The Martha’s Vineyard Hospital has tested more than 350 people for the coronavirus since the outbreak began over a month ago.
The Martha’s Vineyard Hospital has tested more than 350 people for the coronavirus since the outbreak began over a month ago. Sixteen of the tests have come back positive.
But not everyone who contacts the hospital to report symptoms is tested, making the actual rate of infection Islandwide difficult to determine with any real precision.
With testing for Covid-19 emerging as a national issue, hospital president and chief executive officer Denise Schepici, and head of hospital operations and nursing chief Claire Seguin spoke with the Gazette last week about the intricate process for testing on the Island. In an interview, both said they believe there is adequate capacity for testing on the Vineyard — but they also confirmed the hospital has turned away some symptomatic patients, telling them to quarantine instead.
They defended the hospital’s strict testing policies and criteria and said they didn’t see a need for broader mass testing on the Island.
Recent population estimates developed by the Gazette based on Steamship Authority data and other available information puts the current Island population at around 20,000. Using that number, the Vineyard has tested approximately 1.5 per cent of its population. Statewide, the number is approximately 2.6 per cent.
Ms. Schepici and Ms. Seguin said the hospital’s testing criteria are set by Partner’s Healthcare, the hospital’s parent network, and leave a large amount of discretion for who gets tested to individual physicians screening patients. The criteria are aligned with guidelines from the CDC, which change often, they said.
For a variety of reasons, including the fear that a negative test will give people a false sense of security, the hospital turns away some symptomatic patients determined to be low risk, and instead simply tells them to isolate for 14 days.
“Doctors will say, you have symptoms of a respiratory viral illness — those are the exact words — and the advice right now is that you go home and self-quarantine for two weeks,” Ms. Seguin said. “I will say, we have had that.”
She declined to specify the number of symptomatic patients who had been turned away from testing, but said the number was small.
“I don’t think it’s been a lot,” Ms. Seguin said.
Ms. Schepici said it would be difficult to estimate the number of positive cases on-Island that have presented with symptoms but haven’t been confirmed by a test.
“What makes that a hard metric to wrap your arms around is that a lot of these people don’t have Covid,” Ms. Schepici said. “They have a sore throat, and a cough, and muscle aches . . . But we’re going to say in an abundance of caution, you’re going to self-quarantine at home. That’s why it’s a hard metric to get your arms around.”
Symptomatic patients who do not receive a positive test are not entered into the state’s epidemiological database, MAVEN — meaning they are not monitored by local boards of health and they do not trigger any contact-tracing process. They are also not included in the total positive case count provided by the state, hospital or local boards of health.
“At this time, we have to prioritize,” Ms. Seguin said. “There isn’t this unlimited amount of tests that we have out there.”
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The hospital officials described the steps involved in viral serology testing at the hospital. In almost all instances, the process begins with a phone call to either a primary care physician or the hospital’s screening hotline, if a person does not have a doctor. During the phone call, a doctor asks prospective patients a series of questions in order to assess their risk. Two basic elements play into the risk assessment: symptoms, and other risk factors. And while the symptoms doctors at MVH assess have remained the same since testing began, the other risk factors change daily.
“The basic criteria for how the patient presents — cough, fever, sore throat — none of that changes,” Ms. Seguin explained. “But as for who gets tested, who actually gets tested — that’s the thing that changes.”
As it stands now, anyone who is over the age of 70 and experiencing severe chronic lung disease, severe heart disease, immunosuppression or is on immunocompromising medication or dialysis, will automatically receive a test if they are exhibiting symptoms. Anyone who lives in a long-term care facility or group home, like Windemere, or is homeless, or is more than 36 weeks pregnant, also will automatically receive a test if symptoms are present. Medical workers and inpatients who show symptoms automatically receive tests as well.
For anyone else with symptoms, it is up to the primary care physician or doctor to authorize the test. That’s where the discretion comes in.
