigations, we conduct numerous infectious disease and food borne illness investigations year round and this type of work is our specialty,” Stang said.

This story reflects a clarification on where the Nome and regional tests are sent for analysis.