Updated 03/13/20, 7:30 p.m
This post was updated with the info that four presumptively positive cases were confirmed in Montana Friday evening.
Montana county public health officials Friday said testing for the COVID-19 disease remains limited and there is no at-will testing for people concerned they’ve contracted the illness. Friday evening, Montana Gov. Steve Bullock confirmed four presumptively positive cases COVID-19 in the state.
In Bozeman, Yellowstone Public Radio's Rachel Cramer reports public health officials are preparing for more.
Health Officer Matt Kelley with the Gallatin City-County Health Department said private labs and universities may be able to assist with testing in the future. He said the public health department is actively looking for places to provide quarantine or isolation to people for up to 14 days.
"The ideal site would be some place such as a hotel room or a house where someone could be comfortable for up to 14 days, have access to their own bathroom and sink as well as communication with the outside world through computer or telephone."
Kelley said the department is also working with partners to reach people who experience homelessness or may not speak English, and they’ve brought on additional staffing to assess assisted living centers and provide recommendations.
Kelley said people who think they have COVID-19 should call their health care provider first to figure out next steps; not show up at the facility. If they don’t have a provider, he said they should call the public health department.
Eric Lowe is the director of the emergency department at Bozeman Health, he says, "We understand that there’s a lot of people who want or think that they should be tested for COVID-19, and currently we’re following CDC and Gallatin City-County Health Department guidelines for prioritizing those tests."
Lowe said people who are considered a priority have two things: symptoms of lower respiratory illness, such as fever of over 100 degrees, cough and loss of breath, and exposure to someone with a confirmed case or recent travel to a high risk area. He said people who have symptoms severe enough for hospitalization or other significant medical illnesses would also be considered part of the high risk group.
"I think all of us would want unlimited testing to use as much as we could, but unfortunately we do not have unlimited testing supplies."
Health Officer Matt Kelley says Montana has 600 test kits at the State Public Health Lab in Helena. Gov. Steve Bullock says the state has the capacity to test over 1,000 people for the virus.
Kallie Kujawa, System Director of Quality and Safety for Bozeman Health, said health care facilities do not test patients for COVID-19, rather they collect nasal swabs for diagnostic testing.
"Many health care facilities do nasal swabs for lots of other tests that they run; for influenza, let’s say. So it’s the same process that facilities are doing. The difference is, they’re taking those specimens, and they’re coordinating with their local county health department, and they’re sending those specimens to the state lab to get tested at that one central lab in the entire state."
In Bozeman, I’m Rachel Cramer.
[Related: Montana Coronavirus And COVID-19 News]
In Yellowstone County, a coalition of hospitals and county health and disaster services is creating a centralized community testing site, though YPR News’ Nicky Ouellet reports it’s unknown when or where that will be ready.
John Felton with Unified Health Command says the details still need to be worked out but funneling specimen collection to a centralized site would prevent flooding hospitals and medical clinics with potential COVID-19 cases.
"The Unified Health Command is working on that and we expect within the near future that we will have a centralized testing site somewhere within our community."
Felton says the command has talked about using that site for triage in addition to making testing more accessible for more people.
"That's all going to be very fluid, like everything related to COVID-19 is. It’s going to depend on, do we start getting a lot of cases, what’s the demand for testing, what’s the demand on medical practices."
Felton did not know how many test kits are currently available in Yellowstone County or the state. He said numbers are changing very rapidly.
Testing requires a physician's order. County health departments say they’re following clear criteria from the federal Centers for Disease Control and Prevention (CDC) about who should be tested.
That criteria include a fever over 100 degrees Fahrenheit and acute respiratory illness; coming in close contact with someone who has been diagnosed with COVID-19, and being 65 or older.
Felton says the current protocol and timeline of sending test kits to the state public health lab for analysis is clear. Specimens are analyzed on the same or next business day, with results returned the same day unless they need to be submitted to the CDC. But he adds the turnaround time on specimens sent to two private testing labs coming online this week remains unclear.
