PROVINCETOWN — Free asymptomatic coronavirus testing will continue on the Outer Cape. The free rapid-testing program that began here on Dec. 23 was scheduled to end on Jan. 10 and be replaced by a sliding-scale program that would cost most patients $75 per test. But Outer Cape Health Services (OCHS) has received permission and supplies from the state to continue offering free access to BinaxNOW rapid tests until at least the end of February.

Demand for the tests has been high, and testing asymptomatic people has helped uncover new cases. According to OCHS CEO Pat Nadle, the expanded testing has been finding three to six new cases a day, and about 60 percent of newly discovered positives have been asymptomatic people.

“Because of the testing that’s available at Outer Cape Health Services, people who would not know that they are carriers now know about it,” said state Sen. Julian Cyr. “That’s tremendously valuable.”

Before the expanded program, OCHS was giving tests in Wellfleet and Provincetown but only to about 25 to 30 people per day. Only those with symptoms or who had been identified by a contact tracer could get tested, because those are the categories of tests that insurance companies are obligated to pay for. Even if asymptomatic people were willing to pay $150 for a Covid test, they still had to drive to private pharmacies or urgent-care clinics in the mid-Cape to get one.

Now, with the protocols expanded to include asymptomatic people, and with testing free for everyone, OCHS is averaging more than 100 tests per day, said Nadle. Testing takes place at drive-through tents in Wellfleet, Provincetown, and Harwich Port.

“Opening to the asymptomatic, or the folks who were worried about their contacts, we have determined that it drove our positive results,” said Nadle. “Probably about 60 percent of our current positives have been in that category. I think we have learned a lot over these last two weeks. Our team has worked really hard — the volume has been about twice what we expected.”

“It’s taken us a long time to get here with this testing,” said Cyr, “but finally it’s up and running. It’s really important, and I’m grateful for Outer Cape Health Services’ efforts here.

“I will speak personally,” Cyr continued. “I received a test at OCHS, it was extraordinarily efficient. I had an appointment at 2 p.m., I ran a bit late, arrived at 2:03, was swabbed at 2:06, and got a phone call with my results at 2:37. It’s been an extraordinary effort, and I want to thank Pat and her entire team that have been making this happen.”

The rapid tests were provided by the state Dept. of Public Health (DPH) to community health centers to support extra testing around the holidays. They were meant to be a temporary supplement to other testing efforts, but Cape Cod has been a “testing desert” for months, deprived of the free state-supported testing that is common in the rest of the state. The continued lack of state-supported “Stop the Spread” free testing sites here may have played a role in the state deciding to supply OCHS with free BinaxNOW tests for an extra seven weeks.

Rapid antigen tests have not always had a good reputation, but the DPH recommended these particular tests to community health centers for a wide range of uses. The state tested the BinaxNOW against molecular PCR tests at one of its large drive-through testing sites, and found that the BinaxNOW test performed very well, especially at detecting people with high viral loads who were more likely to be contagious.

Keeping Track of Numbers

The fact that the Outer Cape will be relying on rapid tests while the rest of the state uses molecular PCR testing will have some consequences for state-reported health metrics, however. The state uses only molecular PCR tests to calculate several indicators, including testing rates, percent positivity rates, and even “confirmed cases.” Since the summer, positive results on rapid tests have technically been called “probable cases,” confirmed Vaira Harik, deputy director of the Barnstable County Dept. of Human Services.

For contact tracing and other purposes, there is no real difference in how “probable cases” and “confirmed cases” are handled. The state’s weekly Covid reporting is built around “confirmed cases,” however — and that weekly report is the primary source of data for cases in individual towns.

Wellfleet and Eastham don’t report a town-generated tally of cases; their websites point directly to the state’s numbers. The Barnstable County Health Dept. also draws directly from the state’s reports. Truro and Provincetown, on the other hand, post their own tally of “active cases” on their town websites.

“The active case count includes people who have received positive molecular PCR or BinaxNOW antigen test results,” said Provincetown Health Director Morgan Clark. The “blue box” on the town’s website includes all cases that Provincetown’s health dept. is managing — including people who are living here now but have a permanent address elsewhere.

The Independent could not establish by press time exactly which cases are included in Truro’s online tally.

“It is great news to have more testing capacity for the Outer Cape,” said Eastham Health Director Jane Crowley in response to an inquiry. “We will re-evaluate as new test results come in. Our objective is to inform the public.”

“The public health data is going to lag,” said Cyr. “I think the most important thing here is, this testing is helping people identify that they’ve been exposed. It’s helping to keep more people safe. Many people would not know they’re positive if we didn’t have this expanded testing.”