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The Pandemic

how COVID-19 pod testing could save the holidays

This is a milestone birthday year for my wife. Unfortunately, it’s also a pandemic year for the planet.

We were planning a scaled-down celebration to be held outdoors only with immediate family, masks and distancing required.

But with COVID-19 surging dangerously and, it seems, uncontrollably across the country, we wondered if we should even do that.

So I asked an expert – Dr. Manoj Jain, the epidemiologist and infectious disease expert who has been advising the city of Memphis on its response to COVID-19.

He recommended “pod testing” – the latest development in regular, lab-verified screening for the coronavirus.

A COVID-19 pod testing kit contains 20 individually wrapped swabs, a vial filled with a saline solution, and a biohazard bag. It also includes a set of instructions in English and Spanish, and a form to keep track of everyone who gets tested. (Submitted)
A COVID-19 pod testing kit contains 20 individually wrapped swabs, a vial filled with a saline solution, and a biohazard bag. It also includes a set of instructions in English and Spanish, and a form to keep track of everyone who gets tested. (Submitted)

opens in a new windowPoplar Healthcare is assembling thousands of COVID-19 pod testing kits for the holiday season. Each pod testing kit will allow individuals to test up to 20 family members at one time in the comfort and safety of their own homes at a cost of $5 per person.

The local COVID-19 task force is working on a plan to make pod, pooled and individual testing more widely available for the holidays starting this weekend. Details are expected to be announced Thursday, Nov. 19.

Jain believes pod testing – while not a guarantee of safety – is a safe and effective way to help families get through the holidays without igniting more COVID-19 wildfires.

“Hand washing, social distancing, and masking work, and we need to continue to do all of those things through the holidays,” Jain said. “But distancing and masking are going to be more difficult in family settings. That’s where pod testing comes in.”

Now that  opens in a new windowone percent of the U.S. population is currently infected with the coronavirus, could pod testing save the holidays?

Jain thinks so. So does Jim Sweeney, CEO of Poplar Healthcare, one of the first labs to offer pod testing that is certified by federal CLIA guidelines and by the College of American Pathologists.

Earlier this month, more than two dozen restaurants agreed to participate in pod testing via the city’s Test to Protect program.

“We know this works,” Sweeney said. “The challenge isn’t running the tests. We have the kits and the lab capacity. The challenge is logistical, setting up a system for picking the kits up and dropping them off, and paying for them.”

Families can take the kits home and collect their own nasal samples in a single vial. Then they can return the kits to the lab for analysis, and get the results within 24 hours.

The swabbing must be overseen by a health professional who will be available on a quick zoom call.

A negative result clears all of the samples in the same tube.

If a combined tube tests positive, individuals from that pool should be tested again as soon as possible and their samples should be analyzed separately.

Dr. Jeff Warren, a Memphis City Council member and COVID-19 task force member, used two kits last weekend – one for his extended family and another for his neighbors.

“We tested 37 people in an hour and a half,” Warren said. “Both kits came back negative. It was easy. It was safe. It works. We’re hoping this can be like an early-warning system for the holidays.”

Hope for the holidays

Pod testing is a form of “ opens in a new windowpooled testing,” which has been available to city employees since June.

In pooling, trained lab technicians take samples from individuals, then take those samples to the lab and pool them for analysis. As many as 20 individual samples can be tested in a single tube.

The screening process saves time, money and materials. A typical lab-verified COVID-19 test costs more than $100. Pooled and pod testing reduce the cost to about $5 per person.

Nearly three dozen public charter and private schools have offered pooled testing to their staff and students since August.

My wife works for a charter school that invited students back to class in August. She gets tested every eight days.

Testing is the only way to know whether someone is potentially contagious and needs to be isolated. At least one in five people who have COVID-19 do not show symptoms but can be contagious.

“We assume that every COVID-positive person, on average, spreads the virus to at least one or two other people,” Jain said. “But asymptomatic people are spreading it even more because no one knows they have it.”

Screening asymptomatic people isn’t a panacea.

Dr. Lisa Piercey
Dr. Lisa Piercey

“Your test is only good for today,” Dr. Lisa Piercey, state health commissioner, noted in Tuesday’s press briefing in Nashville. “It doesn’t mean you will be negative tomorrow or next week.”

Still, Piercey and other public health officials are encouraging people to get tested before they travel or gather for the holidays.

Pooling and pod testing allow public health officials to cast a wider net to catch more people who are infected with the coronavirus.

That can dramatically reduce the transmission of the virus.

Earlier this month, the regular pooled testing program found eight students at a local private school who tested positive for the virus.

They were immediately isolated from the rest of their classmates and sent home to quarantine.

“They were barely symptomatic,” Jain said. “Can you imagine what might have happened if they hadn’t been tested and had remained in the school? We likely would have had a serious outbreak.”

