POCATELLO — Until recently, Dr. Ronald Solbrig assumed Southeast Idaho’s single-digit list of confirmed COVID-19 cases was artificially low due to the lack of adequate testing.
Solbrig, director of the Idaho State University Health Center, admits he’s been shocked at what the results are showing now that local testing has been ramped up significantly. The coronavirus truly has largely missed the region — to the point that Solbrig argues the community is wasting resources by continuing with a program to test the local population for antibodies.
Solbrig believes further antibody testing provides no additional statistically useful information. He’s recommended that Portneuf Medical Center and its partner in the area’s Crush the Curve testing program, Idaho Central Credit Union, discontinue antibody testing for a couple of months, before conducting 500 more tests to reassess antibodies in the community.
Through Friday night, Bannock County had eight confirmed coronavirus cases, Bingham County had four cases, Power County had two cases and Caribou County had a single case. Statewide, Idaho has 2,205 cases — including 27 new cases confirmed on Friday — and 67 total deaths. There have been no coronavirus deaths in Southeast Idaho.
“It’s surprised us all, and the testing is accurate enough that that’s reliable data,” Solbrig said, adding the data shows the community has made the right choices and taken the health threat seriously to limit the spread.
Prior to about three weeks ago, Solbrig said just a few dozen tests had been conducted within the Pocatello area, based on a lack of laboratory testing capacity and insufficient supplies of the medium used to fill vials for transporting test samples. Within the past two weeks, however, 150 cotton-swab tests have been conducted at a Southeastern Idaho Public Health testing site at ISU. Just two of those tests were positive — consistent with a local infection rate of less than 2%. Crush the Curve, which has a greater testing capacity, has also conducted cotton-swab testing, with no confirmed positives.
PMC staff have also been spearheading an antibody blood test to determine if subjects have COVID-19 antibodies at least three weeks after an infection. Solbrig said 2,000 local people were tested, and there were 11 positive tests.
However, the test has a 1% false positive rate, which would equate to 20 false positives. Solbrig surmises that all of the 11 cases are almost certainly false positives. He believes 500 antibody tests would have provided a good representative sample of the community, and with an incidence of less than 2%, further antibody testing yields no statistically significant data. With insurance companies paying about $100 per test, Solbrig argues $150,000 has already been wasted on 1,500 unnecessary tests.
He contends those funds would be better invested in broadening eligibility for cotton-swab testing.
“My position is right now the antibody testing is a waste of resources,” Solbrig said.
Solbrig said antibody testing in the Boise area has also yielded statistically insignificant data, with just 1.3% of tests coming back as positive.
He’s communicated his sentiments to Dr. Daniel Snell, chief medical officer with PMC. Snell supports continuing the testing, though he acknowledges far fewer people have been coming in for the test recently.
“We’ve already talked about ramping it down because the demand isn’t there,” Snell said.
Mathematically, Snell agrees 500 antibody tests would provide a representative sample. However he believes a sample of that size could present a “selection bias.” Names of test recipients would have to be drawn at random to avoid a bias, he said. Having a pool of 2,000 tests reduces the likelihood of skewed results, he said.
Perhaps more importantly, in Snell’s opinion, the test is relatively inexpensive and gives the community peace of mind.
“From a community standpoint, what the community felt like they’ve needed is testing. ... In this case I think the benefit outweighs the cost,” Snell said.
Solbrig credits Gov. Brad Little with taking a smart approach to reopening the state, doing it in phases. Solbrig’s concerned, however, that Southeast Idaho’s relative safety will be at risk when Idaho lifts nonessential travel restrictions at the end of this month.
He also urges against pressing forward with local events that may draw large crowds from other areas where COVID-19 is more widespread, such as rock concerts featuring bands that have a broad following. Hosting athletic events will also present a challenge, he said.
“We’ve had these discussions on campus. How in the world do you ever protect a football team? I don’t know,” Solbrig said.
The path forward, in Solbrig’s view, involves slowly easing restrictions and reinstating safeguards when inevitable infection spikes occur.
Snell is optimistic that the exercise of living through a quarantine will have a lasting impact on the public, leading citizens to take precautions to help control transmission such as better hygiene, wearing masks, and maintaining space from others.
“We are in such unprecedented times. ... I’m not sure that a ‘right’ decision exists,” Snell said.