Rhode Island is a COVID-19 testing leader.
At an average of nearly 3,000 tests a day, the state has among the highest rates of testing per capita in the country and is on the way to a daily goal of 10,000 that Gov. Gina M. Raimondo set in May. That pace will help to identify more people infected with the new coronavirus who need to isolate themselves, and it will help pinpoint potential hot spots.
In addition, Raimondo wants to expand the number of tests conducted on people without COVID-19 symptoms to as many as 900 a day for close-contact workers, such as workers at gyms, hair salons, barber shops, massage parlors and child care facilities.
State health officials have been working on a format that would allow close-contact workers to be tested as often as once a week.
But testing isn’t going to provide total assurance for business owners and managers who are trying to get other types of employees back into workplaces.
What makes the new coronavirus, which is still only a few months old, particularly challenging is the lack of a foolproof ability to determine who has the virus, who remains contagious, who has had it but is no longer contagious and whether anyone has immunity to reinfection.
When most employers ask about having their personnel tested, Dr. James McDonald, the medical director of the R.I. Department of Health, encourages them to think broadly.
Screening employees with health questionnaires about symptoms and travel history, having all employees wear a face mask and keep at least 6 feet apart, and reinforcing good hand hygiene have to become cultural norms, he says.
“Testing isn’t where we are right now,” McDonald said. “The thing you worry about with this … is that people get false reassurance: ‘Look at me, I’m negative.’ It doesn’t mean anything. What we really need to know is who is coming to work sick.”
That can be harder to figure out than it seems.
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PROTECTIVE MODE: WaterRower Inc. CEO and President Peter King, right, speaks with assembly worker Lenny Laur. After a COVID-19 outbreak at the Warren factory, King says, he wanted to test the entire company of 200 employees for the virus but was advised against it by state officials. / PBN PHOTO/MICHAEL SALERNO[/caption]
‘SITUATION WE’RE IN’
Manufacturers, who have remained open through the pandemic, have months of experience ahead of many other businesses.
After WaterRower Inc., a Warren-based manufacturer, experienced several dozen infections among its workers, its top executive wanted to get the entire company of 200 people tested. But he was told by officials at R.I. Commerce Corp. that it wouldn’t be an effective strategy for keeping infections out because he wouldn’t be able to prevent someone testing negative from getting exposed outside the workplace.
“They said you can’t guarantee what your staff does when they leave at night,” said CEO and President Peter King.
King now sees masks and social distancing as better tools to keep infections out of his factory. He said contact tracing ultimately determined that the outbreak among about 30 people spread among those who were carpooling and among family members working at the plant.
After the initial outbreak, weeks passed without new infections. Then in recent weeks, another smaller cluster was reported in his shipping department. “No positives for several weeks, and then it came in again,” King said.
Karl Wadensten, CEO and president of VIBCO Inc., also tried unsuccessfully to have his 100-person workforce tested. He was told, like King, it wasn’t practical for keeping out infection. “I begged the governor for that,” he said. “You need to let us have access so we know who might be a transmitter, and they don’t know it, and to give us peace of mind.
“At least we would have a damn benchmark,” he said.
Seven people at VIBCO have had tests, Wadensten added, because they came into contact with people who had contracted it or had been exposed to it. None of them tested positive.
Many other business owners are trying to prepare for these uncertainties.
Joseph R. Paolino Jr., managing partner of Paolino Properties LP, owns a number of commercial buildings in downtown Providence. He has deployed ultraviolet light systems in some buildings, bathing interiors with germ-killing light overnight. He’s also installed special air filtration systems at 100 Westminster and Hotel Beatrice. And he’s putting thermal-imaging cameras at building entrances to detect visitors with fevers.
“This is not a perfect solution,” said Paolino. “It’s just the situation we’re in. We’re in the middle of a transition of our lives, of our work, a transition of our economy, a transition of a new normal.”
Marc Crisafulli, president of Rhode Island operations for Twin River Worldwide Holdings Inc., recently reopened the two Rhode Island casinos. The casinos are also using thermal cameras and requiring masks of patrons.
Anyone with an abnormally high temperature will be asked not to come in, Crisafulli said.
Twin River also has had its employees tested for the new coronavirus at the company’s expense, according to a state official overseeing COVID-19 impact aid.
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PUT TO THE TEST: Many of the communities with the highest percentage of positive COVID-19 tests, such as Central Falls, Providence and Pawtucket, are urban communities, where the closer proximity and sharing of public transportation can increase the spread of the virus. / AS OF JUNE 15, 2020 / SOURCE: R.I. DEPARTMENT OF HEALTH[/caption]
HEAVY DEMAND
Rhode Island has two kinds of testing taking place. Both have limitations that are crucial for business leaders to understand, according to infectious-disease specialists.
Surveillance testing, which is designed to determine what percentage of a population has already had the virus, looks for COVID-19 antibodies.
