Covid testing expands amid ongoing surge

12/23/2020

There’s good news and there’s bad news about Covid-19 this week. The good news is that testing efforts are finally expanding in West Marin, and a group of first responders were vaccinated in Point Reyes Station on Wednesday. The bad news is that this week saw the largest number of positive test results of the pandemic, and Marin’s intensive care units are approaching capacity, potentially resulting in more fatal outcomes. 

The pandemic’s three highest days for positive tests occurred in the last week, peaking at 103 new cases last Wednesday. For every 100 positive tests, public health officials predict another five to 10 people will go to the hospital, three patients will go to the I.C.U., and one or two people will die.

Contact tracing has revealed that transmission is being driven by small indoor gatherings, and the pump is primed for Christmas celebrations to exacerbate the crisis, just as Thanksgiving did, Marin’s public health officer Dr. Matt Willis said. While transmission early in the pandemic was concentrated among Latino essential workers, now cases are being seen throughout the county in all races. 

“It’s not necessarily the big party that you’re going to throw—hopefully that’s behind us,” Dr. Willis said. “It’s more around the edges of that. It’s like, ‘Okay, yeah sure you can come into the house. It’s getting cold, so we’ll go inside.’ That, when it’s iterated over 260,000 residents, which is the population of our county, if that happens even a little bit regularly, that’s going to hurt us.”

In West Marin, there have been 26 new cases reported in the past month, 12 of which are active. Once again, a prominent business has closed to test employees: Last week, it was the Inverness Park Market, and this week, it’s Toby’s Coffee Bar.

But positive tests reflect just a fraction of the true spread of Covid-19. Due to untested and asymptomatic cases, the Centers for Disease Control and Prevention estimates that the actual case count is six times higher than reported. 

Still, Dr. Willis is confident in Marin’s testing strategy. The C.D.C. says that when positivity rates—meaning the percentage of tests that come back positive—are above 8 percent, testing is lacking, and asymptomatic cases are spreading unchecked. Marin sets a stronger benchmark, aiming to keep the positivity rate below 5 percent. The county is performing among the most tests per capita of any California county, and its positivity rate is currently 3.9 percent.

“Our percent positivity is reassuring that our testing strategy has been sufficient, but we still want to increase testing. More testing is better,” Dr. Willis said.

In West Marin, tests have been especially hard to come by because there are few health care providers. The Coastal Health Alliance offers 75 weekly tests at the Point Reyes Station clinic, and the West Marin Medical Center offers testing to its patients. But other than that, residents have been sent over the hill, to drive through Kaiser’s testing sites or to county testing sites in San Rafael.

Fortunately, the coast will gain a better understanding of transmission due to a new contract the county signed with Curative, a testing company that deployed vans to the Bolinas fire station and the San Geronimo Valley Community Center on Monday for up to 200 free tests. Anyone can register for the tests online, and the mobile operations will visit anywhere in West Marin where more testing is needed. The tests are self-administered by collecting saliva, making them less intimidating than the long nasal swabs, and results are delivered within 48 hours. Curative is testing staff at the Shoreline Unified and Bolinas-Stinson Union School Districts, too.

The vaccine has also arrived for West Marin’s first responders. Up to 100 firefighters, paramedics and law enforcement officers were offered the chance to receive their first of two doses at the Point Reyes fire station starting on Wednesday. The doses came from the first shipment of the Moderna vaccine, which arrived in Marin this weekend.

The Moderna vaccine uses the same biological mechanism as the Pfizer product, except it doesn’t require ultra-cold storage or a nurse to dilute the dose, making it easier to use in rural areas like West Marin. Both vaccines have shown roughly the same safety and efficacy.

The Pfizer product was used last week to inoculate health care workers at hospitals and skilled nursing facilities. Hospitals are continuing to vaccinate their staff this week, and the county aims to have 7,000 people receive their first dose by the end of the year. Trials showed that the first dose offers some protection after just 10 days.

The distribution of the vaccine comes with a sense of urgency. On Tuesday, 28 of 29 intensive care unit beds were filled in Marin’s three hospitals. At this capacity, hospitals can give everyone full care, but if more patients come in, decisions about discharging or moving patients out of the I.C.U. become more difficult.

“We know how to do this. We know how to rearrange the pieces of the puzzle to make things fit. But if Covid continues to spread, if the cases continue to rise, it will strain the system,” said Karen Shavelson, the chief medical officer for the MarinHealth Medical Center.

Marin’s hospitals are still weeks away from having to set up alternate care sites to treat patients with less severe conditions, but one serious car accident can throw the whole system for a loop, Dr. Shavelson said. The county is denying requests for care from other counties.

Like 98 percent of California, Marin is currently restricted by a stay-at-home order issued by Governor Gavin Newsom for the entire Bay Area when I.C.U. capacity fell below 15 percent last week. The order is scheduled to expire on Jan. 7, but Gov. Newsom said it is highly likely to be extended beyond that date based on current trends. The statewide I.C.U. capacity is around 2 percent.

“The next two weeks are critical for us to protect our remaining resources in terms of health care and allow us to get back on our feet in terms of reopening our economy,” Dr. Willis said.