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Last week, Vermont shut down its Covid-19 testing sites. These sites operated for more than two years and accounted for most of the 3.6 million results recorded by the state Department of Health over the course of the pandemic.
State officials have pointed to the increased use of antigen tests as one reason for this shift. As take-home testing has become more common, public health agencies have adjusted their tools for measuring the virus’s risk. But each of these metrics — whether scattered PCR tests, hospitalizations or wastewater sampling — offers an incomplete picture.
With this change, Covid infrastructure that has been offered at no up-front cost to individuals is increasingly absorbed into the normal healthcare system. And Congress appears unlikely to re-up federal Covid funding, meaning individuals will likely have to pay for future tests, vaccines and treatment either through insurance or out-of-pocket.
On this week’s podcast, VTDigger data reporter Erin Petenko and Dr. Trey Dobson, chief medical officer at Southwestern Vermont Medical Center, assess what the end of widespread PCR testing means at this stage of the pandemic, and what data sources they’re looking to now.
Below is a partial transcript, edited for length and clarity.
Riley Robinson: Last week, the state shut down its Covid-19 testing sites. These sites had been operating for more than two years and were one of the most visible pieces of the state government’s Covid response.
So it feels in some way like we’re closing a chapter on this phase of the pandemic. But it's not like all the big changes that popped up in the spring of 2020, with the empty store shelves with no toilet paper and the long lines for testing and all the wacky homemade PPE people wore in those early weeks. This is quieter, a sort of fizzling out.
I talked to VTDigger’s data reporter, Erin Petenko, about how our information about the pandemic has changed. Over the past couple years, Erin’s done a lot of analysis on the state’s Covid data. She created that pink line chart of daily case data that’s lived on our website for the past couple years.
Erin Petenko: I could probably draw that line in the case data pretty precisely if you challenged me to.
Riley Robinson: It’s just burned into your brain now permanently.
Erin Petenko: Yeah.
Riley Robinson: This week’s Covid data summary from the Vermont department of health is the first report since the state wound down its testing sites. So even though Vermont had “low” Covid-19 levels for the fourth straight week in a row, the data comes with a major caveat — it represents far fewer Covid tests than before.
Riley Robinson: The data that we were getting before, how reliable was that, and does this seem significantly different in any way?
Erin Petenko: I don't know if it's gonna make a huge amount of difference just because the data was so unreliable. Compared to six months ago, it's a pretty massive difference. I mean, I used to be able to say not only pretty reliably how many Covid cases there were each day, but also where they were, what age group was getting sick the most, how Vermont was being affected, on like a daily basis, rather than just like on a weekly or monthly basis.
And, you know, our ability to kind of tell those things is increasingly being lost. I can barely even really say any more, you know, whether people getting sick are vaccinated or unvaccinated. You know obviously the effectiveness of vaccines is being measured by scientists, not by Erin Petenko. But I used to be able to at least look at the data and say, oh, yeah, and X percent of the cases this week were among vaccinated Vermonters.
And that's not really a reliable metric anymore at all.
I would say what's changed fundamentally, is that we no longer have this data that we can use to interpret and make decisions, because we're not really making many decisions about the virus anymore, right.
We have data that kind of work as an indicator to public health practitioners or to hospitals of: Are they about to see a big surge in cases? But the kind of precise metrics that we would need to know things like when to impose mask measures and when to take them off, are no longer being tracked.
We have indicators, we have suggestions. We have ways of seeing how bad it has been, but not necessarily how bad it will be. That kind of stuff seems to be replacing the data sets that we had in the past.
Riley Robinson: How does the CDC calculate whether an area is high, medium or low risk, especially right now that this information is maybe a little bit more unclear?
Erin Petenko: Their determination of what category each place is is based on three factors: the rate per capita of COVID cases in the community, the percentage of hospital patients who have COVID, and the number of new hospitalizations, or new people showing up to hospitals with COVID. And this is a metric that the CDC transitioned to in February of 2021, because they openly said, case data is not as reliable as it used to be, we need to kind of capture a metric that reflects the fact that we are using antigen tests more. And the fact that, you know, omicron, and variants of Omicron are a lot less severe than previous strains. So hospitalizations are what really matters.
Riley Robinson: So tell me about wastewater data. What tools are available now for just knowing what's going on with COVID. And what towns are using wastewater data in Vermont?
Erin Petenko: So in the most recent surveillance update from the Department of Health, they have data from Brighton, Troy/Jay, which is kind of a combined one, and Burlington. Burlington has been reporting data since very early on, like, before even the CDC had started collecting wastewater data. But Bennington, Essex Junction, Johnson, Morrisville, Newport, Springfield, St. Albans, St. Johnsbury, Winooski, they're all on this list of providing data to the National Wastewater Surveillance System, but they don't actually have any data.
And I've even talked to the Department of Health about this, and they're not really sure why they're not reporting data.