On June 12, Rhode Island disclosed the results of a random sampling of families over a two-week period in May. It found 2.2% of the state’s population had exposure to the virus, a smaller amount than state health officials expected. Among Latinos, the exposure rate was 8.2%, and blacks had prevalence of antibodies at 5.2%, which shows that those communities have had much higher infection rates.
The findings show that Rhode Island can’t count on “herd immunity,” the resistance to a contagion spreading when a high number of people are immune, said Dr. Philip Chan, a consultant who helped lead the sampling. “People just have to be careful, vigilant and adhere to public health guidance,” he said.
The more common form of testing – diagnostic – seeks to determine who has the virus. By June 17, 206,470 tests had been administered in Rhode Island.
Several companies have created tests, and each has varying degrees of accuracy because they were developed through an emergency authorization, skipping typical trials and approvals.
“The reason why they do this is there is a tremendous demand for testing,” said Dr. Angela Caliendo, an infectious-disease expert and the executive vice chair of general medicine at the Warren Alpert Medical School at Brown University.
“But what happens when the tests arrive to market … [is] we in the infectious-disease world know very little about how that test will perform,” she said. “We are just learning now that some of those tests are better than others.”
Some rapid-result tests – which give results in 15 minutes – have had high rates of false negatives, inaccurately indicating a person is not infected.
But tests that take several days for a result give contact tracers a late start in combing through a person’s contact history.
Used exclusively, testing has limited value for employers trying to reopen workplaces, according to Caliendo and McDonald.
The antibody, or serology testing, indicates if someone has been exposed to the coronavirus, Caliendo said. It usually takes about two weeks for people to develop antibodies after exposure. But that might not mean they’ve developed immunity.
“It isn’t really a useful test at an individual-patient level to determine whether or not it’s OK for someone to go back to work,” she said. “At this point, we don’t know if you can get reinfected or not.”
The diagnostic test, sometimes called the swab test, works best on people with symptoms. The swabs detect the virus if it’s in the nose or throat.
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REOPENING PRIORITIES: Dr. James McDonald, medical director of the R.I. Department of Health, says employers should rely more on health screenings and providing surgical masks for their employees returning to work rather than getting them tested for COVID-19. / PBN PHOTO/RUPERT WHITELEY[/caption]
For these reasons, screening of employees, rather than a reliance on testing, will remain critically important, McDonald said.
“If I were an employer, I would spend less money on finding a way to test my staff and more money trying to find decent surgical masks for my critical infrastructure workers,” McDonald said.
For employers and workers, there’s no simple answer to what will work best in the workplace, says Dr. Erica Hardy, director of infectious disease at Women & Infants Hospital in Providence.
“I don’t think testing is going to be able to completely solve the problem of whether or not we have to social distance, or who can come back to work, or who doesn’t have to social distance,” Hardy said.
STILL NEEDED
That doesn’t mean testing is pointless, especially outside of the workplace.
Anyone who is preparing for elective surgery, childbirth or a routine medical procedure may be told they’ll need to have a negative result on a COVID-19 test within five days of the procedure.
Beyond patients, the volume of testing and the collection of racial, ethnic and geographic data has helped determine which communities are most impacted.
R.I. Department of Health data has shown that Central Falls, Providence and Pawtucket have the highest numbers of people testing positive, and the greatest infection rates per capita.
In Central Falls, about 25% of the people tested have been found to be positive, although state officials noted recently that the rate has been declining.
Dr. Michael Fine, the health liaison for Pawtucket and Central Falls, and a former director of the R.I. Department of Health, said the challenge of containing the virus is that critical tools are needed for testing, and isolation of people carrying the virus to work.
“The first is speed,” he said. “In order to be effective at stopping disease progression in the population, we have to test anyone who is symptomatic within three days of the onset of symptoms. We have to test, contact and isolate within three days.”
At the forefront of that work is a mobile testing unit, the Rhode to Health.
The unit has been stationed in Central Falls for several weeks. Even on the day it was getting established, people approached and inquired about getting tested, said Bryan Blissmer, a University of Rhode Island professor and director of its Institute for Integrated Health and Innovation.
About 50 tests a day have been taken at Rhode to Health, which is staffed by CVS Health Corp. clinicians. “It’s definitely more walk-up than drive-thru, so it’s meeting the need there,” Blissmer said.
In Central Falls, one of the reasons why the rate of infection is so high is because people live together in large families and in apartments that may have a single bathroom. Many share a minibus or a van to get to work, Fine said.
The virus spreads from workplaces to the community, and from the community to workplaces. At least a portion of that spread comes from people who don’t realize they’re sick, Fine said.
And because asymptomatic people are thought to be most effective at transmitting the virus two days before the onset of symptoms, Fine said, it is challenging to rein it in.
Also presenting a challenge is how little health officials know about COVID-19, though they are learning more all the time, McDonald said.
“I feel like in many ways we’re trying to put a puzzle together, but all the pieces are stuck upside down,” he said. “But the pieces are [slowly] getting turned over.”
Mary MacDonald is a PBN staff writer. Contact her at Macdonald@PBN.com.
