Earlier this month, Vermont health officials announced they were getting 21,000 rapid Covid tests from the federal government.
Despite the fanfare with which President Trump sent out the tests, Vermont won’t be using them. At least several nursing home officials said they don’t need them and the state has stockpiled its shipment until further notice, according to Health Commissioner Mark Levine.
“We don’t find that as necessary,” said Alecia Dimario, spokesperson for Birchwood Terrace Rehab and Healthcare in Burlington. Birchwood received a handheld machine to run antigen tests, plus two initial rounds of testing for the roughly 100 residents. But the nursing home doesn’t have the staff or the time to run the tests.
Levine, who has long been hesitant to use the rapid tests, said he would stockpile the tests until at least January when there could be a shortfall. “The reason we’ve been reluctant to go full-fledged in with antigen tests to date has to do purely with the prevalence of disease in Vermont — it’s not as much a matter of is the test good? Is the platform good? It’s a matter of is it the appropriate time to use the test,” Levine said in an interview.
At this point, “we don’t think it would be as useful,” he said.
Rapid Covid-19 tests, or antigen tests, are taken as a nose or throat swab and measure the surface proteins, or antigens, on the coronavirus. They were described as a game-changer early on; they’re inexpensive and provide rapid results, in as little as 15 minutes.
But they’re also less accurate than other tests. As many as 50% of negative test results can be false negatives.
In late September, Trump sent 150 million antigen tests to states, with a focus on nursing homes and vulnerable populations.
PCR — which stands for polymerase chain reaction — tests, which Levine has heralded as the “gold standard,” screen for the virus by measuring virus RNA. They provide a more accurate result, though results take at least 24 hours and often several days.
The Department of Health has consistently used those tests at pop-up testing sites. PCR tests are Vermont’s “testing strategy,” Levine said, and that’s not going to change. “It’s certainly the strategy for a long time.”
According to Levine, antigen testing can be useful for regular screening, testing people once a week. It’s also helpful in populations with a high prevalence of Covid cases. Regardless, any positive test should be confirmed with a PCR test, he said.
Fifteen states, including Vermont, don’t include antigen test results in their statewide Covid test counts. Some states, such as Florida, are using the tests broadly in schools and nursing homes. Nevada recently revoked a temporary ban on the tests that had been imposed because of concerns about inaccuracies.
Vermont’s experience with the tests has been colored by a controversy in Manchester in July. Manchester Medical Center found that more than 60 people tested positive for Covid with antigen tests, but only four of those people tested positive with a confirmatory PCR test. The state hasn’t been able to determine the reason for the erroneous results.
According to Levine, Vermont has plenty of PCR tests and notifies people who test positive within a day or two.
“Covid-19 antigen and antibody tests are not performing well, with too many false positives and false negatives, especially in a low-prevalence setting like Vermont,” said Dr. Debra Leonard, chair of the pathology department at the University of Vermont Medical Center.
That’s why the state decided not to use the tests, Levine said. Long-term care facilities have plenty of PCR tests through the end of the year. That may change come Jan. 1, he said, but “we haven’t decided that definitively yet, you know, 100%.”
The tests also haven’t been useful at nursing homes. Nine Vermont nursing homes owned by Genesis Healthcare have received the handheld machines from the federal government to process antigen tests, said Dr. Richard Feifer, chief medical officer for Genesis. The company has continued to rely on PCR tests for regular staff and resident testing, but has started using antigen tests for those who are symptomatic, Feifer said in an email.
The new shipment of tests from the feds just isn’t useful, said Dimario, of Birchwood. The staffing is more complicated for the rapid tests, and the facility is responsible for paying for additional antigen tests, she said. “We find [PCR tests] to be the most accurate test and we can get the same-day result,” she said.
Opening in the market
In some cases, the state’s reluctance to embrace the test has opened the door for private companies and clinics to offer the tests. Garnet Transport Medicine, a Colchester company, has started offering antigen tests to travelers arriving at Burlington International Airport, and also contracts with companies to provide regular antigen testing for employees, including Hula and Spot on the Dock in Burlington.
Garnet has run 2,300 antigen tests since June; only four have been false positives, said Garnet CEO Ryan Ferris. That comes down to a 0.17% false positivity rate, he said. “The accuracy of the Covid antigen test is higher than the flu test.”
Some people who travel to Vermont aren’t in-state for a whole week and aren’t quarantining, Ferris said. They don’t qualify for a PCR test while they’re here. “Antigen testing is the only way we can achieve a mass public screening,” he said. He called Vermont “an outlier” among states and public health organizations that accept antigen tests.
The state is “a little insular and misinformed. They’re looking at it in a narrow lens,” he said.
Antibody testing
Another test that hasn’t lived up to the hype? Antibody tests.
Those tests measure whether a person has already had Covid and recovered from the virus. In April and May, antibody test proponents said the test could help those who had recovered from the virus return to work or school without fear of infecting others.
But the tests are often inaccurate, and more recent research has shown that immunity is likely not permanent.
An experiment with antibody tests at Copley Hospital in Morrisville didn’t yield clear results last spring. It was a useful exercise, said chief medical officer Don Dupuis. “We have the backbone of the PCR testing. We think there’s other things that might be useful on top of that.”
Neither the state nor Garnet has considered offering the antibody tests. And while the information may be useful to an individual, it’s not beneficial on a broader scale, Ferris said. “It’s not useful from a public health or a risk management standpoint,” he said. “There’s no action to be taken on it. “
Still, state and hospital officials should keep an open mind, he said. Multiple tests and approaches “give you another arrow in the quiver” in the fight against Covid, he said.
Correction: This story has been updated to include Genesis Healthcare has been using antigen testing for symptomatic patients and staff.
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