PROVINCETOWN — Until this week, only people with symptoms of Covid-19 and those who have had direct contact with infected people have been able to get tested for the coronavirus at Outer Cape Health Services. Yet it’s well established science that people without symptoms can spread the virus.
Asymptomatic testing has now finally arrived here.
The state is giving OCHS a supply of rapid tests — known as the BinaxNOW — that should support almost three weeks of completely free asymptomatic testing at all three OCHS sites from Dec. 23 through Jan. 10, according to CEO Patricia Nadle.
“If we run low,” Nadle said, “the state has agreed to provide additional tests.”
These tests detect antigens — proteins that are part of the virus. They are fast, and they’re considered most accurate when they give a positive result, though they can miss some cases where the infection is present but has not yet produced antigens.
A county-supported testing program offering molecular PCR tests is also expected to reach the Outer Cape soon. PCR tests detect the virus’s genetic material even when the amount is very small and are often used to confirm previous tests. A PCR testing site has already opened in Hyannis. The charge for these tests is on a sliding scale.
“The BinaxNOW test will be used for both our symptomatic and asymptomatic testing,” said Nadle. “It is a very effective test, and the trust in the result is very high. The only time we would do a PCR to confirm a result is if the provider really thinks that a person has Covid, based on symptoms or exposure, and the BinaxNOW comes back negative. They would do a further PCR test then.”
The state Dept. of Public Health has issued instructions for the use of the BinaxNOW rapid test. The test, produced by Abbott Laboratories, has received only emergency use authorization from the FDA for symptomatic cases, but the state conducted its own research to validate it for asymptomatic patients.
At one of the state’s drive-through testing sites, 1,380 people were given both the BinaxNOW test and a PCR test, and the results were compared. The state judged the BinaxNOW test to have “very high sensitivity in adults with high viral loads,” meaning it correctly identifies positives and negatives in the people most likely to be actually contagious.
“Based on what our providers have been reading, and the release of all this information, they are comfortable with this use, and have high confidence in this testing,” Nadle said.
Scaling Up Testing
OCHS has been averaging about 25 to 30 tests per day in December, and only for people with symptoms, said Nadle. People have been calling and asking for asymptomatic testing, she added. She expected her organization will be doing about 50 to 60 tests per day in each of its three locations, once asymptomatic testing has begun.
Testing in Wellfleet will be on Mondays, Wednesdays, and Fridays from 1:30 to 3:30 p.m. In Provincetown, it will be Tuesdays, Thursdays, and Saturdays from 1:30 to 3:30 p.m. And in Harwich Port, the plan is to do testing on Tuesdays and Thursdays from 1 to 3 p.m.
If each of those sites is doing 50 to 60 tests per day, that would total 400 to 500 tests per week — roughly double the prior testing rate.
The testing locations are configured as drive-throughs (or walk-ups) and tests are by appointment only. Appointments can be scheduled with a phone call to 508-905-2888, and are not limited to Outer Cape residents or to prior patients of OCHS.
What Will Be Found?
The big question about free asymptomatic testing is this: how many positive cases will be uncovered? If virus prevalence is low, large-scale testing efforts can come up with no cases, as happened on the Outer Cape several times in the summer. If virus prevalence is high, two weeks of free testing might find a lot of cases. Some new light is about to be shed on our situation here, but it’s hard to guess what we will see.
As of Barnstable County’s Dec. 17 weekly Covid report, there were 5 active cases in Provincetown, 3 in Truro, 8 in Wellfleet, and 11 in Eastham. This is a significant rise from only a month ago, but it is also a much lower prevalence per resident population than almost everywhere else in the state.
Provincetown’s wastewater testing is one indicator that’s independent of individual tests. The town’s numbers went through a massive spike in the days after Thanksgiving, with readings 4 to 20 times higher than the previous high-water mark, which came the weekend after Election Day.
But Provincetown’s sewer system readings are affected by people who come to town, visit Commercial Street, and go home, pointed out Morgan Clark, Provincetown’s health director.
After the Thanksgiving weekend spike, the wastewater numbers came down. But they’re still much higher than they were in November. Free asymptomatic testing is a chance to find out if cases are being missed.
“One thing I would stress is that some of our cases report mild symptoms,” said Clark. “I’ve been telling people lately there’s no such thing as ‘just a cold,’ or ‘it’s just seasonal allergies.’ Please get tested if you have any of the symptoms of Covid-19. We want people getting tested, especially while these additional testing opportunities are opening up.”
Editor’s note: This story has been updated to include the beginning date of free testing, Dec. 23, which OCHS could not provide at press time. The story has also been corrected to indicate which days of the week will see testing in Wellfleet and in Provincetown, which had been incorrectly described in an earlier version.