“Criteria is a guide, but it is not meant to replace a physician’s judgment,” Ms. Schepici said. “If you called, and you had a symptom of Covid, and your doctor feels that you are high risk, and thinks, oh, if you live with eight other people in your house, and you should really know, then they’re going to go ahead and approve that test.”
It also can work the other way.
“Sometimes there are folks with symptoms, and we’re just going to instruct them to self quarantine,” Ms. Seguin said. “They are pretty low risk from the categories, and if their doctor thinks it is appropriate, they will do that.”
Anyone authorized to get a test is instructed to schedule an appointment for the hospital’s drive-up testing tent, which is booked in advance like a doctor’s appointment. The patient will receive a nasal swab from a fully-donned nurse, which is then packaged and sent via courier to Boston in a viral medium. The turnaround time on tests is now 24 hours.
The hospital also has a 45-minute testing kit, but due to limited supplies reserves those tests for in-patients and health care workers.
Once the test is registered in the state system, a primary care physician or hospital staffer will notify the patient of the result. In an almost parallel process, the hospital’s internal prevention infectionist will inform the health agent from the town if the result is positive.
Ms. Schepici and Ms. Seguin said the lower testing rate on the Vineyard compared with the state at large is likely because of the low prevalence of the virus on the Island, as opposed to, for example, the city of Chelsea. They added that it was important to preserve much-needed testing equipment for harder-hit communities.
Both said they were satisfied with the current rate at which testing is being conducted on the Island, and said the main goal with testing is to focus on high-risk patients, using those numbers to plan for capacity at the hospital.
“If you think about the way we use criteria, it is a way for us to prioritize those patients who are likely to get really, really sick from this,” Ms. Seguin said. “As far as patient safety and good, sound, clinical care, I’m happy with the process that we have for now.”
Ms. Schepici said part of the reason for the limited testing and strict criteria was that the hospital could not handle a rush of patients demanding requests.
“We’re just going to be bombarded,” she said. “And it’s just not fair to our health care workers. It’s not fair to our supply system. It’s not fair to everybody else who is trying to follow the rules.”
Ms. Schepici also said mass testing would be unnecessary and counterproductive at this point, fearing that thousands of negative tests could prompt people to take greater risks than if they are simply told to quarantine.
“The point is this: if we test that person, and the person is negative, right, that gives that person the false sense of security that they don’t have the virus,” the hospital president said. “We can’t open it up to mass testing for that very reason.”
She continued:
“That’s why we’re not doing that testing. That’s why we’re saying, self-quarantine. If it is medically necessary, and the physician thinks it meets the criteria, they’re going to have you come in. But if it’s not . . . the pill we’re giving, is quarantine. It’s the quarantine pill. That’s what it is.”
Comments
I understand why the MV
Mark HahnI understand why the MV hospital cannot test everyone who calls in with symptoms, because of the limited number of tests and the potential for false negatives. The danger, however, is that the apparently low number of reported positive results on MV may provide a false sense of security to residents and those thinking of coming to MV as a safe haven. (This is further exacerbated by the hospital’s statements that “No one is currently hospitalized here with the virus”, which omits that fact that some have been transported for hospitalization off island.)
The reported number of positive tests underestimates, possibly by a substantial amount, the number of people on MV with the virus, because of the lack of testing and the fact that many who have the virus are asymptomatic or pre-symptomatic. I suggest that the hospital incorporate such a statement in their daily reports, and that they include in their reports the number of symptomatic patients who have been told to self-quarantine without being tested.
I agree with you! There
Annie OBI agree with you! There should be those kind of stats posted. The current low numbers give a false security, so a far worse fall-out is likely when people start ignoring guidelines when the weather gets nicer.
I agree with you--this
Birdy West TisburyI agree with you--this reporting suggests it's 'safer' here than it may actually be. I have friends who had the virus, were told by MV Hospital to go home and self quarantine. They came through it, but why aren't these people being counted and contact traced? This is not right. They were told their 'symptoms' didn't appear in the 'correct' order per the CDC's guidelines. Really? Test, test, test and report, report, report. The more transparent the numbers are, the more seriously people will take this situation. This is just not right.
