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CareWell Urgent Care

    THE COVID EFFECT

    Rumors Swirl Over Closing of Restaurants

    What were the test results? Answers are not required

    By

    Rumors started to circulate last week that a rash of Wellfleet restaurants had closed due to positive Covid-19 tests among staff.

    According to public notices from restaurateurs, Mac’s Shack closed for 24 hours for a deep cleaning on July 30 after a staff member tested positive; the Fox & Crow shut down voluntarily for deep cleaning on July 30 and 31, though no staff tested positive; and Van Rensselaer’s closed for deep cleaning on July 31 and Aug. 1, without stating why. Mac’s and the Fox & Crow declined to comment for this article, and V.R.’s could not be reached before deadline.

    (A July 27 article by Derek Thompson in The Atlantic argued that “deep cleaning” to prevent Covid transmission is a waste of time. Calling the practice “hygiene theater,” he cited research evidence that surface transmission of the virus is exceedingly rare, and that news reports of studies showing the virus remaining alive on surfaces for days were wildly exaggerated.)

    The Wellfleet closings followed others in Provincetown. According to public statements by George’s Pizza and Provincetown Brewing Co., each had a staff member test positive for the coronavirus.

    To verify such statements and halt false rumors, is there any official way to find out which restaurants have had employees with the virus?

    The answer is no. In Provincetown, Wellfleet, and Eastham, local health officials are not naming restaurants with Covid cases. There is no state mandate for reporting. Emily Beebe, Truro’s health director, said on Tuesday that she was still pondering the question.

    Elsewhere in the state, Quincy Mayor Tom Koch posts highly specific updates. On Aug. 3, he wrote: “An employee of Manet Lunch at 1099 Sea St. Quincy has tested positive for Covid-19. If you were a patron on 7/11/20 5PM-1AM, 7/12/20 12-5PM, 7/18/20 5PM-1AM or 7/19/20 12-5PM, please call Quincy Health Department at 617-376-1286 or 617-376-1272 so we may advise you regarding further actions.”

    Morgan Clark, Provincetown’s director of health and environment, has no intention of naming restaurants because she does not want to “contribute to shaming,” she said. “This community should be more aware than most, given how we lived together in the 1980s,” she added, referring to the AIDS epidemic.

    According to Mass. Dept. of Public Health epidemiologist Hillary Johnson, when and where a person worked may not be relevant. That is something contact tracers attempt to deduce.

    “There is not a one-to-one correlation with work and infections,” Johnson told the Provincetown Select Board on Monday. That is, roommates, family, or a certain dinner party guest may need to be informed of positive test results, not a business where masks were worn.

    Requiring Disclosure

    Still, some are pushing for mandatory restaurant disclosures of positive tests among staff.

    “Shining lights on the actual facts is the way to dispel the rumor mill,” said Louise Venden of the Provincetown Select Board. “I want to thank those who did disclose.”

    Erik Borg, co-owner of the Provincetown Brewing Co., said it posted results on social media because “some story will get out there anyway, so why not get the real story?”

    Provincetown Select Board member Lise King is advocating that the town list both the numbers of residents and workers employed in Provincetown who test positive. Particular businesses would not be named, said King, but it would give the public notice.

    In Wellfleet, Mike DeVasto, chair of the select board, is pushing for full disclosure. “I feel strongly that restaurants should report if they have a case,” he said.

    Beebe, Truro’s health agent, said naming the restaurant could motivate owners to focus on mask and hygiene requirements. But, she added, she doesn’t want to discourage businesses from communicating freely with her department.

    In Wellfleet, Health Director Hillary Greenberg-Lemos said she depends on businesses to call her about positive tests, since there has been at least one significant lag in results going to the state.

    Which Test Is Valid?

    But testing itself presents a number of thorny questions. For one, which test is valid? The molecular test that’s covered by insurance at Outer Cape Health Services is the most reliable, but wait times for results have been a week or longer. (Quest Diagnostics claimed on Aug. 3 on its website that the wait time is now five days on average.)

    Meanwhile, should a restaurant close, or should only a few employees stay home until results come in?

    On his business website, Mac’s Shack owner Mac Hay stated that he learned on July 30 that an employee tested positive. “Following dept. of public health and local board of health directions and protocol, we closed for a deep cleaning and had staff tested,” the statement continued. “All tests came back negative. We believe the negative test results are a testament to following proper guidelines and mitigating risk whenever and wherever possible.” The tests were done at CareWell Urgent Care, with results back that same day for about $160 each.

    Health agents, including Clark and Eastham’s Jane Crowley, said they don’t recommend the rapid tests, for which negative results are only about 70 percent accurate. Yet many businesses use the rapid tests anyway. “A lot of times, by the time they get to me, business owners have already gone to CareWell, spending almost $200 a test to do something I wouldn’t even recommend,” Clark said.

    On the other hand, the week or longer lag in receiving molecular test results presents a huge problem for contact tracers and businesses. And there’s no easy solution, since Quest Diagnostics, which conducts the virus tests here, is backed up, due to high demand nationally and a lack of supplies, Clark said. Dr. Andrew Jorgensen, medical director of Outer Cape Health Services, said a shortage of plastic has made it difficult to get test pipettes.