About a week ago, Jain asked New York University to estimate the potential impact of pod testing in Shelby County.

With no testing, local COVID-19 cases would continue to rise until February. If 10,000 people a day were tested, cases would continue to rise until January.

If 20,000 people a day were tested, new cases would begin to decline by Dec. 1.

Sweeney says Poplar Healthcare has the capacity to test 2,000 pods a day, or up to 40,000 people a day.

American Esoteric Laboratories (AEL) in Memphis also has approval, but has decided not to take part in pod testing. However, AEL has agreed to run follow-ups for pods that test positive.

“A month ago, when the latest surge began, I had no hope for the holidays,” Jain said. “Now I’m excited about the possibilities. Pod testing can’t eliminate the risks, but it can greatly reduce them.”

The coronavirus seems to thrive on holidays.

COVID-19 cases and related hospitalizations surged locally and nationally after Memorial Day, the Fourth of July, Labor Day, and Halloween.

Public health officials are even more concerned about Thanksgiving, and other small, indoor family gatherings during the holidays.

Small social gatherings, including families, have become the primary superspreaders of the virus. The odds of getting infected with the virus are 20 times higher indoors.

“We’re going into a precarious situation,” Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases,  opens in a new windowsaid late last month. “Cold weather is forcing people indoors, cases are going up in all age groups, and holidays are likely to bring people together in groups.”

Fauci is recommending that families gathering for Thanksgiving wear masks, unless they have been quarantined or tested for the coronavirus.

“There is community spread right now,” he said. “(People) don’t have symptoms, they don’t know they are infected. So, we need to pull more testing into the community.”

Local public health officials agree, as they noted in a recent health guidance.

“We want everyone to get tested as we go into the holidays, especially before you travel or before you bring people into your home,” said Shelby County Health Department director Alisa Haushalter (shown during a press conference on Monday, Nov. 9). (Mark Weber/Daily Memphian)
“We want everyone to get tested as we go into the holidays, especially before you travel or before you bring people into your home,” said Shelby County Health Department director Alisa Haushalter (shown during a press conference on Monday, Nov. 9). (Mark Weber/Daily Memphian)

COVID-19 assurance testing “helps to contain transmission and reduce uncontrolled outbreaks through early detection of cases in select settings,” wrote Dr. Alisa Haushalter, director of the Shelby County Health Department, Dr. Bruce Randolph, county public health officer, Dr. Jon McCullers of the University of Tennessee Health Science Center, and Jain.

“We want everyone to get tested,” Haushalter said at Tuesday’s regular briefing, “as we go into the holidays, especially before you travel or before you bring people into your home.”

12 swabs, 1 vial 

Last Wednesday, I drove to Poplar Healthcare and picked up a pod testing kit.

The cardboard box contains 20 individually wrapped swabs, a single vial filled with a saline solution, and a biohazard bag.

It also includes a set of instructions in English and Spanish, and a form to keep track of everyone who gets tested.

We all met the requirements for pod testing:

  • None of us were experiencing COVID-19 symptoms.
  • None of us had been in close contact with someone who tested positive for COVID-19.
  • Some of us had been tested before, but none of us had ever tested positive.

Before we began the test, we watched a brief video in which Jain demonstrates how to self-swab, in five easy steps.

  1. Sanitize your hands.
  2. Stand the vial upright in a cup and open the vial.
  3. Swirl the swab for 15 seconds a half-inch inside each nostril.
  4. Put the swab inside the vial and put the cap back on the vial. Everyone’s individual swab goes into the same vial.
  5. Sanitize your hands again.

The pod testing instructions include a link (and a QR code) to a Zoom call that will allow a medical professional to observe each swab. The Zoom call will be available every day from 8 a.m. to 8 p.m.

“It’s a precaution, but a smart one,” Warren said. “And it’s not difficult. Just takes a phone call.”

The self-swabbing was the easiest part. A few of my family members whose noses are more sensitive teared up, but the swabbing didn’t hurt any of us.

The hardest part was working out the logistics. Each test takes only about 30 seconds, but it took more than four hours Thursday afternoon to test a dozen family members in four different locations.

Once everyone had been tested, I put the vial inside the biohazard bag. I signed the lab form and slid it into a pocket on the side of the bag.

I put the bag back in the box and returned it to the lab late Thursday afternoon.

We got the results Friday morning.

Negative.

That evening, a dozen family members got together to celebrate my wife’s birthday. We still wore masks. We still kept our distance. We stayed outside.

We know there’s still a risk of infection where any two or more are gathered during this pandemic. But we felt a lot more at ease knowing we had taken a lab-verified extra step to mitigate the risk.

This story first appeared at dailymemphian.com under an exclusive use agreement with The Institute. Photos reprinted with permission of The Daily Memphian.

David Waters
Written By

David Waters is Distinguished Journalist in Residence and assistant director of the Institute for Public Service Reporting at the University of Memphis.

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