My daughter and her husband,
Carolyn O'Daly EdgartownMy daughter and her husband, both young and healthy, had pneumonia in February. They should have antibody tests. How many cases of pneumonia were diagnosed before they were aware of Covid-19?
Enough with the nonsense.
Right Whale Hooter BuoyEnough with the nonsense. Let's get the testing going here. Hundreds of thousands of tests are being done on the mainland.
The comments attributed to
DPP West TisburyThe comments attributed to the Administrators are troubling. The only way to plan is to know data, not hoard resources. We are a relatively small population, an aggressive and orderly testing plan would enable data driven public policy.
Testing, testing, testing!
JC EdgartownTesting, testing, testing! That's what the experts are talking about everyday. So MV Hospital is "saving" the tests for what reason? They don't want to know/report the number of people here who are infected? And if you get sick, go back home or be prepared to be shipped off to Boston. So how are we going to get out of this mess?
I agree strongly with Mark
JonathanR West TisburyI agree strongly with Mark Hahn. The 'logic' of this approach escapes me:"Ms. Schepici and Ms. Seguin said the lower testing rate on the Vineyard compared with the state at large is likely because of the low prevalence of the virus on the Island," --if you aren't testing, how do you know this??
Good question!
Birdy West TisburyGood question!
Jonathan R, you are so right.
Lorraine EdgartownJonathan R, you are so right....there is no way to know who has had the virus not only on the island but anywhere in the world. Each person would have to be tested, each test would have to be assayed as to false positive/negative according to the kind of test given. This, currently, is impossible. What most of us are ignoring is that we know very little about this virus. We expect magic solutions from experts who are not fully knowledgeable about this virus. Yes, people of great intellect and experience are working on it, a sort of Manhattan Project, if you will, and we will find out more. But there is no way to know who has had it, who currently has it and therefore most of the remarks are not valid.
"Testing criteria are set by
John West Tisbury"Testing criteria are set by Partners Health care." This makes one wonder if "testing criteria" are set for economic reasons, rather than concern for well being of patients or the island population. While supposedly a non-profit, many who have had to use the facility over the last few years have noticed the increase in costs and bureaucracy that has ensued since they took over "our hospital".
Just as a point of reference,
Warbaby OBJust as a point of reference, "non-profit" does not mean a business is run without regard to whether or not there is a positive bottom line--such is necessary for any business to remain a going concern over time. It simply designates an entity that uses profits from operations to reinvest in the business or further its stated purpose rather than distribute them to the owners. Such a company also does not pay income tax.
The hospital’s response to
Coblyn Chip OBThe hospital’s response to the ‘testing problem‘ is exceedingly disappointing, even shocking, and is more in line with the White House than with Beacon Hill. If we can’t establish a ‘Covid’ baseline among the island population, how in the world are we going to safely reopen our businesses for local use, to say nothing for the annual influx of summer visitors—now surely emboldened by the rosy scenario implied by the hospital? Are we to simply shelter in place indefinitely until “like magic” the epidemic disappears? Because right now—without 20,000 accurate test kits—there is absolutely no evidence convincing me that it’s okay to resume even a semblance of normal life.
Thank you Mark Hahn
Sally cohn EdgartownThank you Mark Hahn
Weeks ago I was taking my temperature because I had a cough and unusual chills and headaches which I never get
And I had a very odd sense of not feeling right
We deserve to all be tested
We are just as vulnerable
It could hit us here on the island too
Let’s not be the Monday morning quarterback
Too many people have been and now we have a pandemic
Testing, testing, testing -
Carol West TisburyTesting, testing, testing - what about testing for breast cancer, colon cancer, failing vision, gum disease, heart conditions, kidney failure? I get the lust for data and sure, test all you want, but we need to get our healthcare system back - and our jobs.
