Scott says more testing coming to help open economy

The Vermont Department of Health reported no new cases and no additional deaths today.

by Timothy McQuiston, Vermont Business Magazine Governor Phil Scott and Health Commissioner Mark Levine, MD, said at the governor's press briefing today that the state will increase testing for COVID-19 to include even those showing mild symptoms. Already, the state is testing anyone who is showing typical symptoms of the novel coronavirus, those who might have been exposed, frontline health care workers and those at institutions like nursing homes or correctional facilities where there has been a case. Now, the state is planning to test 1,000 Vermonters a day, seven days a week. The tests, however, will not include the random general public yet.

The testing and associated contact tracing will be able to achieve what the state and even more so the nation could not do when the coronavirus first hit the US two months ago.

Governor Scott, with face mask, listens as Dr Patsy Kelso, the State Epidemiologist for Infectious Disease, answers a question during Wednesday's press briefing. Screen capture.

Levine explained that both Vermont and the rest of the nation were short on testing supplies. Only those with pronounced symptoms were tested. Even then, most of those tests resulted in negative results for CVOID-19. But because of the short supply, the state had to limit the testing.

As the state was able to acquire more testing equipment and supplies, and work with the University of Vermont and outside laboratories, the state could be more aggressive in its testing. For instance, any institution with a positive test for resident, patient or staff will result in a test of everyone associated.

Those who test positive will also be part of contact tracing to identify who they may have either acquired COVID-19 from or perhaps given it to.

For instance, the Vermont Veterans Home in Bennington had one case with a staffer two weeks ago, so everyone there was tested, without any further positive cases.

The Northwest Correctional Facility in St Albans Town had several positive cases among staff and inmates, so every person there has been tested and retested. The state is now in the process of testing every staff member at every prison in the state. This also goes for the two nursing homes in Burlington -- Birchwood and Burlington Health & Rehab where there were multiple cases and multiple deaths, especially early on in the pandemic.

The state is able to be more aggressive because of its stockpile of supplies.

Scott pointed out that this also would not be possible if the infection rate in Vermont were not so low. All the current metrics show Vermont is trending lower than even the best-case scenario modeling. Today there were no new cases of COVID-19.

Other states, he said, with higher infection rates are having a difficult time keeping up with testing symptomatic patients.

Dr Levine said before a vaccine comes along, if one ever does, that anti-viral interventions will become important. (Dr. Anthony Fauci on Wednesday said a study of the antiviral drug remdesivir showed promising signs for treatment, as it blocks a key enzyme the coronavirus needs to attack the body.)

Dr Levine said that social distancing, or as he now prefers to call it "physical distancing," wearing a mask in public and washing hands will still be the primary methods of keeping Vermonters safe.

But interventions like antiviral medications, aggressive testing and tracing, stockpiling of testing products, and general preparedness will allow for far greater containment of COVID-19 than was possible six or seven weeks ago. He said he does expect some level of a second wave or infections. It is not possible, he said, to say when or to what level, but that the state is more prepared in any case.

Levine also said that as the number of tests increase and the economy opens up, he would expect more COVID-19 cases. As for the economy opening up, there will be a lag time between then and when infections present themselves. There is a pre-symptomatic infectious stage that can last about 48 hours, and it could take up to two weeks for an infection to manifest.

Levine said the Task Force will remain focus and strategic.

Dr Patsy Kelso, the State Epidemiologist for Infectious Disease, said they are ramping up their testing and tracing capability and will be able to track up to 900 positive cases. As of today there have been a total of only 862 total cases since the first case presented in March.

The first expansion will bolster testing for vulnerable populations and health care workers in group settings where outbreaks have been most prevalent. Long-term care and other facilities housing vulnerable populations, and which have had a positive test result for COVID-19, will receive expanded, facility-wide testing. This will include universal re-testing of residents and staff who test negative at day three, seven, and then weekly after the initial tests. The program will also now include testing of all intakes and discharges, in addition to residents who are regularly treated outside of the facility.

While symptomatic health care workers currently receive priority testing, the enhanced testing program will now test asymptomatic workers who have contact with COVID-19 patients and additional personnel in preparation for potential health care re-openings. All Department of Corrections staff will also be tested over the next two weeks, bolstering the testing protocols already in place.