I've just reached out to a bunch of towns to try to track down the reasons for that.
I will also say what wastewater data is useful for understanding, like, at a basic level. But we're not going to know what's the daily case count, who's getting infected, how many direct hospitalizations, is this going to translate to our ICU, is it going to get overwhelmed, from wastewater data.
Wastewater data is kind of like, how, how hard is it raining outside right now? Like, you're going to be able to tell the difference between a drizzle and a downpour. But you're not going to say how many raindrops exactly are going to fall on to your roof.
Riley Robinson: You've been talking with higher risk folks about how they're dealing with this phase of the pandemic and how they're approaching it. Has this data collection bit come up as part of that conversation? How important do you think this is?
Erin Petenko: My impression of talking to high risk people is they tend to pay very close attention to the data, to the point where, you know, a lot of them are practically becoming data scientists or data journalists themselves, because they really want to understand it as well as they can to protect themselves. Until we kind of lost a lot of information.
But now there is kind of a level of distrust in the data. Because we're not collecting as much data as we used to. We're not publishing as much data as we used to. And the way that we publish that data has changed a lot to kind of be more geared towards epidemiologists, and less towards everyday Vermonters just trying to understand their personal risk level.
Riley Robinson: I also called Dr. Trey Dobson to ask him about what’s changed.
Riley Robinson: Dr. Dobson. Hello.
Trey Dobson: Hey Riley, how are you?
Riley Robinson: I’m good. Thank you so much for jumping on. I heard you were running over from the emergency department.
Trey Dobson: Yeah, yeah. I just walked in here. So give me a second to get out of seeing patients mode.
Riley Robinson: Dr. Dobson is the chief medical officer at Southwestern Vermont Medical Center in Bennington, and he’s also an emergency medicine physician. The last time I saw him was back in December, in the thick of the winter surge.
I was reporting on how the rise in cases impacted rural hospitals, and Dr. Dobson walked me around his emergency department, which at that time, had several patients very sick from Covid.
Trey Dobson: You can see this woman’s oxygenation is not good, that woman’s oxygenation is not good. But you can see all these peoples’ oxygen is low. You should be at 100 percent. They’re at 90 percent.
Riley Robinson: What does your emergency department look like today?
Trey Dobson: We are seeing patients in higher volumes than prior to the pandemic. And it is likely due to a variety of reasons.
What we're not seeing are lots of sick people with Covid-19, which is fantastic. And it's most assuredly due to the protection that we have garnered through both vaccination and prior infections. As you know, in January through March, about half the country probably was infected with Covid-19. And even though these new variants like the (BA.4 and BA.5 subvariants) that are now the most dominant variants, are able to evade prior infection, they're not able to cause severe illness, so we're not seeing lots of people re-present to the hospital sick.
Riley Robinson: Do you have folks in your ICU today with COVID?
Trey Dobson: You know, I would have to just look on our board real quick. But on any given day, we have a few people in the hospital, between two and six, that have COVID-19. And some of those may be in the ICU. Certainly the older vulnerable populations are who wind up in hospitals these days.
Riley Robinson: How does that compare to December?
Trey Dobson: Well, certainly less numbers of people in the hospital, and they are staying for less of a duration. In other words, they are not requiring six and eight day stays. They’re typically requiring three and four day stays.
Riley Robinson: When did you start noticing a change? Like when did things start to ease off for you all?
Trey Dobson: Our hospitalizations have been quite steady for, you know, probably three months at least. Let's see if I can calculate that out right: March, April, May, June — yeah, about three months our hospitalizations have been low and steady – between two and six patients in the hospital.
Riley Robinson: Southwestern Vermont Medical Center ended PCR testing for the general public last week. The hospital’s testing center collected more than 110,000 swabs in the past year and a half.
Riley Robinson: To jump a little bit, when hospital leaders started talking about winding down PCR testing, was that driven by case loads? Was it driven mostly by the funding? Was it driven by the caseloads? What was the planning like there?
Trey Dobson: You know, if you look at the graphs of cases, in the newspaper around the country, or in Vermont, and it goes up and down, that's the same with discussions on should we continue testing or not. There was times in July of 2020, where we would have less than 10 people present to the hospital for Covid-19 testing on a given day. And you have to think, you know, is this adding value to the community to have a large scale operation where we're only seeing 10 people a day? So those discussions have occurred really, almost throughout the pandemic.
What's different today, and the reasons that we could stand down the surveillance-type PCR testing, is again, access to self administered tests, a better understanding among society on how to interpret these tests, how to handle them. And then also, the virulence of the disease has declined. It's certainly still deadly for those that are vulnerable. But so many of us are vaccinated and/or have had prior infections, that right now even these highly transmissible Omicron variants are causing disease, but they are not causing people to be ill enough to be in the hospital.
Riley Robinson: Dr. Dobson said the hospital is still doing some PCR testing, when doctors think it’s necessary to find out what’s happening with a patient. Broad-based testing for the general public is what’s going away.
