As Nevada prepares to continue a gradual reopening process in the coming weeks, testing capacity and results continue to be one of the primary data points used by state leaders to determine just how fast the state will open back up.

In the middle of Nevada’s testing process in Nevada is Public Health Laboratory Director Dr. Mark Pandori, who for months has been key to the state’s effort to track, trace and test for COVID-19.

Months after the start of the pandemic, the role of testing in Nevada’s road back to normalcy is changing.

The Nevada Independent spoke with Pandori on Thursday to discuss testing in skilled nursing facilities, wider testing of asymptomatic people and the reliability of Abbott testing machines.

What role does testing play during or after outbreaks?

With outbreaks happening in nursing homes and clusters of communities, the role of testing is even more crucial. Pandori said an effort is underway to address the situation.

“Our chief medical officer for the state of Nevada wants all of the skilled nursing facilities tested by a week from Friday,” Pandori said.

“So that's step one. There's going to be a massive testing assault on that issue. And so that's a start, because you'll get a baseline. We'll find out how many people are infected patients and staff at these skilled nursing facilities.”

Pandori went on to say that testing “plays a huge role. So the staff and the patients get tested, and when positive cases are identified, number one, if they’re staff, they don't go to work. So they can't infect those vulnerable populations that are captive, so to speak, in a facility.”

“If some of their brethren in the facility are positive, you can quarantine them or isolate them. So it can protect the rest of the patients and the staff. So testing… is the start to it, you really actually can't take any defensive measures, any real solid or consistent ones without testing.”

Asymptomatic testing

The quad counties (Carson, Storey, Lyon and Douglas) have recently been conducting testing in asymptomatic people. After testing 1,798 residents, they found only one positive result. This data initially seemed surprising because there have been reports of clusters of asymptomatic individuals where many more positive results came back.

Pandori explained that in an asymptomatic population, it can be difficult to predict the prevalence of positivity. 

“In cases where we have seen asymptomatic infection, where we have numbers — an example would be the cruise ships, where if you look at the percentage of people that were positive for SARS COVID... 17 percent of those, on one of those cruise ships, were in fact asymptomatic.”

“If you're testing a population for which we knew the virus was circulating, you might find that a decent proportion of infected individuals were asymptomatic,” he said. “But if you're testing an asymptomatic population, where there's no known circulation of the virus, we don't know what to expect.”

How much do tests actually cost?

Testing has been talked about constantly during the pandemic, along with the associated costs. Those are usually talked about in terms of insurance coverage or externalities of the virus, though, such as the economic impact of the shutdown.

An $89 million ELC grant was created by the federal government last week to help with testing. So when it comes down to the nuts and bolts, what is the dollar amount that a single test would cost to conduct? 

“There's the cost of reagents, which are chemicals to run the [PCR] test... you're looking at anywhere from $30 to $40 for those materials. And then we could add labor onto that, but our lab staff are already in place… so we don't charge for that,” said Pandori. “It's not atypical for a molecular test, as we call it, a test that detects DNA, RNA of a virus to cost about a hundred bucks.”

Are Abbott tests/rapid result tests reliable?

Abbott ID-now tests are being deployed all over the country, on the basis that they can return results for coronavirus in about ten or fifteen minutes. A New York University study recently showed that the Abbot test may not be as reliable as it was initially thought to be, though. What should we make of that? 

“I think we have got to just be extremely cautious with running away with the idea that it's a faulty test,” said Pandori. “Virtually in every case that you have point of care testing, there's some sacrifice to sensitivity or specificity. You can very rarely have your cake and eat it too… when you're looking for antigens… viruses and stuff, bacteria, at point of care, the fact that it's a point of care test means that some sacrifice generally is made technologically.”

“Now, having said that, a published paper in the Journal of Clinical Microbiology did show that the sensitivity of that rapid ID, that Abbott test, was about 94 percent out of a lab-based detection system like the one we run here, the PCR that we run here now,” Pandori added. “That's pretty good for a point of care test.”

“In the cases where you're hearing that the test may be faulty, there's some evidence that possibly the tests weren't run correctly, so…. We do not want to panic anyone into thinking that that test is faulty.

“Because number one, there's already data that suggests that it's pretty good. And number two, in order to have achieved an emergency use authorization by the FDA, that actually had to be a case where they submitted a fair amount of data that showed that it did perform well. And so that can't be discounted.”