We have a great opportunity
Quansoo Lady ChilmarkWe have a great opportunity to learn so much from the current local Covid 19 situation. We live in an insular community with a captive audience and we could put our resources to good use for our community (if they are willing) and the Nation by doing what the President and Federal Government refuse to do--- asking all residents to volunteer to be tested.Doing this will greatly assist Researchers in their efforts to study & understand the virus, assist our local leaders in every town to make the most informed decisions possible such as when we can safely reopen local schools or businesses. It is my understanding that Testing is currently the only known way in which to assess and get ahead of this situation Yet despite being made aware of this critical fact -the President & his Administration have made it abundently clear that they will not provide testing for all. No one in the current Admnistration should ever "have to get tested" if they dont want too but I for one stand with the Scientific c & Medical Community & would welcome the opportunity if the local hospital would step up to the plate and offer it.
There is another unfortunate
Sue West TisburyThere is another unfortunate consequence to the MV Hospital's reluctance to administer covid-19 tests: the costs accrued for services needed by sick patients without the positive test, results in no coverage by health insurance. No matter how sick I was when treated in March at MVH, Blue Cross will not cover my x-ray beyond the $27 insurance adjustment even if I show antibodies in the serology test. To get Blue Cross to cover the remaining $452 of the bill, I need the positive covid-19 test. Remember at the start of the Pandemic, insurance companies assured the public that they would cover costs for covid-19? It doesn't work if the Hospital refuses to offer tests. It's a big bill to pile on when you're already out of work.
It is being said again and
Jessica Vineyard HavenIt is being said again and again by every epidemiologist, doctor and public health expert, except apparently on this island, that testing is the key to understanding the spread, extent and impact of this virus on communities and the wider world. Testing is also key to understanding immunity, and the potential trajectory of the disease in the future. We also now know that up to 50% of people may be asymptomatic (reported by the Navy on the RSS Roosevelt, admittedly a healthy, young demographic). The idea that the hospital will not even test those that show all symptoms, is a huge problem. The hospital is NOT being bombarded by people asking for tests and shortages is not currently an issue. The idea that by testing you are giving someone a "false sense of security that they don't have the virus" is completely backwards. YOU ARE GIVING THEM 70% THE PEACE OF MIND that they don't have a potentially deadly disease, and giving them the realization that since they do not have the disease they are still susceptible to it. That the CEO has decided that inciting fear into towns rather than responding with numbers and data is unacceptable.
MV Hospital cannot test
Valerie Palms ChilmarkMV Hospital cannot test everyone with symptoms but we are limiting our ability to control the spread of infection on the island if, as the article states, symptomatic patients who are not tested are not entered into the state’s epidemiological database, not monitored by local boards of health and do not trigger any contact tracing process.
As reported in the New York Times on April 27, the Council of State and Territorial Epidemiologists has recommended to the C.D.C. that "cases should be reported if there are positive lab tests, but also if there are clinical symptoms that meet one of several thresholds. One category involves people who have cough, shortness of breath or difficulty breathing. Another involves people with two of the following symptoms: fever, chills, shivers, muscle pain, headache, sore throat or new dysfunction of taste and smell.”
Guiding patients with symptoms to quarantine is of course crucial to limiting the spread of Covid-19.
But we also need to trace the contacts of those patients whose symptoms meet the threshold for possible diagnosis with the disease as aggressively as we are tracing those who test positive. The test shortage in the U.S. is tragic and could have been avoided but we can still identify many of those who are symptomatic and may be infected with this deadly virus.
MV Hospital will hopefully be adapting its policies to follow the new recommendations of the C.S.T.E. and the C.D.C. Patients who present with symptoms that meet the threshold for diagnosis need to be reported as possible Covid-19 cases and be added to the Massachusetts database for contact tracing.
We know now that being young, healthy or having only minor symptoms at the onset does not necessarily predict that a patient will survive Covid-19. Hopefully we will soon have greater testing capacity and the ability to positively identify everyone who actually is at risk regardless of whether they appear to be at risk or not.
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