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7 things to know as Lancaster County begins $42 million COVID-19 testing, contact tracing

testing site

Screening and testing for COVID-19 takes place in tents outside Clipper Magazine Stadium, 650 N. Prince St., Lancaster, starting April 7, 2020. The site is a partnership of Penn Medicine Lancaster General Health and UPMC Pinnacle.

Lancaster County on Friday launched a monumental, $42 million public health initiative to test as many as 830 people a day for COVID-19 and to alert those who were in close contact with people who test positive.

The work, which runs through December, could create over 100 temporary jobs.

Experts view the effort, paid in part by $24.7 million in federal coronavirus aid funding, as the best way to contain the highly contagious virus, which has been found in over 2,700 people here and has been responsible for at least 277 deaths since March, mostly in the elderly.

The county commissioners Wednesday awarded Penn Medicine Lancaster General Health the contract to quickly ramp up testing and contact tracing.

Prior to the countywide effort, contact tracing was happening only in Lancaster city and for Lancaster Health Center patients.

In the first two months of the pandemic, nearly 15,000 people with symptoms were tested in Lancaster County at a rate of about 250 people a day. About 15.8% have tested positive. The new initiative could perform from 550 to 830 tests a day if needed, said Dr. Michael Ripchinski, chief clinical officer at Penn Medicine Lancaster General Health.

There’s no way to predict how many people will end up getting tested, Ripchinski said. It will depend on how strictly Lancaster County adheres to mitigation practices, such as social distancing and wearing masks, which has helped to keep hospital admissions here far lower than early models predicted.

Until a vaccine is available, testing and contact tracing are the best weapons for fighting the pandemic, he said.

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Dr. Michael Ripchinski, chief clinical officer for Penn Medicine Lancaster General Health, speaks May 5, 2020, during a weekly COVID-19 news conference at the Lancaster County Public Safety Training Center near Salunga.

Here are key aspects of the initiative.


Testing not for all

Not everyone who wants a test will get a test. Testing remains only for those for whom it’s clinically warranted, Ripchinski said.

A candidate for testing is someone with two common COVID-19 symptoms, such as fever, shortness of breath or cough. Also, those who have one symptom and have been a close contact of someone who tested positive will be tested.

Certain people who don’t have symptoms may be tested if they’ve been in close contact with someone who tested positive. Close contact means spending at least 10 minutes within 6 feet of a positive individual and not wearing masks.

Others who are asymptomatic but can be tested include patients having elective medical procedures and women in labor.

Asymptomatic testing may also be used to investigate outbreaks or to work with the state Health Department in surveillance of the coronavirus’s spread.


No out-of-pocket cost

Those who are tested will have no out-of-pocket costs, but health insurance providers will be billed for their insured clients.

The cost to insurers was budgeted at $17 million, but would reach that amount only in a worse-case scenario of widespread disease, said John Lines, spokesman for Lancaster General Health.


Aiming for quick results

Laboratory turnaround time for tests is often a few days. But the plan is to contact the patient within 24 hours of the hospital receiving the result.

Testing specimens are being processed at Lancaster General Hospital, the Hospital of the University of Pennsylvania, and Quest laboratories in Virginia. 


Multiple sites

As of Friday, people were being tested at nine sites.

They include Clipper Magazine Stadium in downtown Lancaster; Pennsylvania College of Health Sciences in East Lampeter Township; Lancaster WellSpan Family Medicine, 136 Lake St. Ephrata; and Lancaster WellSpan Urgent Care, 101 Airport Road, Lititz.

They also include five Lancaster General Urgent Care centers: 547 N. Duke St; 2118 Spring Valley Road; 432 Cloverleaf Road, Elizabethtown; 895 N. Main St., Ephrata, and 51 Peters Road, Lititz.

Other sites are being evaluated. Mobile testing, possibly provided by Lancaster EMS medics, will be available for those who can’t leave their homes.


Monitoring

Nurses will monitor temperatures and other symptoms for 14 days, either by phone email or text.

People who have special needs while in quarantine will be connected to social service organizations that can help with meals, health care and housing.


Contact tracing

More than 20 registered nurses and community health workers have started calling those who test positive and their contacts.

Over 100 may ultimately be hired if testing leads to a surge in people who must be contacted. Job information is at LGHealthjobs.org.

Nurses call those who test positive to learn who they’ve had close contact with, going back two days before symptoms began. Community health workers then alert the contacts.

Lancaster General will contract with tracers already working for Lancaster city, Lancaster Health Center and WellSpan Ephrata.

Tracers will try to notify contacts within 24 hours. They will ask the contacts to restrict their interaction with others for 14 days, starting from the date of exposure. Tracers will be trained to convey health information in plain language, and a translation service will be available.

Contacts will not be told who may have exposed them to COVID-19. Tracers, in fact, will not have that information.

Contacts who develop symptoms will be tested.


Type of test

Antibody testing is not part of the initiative because it doesn’t identify those who have the coronavirus and may be spreading it, Ripchinski said.

Antibody testing uses blood samples to see whether a patient has antibodies against the virus, indicating they either have the virus, had it previously, or were in contact with it.

The initiative instead uses virus testing, which involves swabbing the nasal cavity and testing for the virus’ presence. It can see only whether a patient currently carries the virus.

Less invasive swabs for the front of the nose will be used.