The second phase will include populations that are key to restarting priority sectors, further focusing on health care and home health workers, as well as child care providers. And as the Governor considers allowing more health procedures, testing would be expanded to many of these patients as well.

The final phase would further expand testing to these populations and allow for testing of some Vermonters who are under a mandatory 14-day quarantine as an option to reduce the quarantine period.

The Vermont Department of Health reported no new cases and no additional deaths today.

Dr. Levine also outlined the principles of the state’s testing strategy, noting: “Throughout our pandemic response, our strategic planning and actions have been evidence-based and science driven. In developing this expanded program, we have sought to focus on Vermonters most vulnerable to serious impact of the virus, to improve on lengthy quarantines for asymptomatic people, and strive to suppress outbreaks whenever they might arise. The health of Vermonters is critical to our Restart VT efforts.”

The state’s contact tracing program will also be enhanced to accommodate this new level of testing. Tracing will be expanded to include the 14 days prior to symptoms for COVID-positive individuals, to try to identify their source of infection. The Department of Health will engage with cases and their contacts using SARA Alert technology, a text-based monitoring system. The state is able to handle 300-900 cases and their contacts per week under this new strategy. The state currently has 53 trained contact tracers who could handle up to 500 cases and their contacts per week and is implementing a plan to train additional tracers as needed.

“It’s important to understand that as more testing is performed, and as people engage in greater activities, we will see an uptick in the number of positive cases – perhaps by a lot,” said Dr. Kelso. “This program is designed to provide the data that will inform state decisions and help us to respond more quickly to what the data tells us about COVID-19 activity in our communities.”

The governor emphasized the need to be nimble and responsive during this ramp-up, and established the Vermont Enhanced Testing and Tracing Task Force, comprised of experts from the Department of Health and agencies of Human Services and Digital Services to help monitor new developments and recommend new strategies.

Friday is usually when Governor Scott announces his latest plans regarding COVID-19 mitigation steps and/or moves to re-open the economy.

Some of steps he could take come Friday include further extension of the construction industry and other outside industries. Currently those jobs are limited to five workers.

Another decision he will have to make soon is on when to lift his emergency order. Right now, it is set to expire on May 15. Given the hints he often offers to prepare the public, that is likely to be extended.

But he also hinted that some more businesses openings to "turn the spigot another quarter turn" are coming Friday. This could include elective surgeries and procedures at hospitals and health care facilities. The money-strapped hospitals would likely welcome the economic opportunity. At least two hospitals have had to layoff staff, Rutland Regional and Brattleboro Memorial, as revenues have been squeezed. BMH reported earlier this month that it has lost 80 percent of its revenues because of the pandemic and resultant cutbacks.

What Scott seems unlikely to open are the travel and tourism venues.

He frequently mentions the infection rates and deaths in the New York City and Boston areas. He frankly does not want visitors coming in from out of state and possibly bringing the virus with them.

The state is still monitoring some points-of-entry to see what license plates are coming in (they are not logging plate numbers).

He acknowledged that what is happening in nearby regions is helping direct his decisions in Vermont.

Nor does he know when gatherings of more than 10 again will be allowed. This puts a crimp in everything from parades to high school graduations.

As for graduations, Education Secretary Dan French said guidance on graduations will be coming next week that will spell out how these high school milestones can be celebrated; but do not expect anything like a gym crowded with family and friends.

University of Vermont President Suresh Garimella said UVM will open with in-person classes and residential students this fall. At the press briefing Scott was not aware of this announcement, which also happened Wednesday morning.

The governor opened his remarks today by saying that the Pandemic Unemployment Assistance unemployment benefits went out this morning.

Some 8,500 self-employed, contractors and sole-proprietors received a total of $24 million. This included the federal benefit of up to $600 a week that is also offered to regular UI filers.

Because this program only just began, many filers were paid back four weeks to the beginning of the emergency. While each check showed up as a separate item for those who have electronic direct deposit, the total average per filer was just over $2,800. The next deposits will be for a single week. Paper filers will receive checks in the mail starting next week.

Unemployment insurance and PUA filers with questions may go to https://labor.vermont.gov/.