"What is unknown at this point is what will be the process as those private lab companies come online as to whether those are gonna be tested, the actual tests done locally, or they're gonna be sent out. That really drives the timeline and those are one of the unknowns. We certainly anticipate more tests becoming available and as we get our centralized testing system up and running, whether it's drive-through or not is unsure, but at some place as you can get centralized testing, that will help. But we still don't know the answer on timeline."
The Unified Health Command is recommending event organizers postpone to mitigate the risk of exposure and for people to widen their personal bubbles as part of social distancing.
Felton urged people feeling ill to call medical care providers ahead of visiting and use the same health care logic they’ve used their whole life.
"If you believe you're sick enough to have gone to the doctor when there wasn't the risk of COVID-19, you should go to the doctor. If you believe you would've been sick enough to go to the emergency department before there was though of COIVD-19,you should go to the emergency department. If, prior to the thought of COVID-19, you would have stayed home and taken a day or two off work or away from school, stay home and take a day or two off of work or away from school. The risk of this does not change that sort of standard way we have done this."
In Billings, I’m Nicky Ouellet.
[Related: Montana Coronavirus And COVID-19 News]
Missoula’s political, health and educational leadership acknowledge the emerging coronavirus emergency is stressful on everyone. However, MTPR’s Edward O’Brien reports they say they’re learning quickly and that essential government services will continue uninterrupted. They add that we’ll eventually get through it, but not without a few disruptions.
Missoula County Public Schools, for example, has no plans to cancel classes after next week’s scheduled spring break, but almost all school activities are canceled through at least April, including all out-of-state school-related travel.
If a staffer or student tests positive for coronavirus, their school will be closed for two to five days to allow for follow-up investigation.
So, where would that leave students with working parents and no other place to go?
MCPS Superintendent Rob Watson says, "We want to be accommodating to our parents and our families and we’ll do the best that we can, but it will be a very difficult situation for those families, and a hardship. The reason we’re doing so is because we’re trying to stop the spread among that individual school population."
If a Missoula school was to temporarily close, Watson asks local employers to be as accommodating as possible to employees with children.
Missoula’s COVID-19 incident commander, Cindy Farr, says while Missoula doesn’t currently have any cases, she says, “We know that that is probably going to change in the foreseeable future."
Someone who says they’ve been in contact with a COVID case or who have traveled somewhere where there’s been lots of spread will be asked to isolate for the disease’s 14-day incubation period. Public health nurses will check in on them daily.
Testing is currently limited to those presenting specific symptoms: fever over 100.4 degrees, coughing and shortness of breath.
"We are in cold and flu season, so that's why that is important," Farr says. If it was summertime, we would probably have different protocols in place. But right now we have so many other respiratory illnesses going through our community that we do need to rule out some of those other illnesses before they go to the COVID-19 test."
People who test positive will be required to self-isolate until they can return two consecutive negative tests. That could range from two to six weeks
Missoula’s Poverello homeless center has closed its food pantry to limit outside visitors to the building. The shelter is also limiting all volunteer work to its essential soup kitchen activities.
Local health officials say they’re also in close contact with Missoula County Detention officials to discuss protocols that can help prevent the virus from getting in the facility and what to do to protect other prisoners if one gets ill.
The Missoula City County Health Department will keep its informational phone line open Saturday from 8 a.m. to 5 p.m. That number is 258-INFO.
Flathead County Commissioners today delegated Flathead County Health Officer Hillary Hanson to serve as the county’s incident commander. The county is working within an Incident Command System structure, similar to wildfire season, with the county health department acting as the lead agency in local COVID-19 response efforts.
Flathead City-County Health Department has created an information-online hotline for community updates at (406) 751-8188. It’s also created a website at https://flatheadhealth.org/novel-coronavirus-covid-19/.
The Cascade City-County Health Department says it’s following clear criteria from the federal Centers for Disease Control and Prevention (CDC) about who should be tested.
That criteria include a fever over 100 degrees Fahrenheit and acute respiratory illness; coming in close contact with someone who has been diagnosed with COVID-19; and being 65 or older.
The department asks people to not bog down critical health care facilities like emergency rooms. Instead, it advises to call your primary care doctor first to determine if a covid-19 test is required.