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A “probable” case of COVID-19 infection reported to the Perry County Health Department this week raised a number of questions for residents and local health officials.
The case was identified through the use of an antibody test to detect previous infection, rather than the now common nasopharyngeal swab to detect an active infection, and was the first of its kind to be reported in the county, leaving health officials initially uncertain what to do with the information.
“When we contacted the Missouri Department of Health and Senior Services regarding this particular test result, one of the things we learned when we were briefed was that the state of Missouri is not currently adding these cases into county and state totals,” said Perry County Health Department director Sylvia Forester. “As such, our health department will be mirroring them and not adding it to our total. We will keep a separate total of probable cases. Although this is not included in the case count, it is still a mandated reportable result — meaning that any hospital who runs a positive antibody test on a Perry County citizen must report those results to the Perry County Health Department.”
Forester said that after her department completed paperwork and reported the result to the state, they would contact the individual and discuss any symptoms they might have had and a timeline of those symptoms.
“Based off that information, a contact investigation may or may not take place,” Forester said.
According to Forester, antibody testing is used to determine if a person has been exposed to a virus and has gone through the process of developing antibodies to a previous exposure.
“It can be used to determine the prevalence — or amount of the disease — in a community,” Forester said.
Unfortunately, at this early stage, the antibody tests in use for COVID-19 may not be that accurate.
“While some of the tests claim high percentages of sensitivity and specificity, many only received emergency approval and have not undergone the full scrutiny of the [U.S. Food and Drug Administration],” Forester said. “This means there could still be false negatives and false positives potentially associated with these tests. Furthermore, some of these tests may show a positive result based off antibodies the body produced in response to other coronaviruses and not the one that causes COVID-19.”
Still, she said, antibody testing still serves a purpose.
“There is a lot we still do not know about COVID-19 and the antibodies produced by the body after infection or the protection it may or may not give against future infection or the length of any protection those antibodies may provide,” Forester said. “Right now, antibody testing is being used as a decision-making tool and an assessment of disease prevalence in a community.”
All of those reasons explain why the case is identified as “probable,” she said.
“Definitions for a confirmed or probable case of COVID-19 are set by the [Centers for Disease Control and Prevention] and other professional organizations who work together to build what is called a case definition,” Forester said. “A confirmed case must have a confirmed laboratory diagnostic test. Since an antibody test is not considered a diagnostic tool, there are several other factors that have to be taken into consideration and other criteria that has to be met in order to meet the probable case definition. We did verify this was the best and accurate description for the patient with the Missouri Department of Health and Senior Services.”
Forester said that although the State and the Health Department will not be including these cases in the total count, as more antibody tests are conducted, her department still plans to present this information to the public “in the spirit of transparency regarding this pandemic.”
“Obviously, this is a process that is still being worked out and a new learning curve for everyone, not just us but the public as well,” Forester said. “We appreciate everyone’s patience and support while we work on the best way to accurately report new data and information to everyone.”
As of Tuesday afternoon, the Perry County Health Department reported a total of 47 confirmed cases of COVID-19 infection, along with 45 recoveries. Statewide, there have been a total of 11,080 cases, with 616 deaths reported.
Perry County’s most recent confirmed case was reported on Monday, and was the first since May 12. Before that, the last reported case was on May 8.
The reduction in active cases, Forester said, is good news for the county and will also have a positive impact on her department, which plans to resume modified operations.
“We started to open our doors to the public so that we can offer our needed traditional services,” Forester said, adding that there will be a few changes for the time being. “We are asking that the public make an appointment for our nursing services. While this is new, your appointment will still be very quick with little to no wait time. I think that’s one of the things people enjoy about getting their vaccines, tests, and other services with us, is the efficiency.”
Forester said the only service that will not require an appointment is obtaining copies of birth and death certificates, although the department is asking individuals to visit the health department website at www.perrycountyhealth.com and print and complete a vital records request forms before visiting the health department if at all possible.
“Clients can expect to be screened for symptoms upon arrival and will be asked to wear a protective face covering,” Forester said. “If an individual does not have one, the health department has cloth masks that can be borrowed and then returned. These are laundered every evening. Our staff that will be in close contact with clients will also be wearing protective face coverings.
Forester said resuming normal services while abiding by public health guidelines will be a bit of a challenge.
“It will definitely be a balancing act,” Forester said. “If we see more positives, we may have to limit some of our appointments to allow staff time to respond, but I believe we have a good plan in place to be able to meet all of the public’s needs at this time.
“We have such a great team, and they have been so supportive, flexible, and hard working during this unprecedented time. A lot has been asked from them and they have stepped up to the challenge.”