    Quest’s website says demand has “plateaued” and wait times on test results should decrease.

    On July 31, the Provincetown Board of Health sent a letter to the Mass. Dept. of Public Health demanding 48-hour test results. Clark brings it up during every call to the DPH.

    “We’re not going to stop talking about it until it is improved,” she said.

    HEALTH

    How Much Is a Covid Test? Who Can Get One?

    The answer, as usual: it’s complicated

    By

    PROVINCETOWN — Health care is rarely simple. The question of who can access it, where, when, and for how much often gets a conditional and specific answer that’s different for each particular constellation of symptoms, insurer, and office. The Covid-19 pandemic hasn’t changed the system — it’s just made it more visible.

    The primary question for getting Covid tests is the famous one from Chicago politics: who sent you? If you have symptoms, or if a contact tracer told you that you were in close proximity to an infected person for a prolonged period of time — then, a test is considered medically necessary. The office visit, sample collection, and laboratory work may all be billed separately, but insurance should cover nearly all of it.

    For the uninsured, undocumented, or people from out of state, however, things can quickly get complicated. Health Safety Net is a state program that can cover some of these situations, according to Gerry Desautels of Outer Cape Health Services, but an out-of-pocket bill is still possible. State money could pay for the test itself, for instance, but not for the office visit where the sample is collected — or vice versa.

    A lot of energy and money is going into making sure that people who are contact-traced get tested. Local health departments may have money for a test if the state or insurance companies aren’t helping. In general, people who have symptoms or have been contact-traced can find financial support for getting tested.

    Testing Without Symptoms

    What makes this coronavirus so dangerous, of course, is that it can be spread by people who never feel symptoms and don’t know they’re infected. Testing those people is part of the solution, too, but the questions of how and who pays still exist.

    CareWell Urgent Care in South Dennis is the closest location to get Covid-19 lab tests for asymptomatic people. It’s at 4834 Route 134, in a former Pizza Hut. (Photo CareWell Urgent Care)

    Insurance generally doesn’t cover testing in symptomless people who have not been contact-traced. CareWell Urgent Care, a network of 17 private clinics in Massachusetts and Rhode Island, offers a lab-based Covid test for $160 for asymptomatic people. Its South Dennis clinic is the closest place to the Outer Cape that offers testing to people on these terms.

    Some of the people who come to CareWell for a Covid test want to know if they can safely see their elderly parents or extended family, according to Sarah McLain, a senior market leader at CareWell. Others want to send their kids to camp or clear themselves for travel.

    “These are diagnostic tests — they weren’t really designed for some of these social decisions,” said McLain. “There is a chance of a false negative, and we explain that. But we’re going to use the tools we have for the situations we face.”

    Expanded Screening

    Some jurisdictions have begun systematically screening workers in high-contact industries. Rhode Island has an asymptomatic testing program that includes bus drivers, child-care workers, first responders, and restaurant workers. Nantucket’s health dept. specifically invites groups of essential workers to get screening tests, and on Martha’s Vineyard anyone who believes they may have been exposed can get a free test.

    Provincetown is working on a testing program for workers who are heavily exposed to the public, said Health Director Morgan Clark and board of health chair Steve Katsurinis. Employers would pay half the $150 cost of each test, and the town would pay the other half.

    Even picking up half the cost can add up. Provincetown is hoping to see 200 frontline workers tested next week, according to Katsurinis. At $75 per test, the town could spend up to $15,000. The timing of the program, two to three weeks after July 4th weekend, is meant to find out whether the crowds that were here ended up spreading the virus. Provincetown hasn’t reported any infections in almost six weeks, and the health dept. is hoping to find new cases early.

    The Cape’s state legislators are working to bring a mobile testing program to Barnstable County. State senators Julian Cyr and Susan Moran added $250,000 for this purpose to a bill that passed the senate but still has to be reconciled with one from the state house of representatives.

    Delayed Results

    Large-scale testing is limited by more than just available funds, however. According to Dr. John Cornwell, regional medical director for CareWell, “Dramatically expanding the testing would be ideal … but it’s overwhelming the work force and the equipment available,” especially in the labs.

    Early in the crisis, when all tests were processed by the Centers for Disease Control lab, results took about 7 to 10 days, said Cornwell. “When the private sector got their labs going, turnaround time was down to around four days,” he said. “Now that capacity is overextended, and results take about eight days.”

    Waiting eight days for a Covid test result can be a real hardship, especially for people who have symptoms or were identified by a contact tracer — they often have to self-isolate until results come back. Three days is a relatively small disruption; eight days is an entire week of income.

    There is a rapid test that gives results in 15 minutes: it costs about the same, but its false negative rate is more than double that of the lab test, according to Cornwell. False negatives are the bête noire of screening — they give people an implicit sense that they can safely mingle, and thus contribute to the very spread of virus that screening was meant to stop. This is why lab tests remain the standard for now.

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