Trey Dobson: We want to be careful to not be testing people who are just concerned and want to have a PCR test. It's not value-added for the cost, that not only they would incur, but the system would incur. And so it's a move from the highly costly test to a different phase of the pandemic. And it's now appropriate. By the way. It would not have been appropriate a year ago to make this move. So like many things with this pandemic, you have to look at the right time and the right situation.
And I don't imagine that there will be a time where we need to return to these large scale drive-through PCR testing that we were doing before, but certainly it is possible. And if that's the case, we will be ready to stand up and get our drive-thru going.
Riley Robinson: How much money are we talking, to set up this kind of testing operation?
Trey Dobson: It would depend on the timeframe we're talking about, but I'll just give you some examples of what's invested. Just the materials to do the testing itself, not even the equipment, but just the materials, are around $40 per test. Now that's a ballpark number. That's pretty high right there. We're just talking about, like, the reagents and supplies, but not to mention buying the actual equipment. And I would say that the equipment itself is in the thousands to tens of thousands of dollars, depending on the type of machine. We actually have several different types of machines.
And then there is the cost of staffing. So we're taking nurses, in some cases, physicians, but usually nurses and pharmacists and techs away from their normal job, and placing them to do the testing and vaccination. And so you'd have to just add those things up, and that can get quite expensive. Certainly, it was the mission of the hospital to do the best we can to maintain financial sustainability while we take care of the public. And, you know, fortunately, we've been able to do that.
Now, some of that, again, is based on federal stimulus and surplus monies that were given to different organizations. So we used all of that in that way. And then there were some other means, like I talked about, HRSA funds to do testing, that is no longer there.
Riley Robinson: HRSA stands for the Health Resources and Services Administration. It’s a federal agency, and it was responsible for handing out the billions of dollars in Covid funding that reimbursed hospitals for things like testing and vaccinations and treating patients who don’t have health insurance. The agency stopped accepting reimbursement claims in March when it ran out of money.
A deal in Congress to re-up Covid funding seems pretty much dead. In March, Sen. Mitt Romney of Utah and Senate Majority Leader Chuck Schumer announced a $10 billion package to fund testing, treatment and vaccine development. But then, Senate Republicans said they wouldn’t vote on the deal if it didn’t include an extension of Title 42, which is this public health order that gives the government more leeway to turn away migrants and asylum seekers at the border.
Then last month, the Biden administration moved some Covid money around and set aside $5 billion to purchase a round of new, updated vaccines if and when they become available. This prompted criticism from some Republican senators, including Mitt Romney. They basically accused the Biden administration of lying to lawmakers about what funding was needed and how much was available.
Outside of Washington, this dustup means that the Covid infrastructure that has been offered at no up-front cost to individuals will probably be absorbed more and more into the normal healthcare system — meaning people will have to pay for vaccines and treatment either through insurance or out-of-pocket.
Riley Robinson: Do you think there's ever going to be a moment when the pandemic really feels over? Does it just sort of fizzle out?
Trey Dobson: Yeah, it fizzles out. This type of pandemic, it doesn't end on a particular day. Of course, it has ended for many people because they started to ignore it. But for those of us in healthcare, and others, who know that the virus is still very prevalent, we need to see the number of deaths per day go from 300, down to 100, which would be on par with influenza. And then it needs to be stable before we say it's no longer a pandemic; it's endemic in a particular region.
And by that, what I mean — there’s a lot of confusion about what endemic means. But endemic, really the best way to think about it, its a stable number of expected illness.
There's too many variants developing to say we're out of a pandemic. We're not at all.
The good news is, is society handles that much better. And the virulence appears to be declining, again, probably due to a number of factors, but particularly including, as you’ve read recently, the calculations, so many lives, as well as immunity developing from prior infection. And in many people, it's both. And that’s what’s probably going to continue.
Riley Robinson: So when there's no more state run PCR testing coming in, or I guess — our data sources have been changing, right? If we're relying on self reporting, how do you think about that? How do you work with that? Are there other sources of information that you're looking to, to understand prevalence? Or how does that work now?
Trey Dobson: Well, it's no longer scientific, it is much more of a gestalt, or an anecdotal type idea of what the prevalence of the virus is. And it is truly not scientific, because there is no information anymore on prevalence that is reliable. We happen to have done a lot of testing, up until today or tomorrow. But even then, most of the testing is occurring in the homes. That's OK. Because the cost of doing this testing in society is now greater than the value it adds.
What is important is to look at is first off, hospitalizations, and second, absenteeism from work and school. And that's where we're gonna get our information about what the prevalence of the virus is.
It's important that we don't just say to someone, look, you have symptoms that are consistent with the virus, stay out of work without some definitive understanding of whether or not they really do because we need people to work. We need kids to not miss school. We need to be able to exist with this virus in a reasonable way.
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