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By Anne Blythe

You can get free beer, burgers, cash cards, Krispy Kreme doughnuts, a paid day off from work, shots of booze, tickets to an Asheville Tourists baseball game and other incentives these days for getting a COVID-19 vaccine.

Gov. Roy Cooper even is weighing the possibility of pulling a page from Ohio Gov. Mike DeWine’s pandemic playbook and creating something akin to the Vax-A-Million lottery to push the percentage of vaccinated North Carolinians higher.

Even as the focus shifts to getting vaccines in the arms of the hesitant, there’s still a need for continued testing for COVID-19.

The rate of testing crashed from 73,092 one day in December to 15,466 completed on June 8. That’s way down from the winter peak, shortly after vaccine distribution began, when North Carolina reported more than 10,000 new cases a day several times. 

As headlines highlight the creative array of incentives that states and businesses across the country are offering with a vaccine, it’s rare to see the same kinds of gestures offered for the unvaccinated and the vaccinated with COVID-19 symptoms to continue to get tested. 

In Pitt County, though, residents are taking part in a pandemic experiment as Greenville looks ahead to days when the presence of COVID-19 is not as powerful a menace as it has been for most of this past year. Nonetheless, with only 40 percent of North Carolinians fully vaccinated, the virus remains a threat.

In North Carolina, the number of COVID vaccines being administered per week peaked on April 5 at 684,785 doses, according to the state Department of Health and Human Services vaccine dashboard, 345,983 of which were second doses. Since then, there has been a steady drop to just 120,472 vaccines administered from May 31 to June 6. Only 45,532 were first doses, according to the dashboard

As of June 9, just 54 percent of adults over the age of 18 have received one dose of vaccine, and 50 percent have received both doses. That’s far short of the rate required for “herd immunity.”

How will home testing work?

Pitt County is lagging behind some of the more metropolitan counties such as Wake, Durham and Orange, which have at least 50 percent of their populations fully vaccinated.

Orange County has the highest vaccination rate in the state with 59 percent of the population fully vaccinated as of June 7. By comparison, on that same day, only 37 percent of the Pitt County population was fully vaccinated.

“I think we’re all looking forward to the day when we can kick COVID in the fanny and chase it out of Pitt County,” John Silvernail, Pitt County health director, said May 20 during a Zoom call with reporters shortly after Cooper ended the statewide mask mandate. “The virus is still out there, and there are a lot of people who still are not immune to the virus.”

In late March, the Centers for Disease Control and Prevention and National Institutes of Health launched “Say Yes! COVID Test,” a program that encourages at-home testing even as vaccines are available.

The QuickVue test developed by San Diego-based diagnostic company Quidel will be used throughout Pitt County to allow residents to do at-home COVID testing. The test received emergency use authorization for at-home use with a prescription by the U.S. Food and Drug Administration in March. The Centers for Disease Control and Prevention announced on March 31 that Pitt County would be one of two test sites to receive the test kits for county residents. Image courtesy: Quidel

Pitt County and Chattanooga, Tennessee were the two places selected for distribution of the 2 million tests for 80,000 households.

The program was designed so residents who work outside the home could themselves and others in their household for COVID-19 three times a week. The designers especially encourage the at-home testing for people who work in nursing homes, schools, prisons and other settings where many congregate.

The tests are relatively simple to conduct, program advocates say.

Quidel, a diagnostic health care product company based in San Diego, makes the home kits being used in the Pitt County study. It’s the same company that makes rapid flu tests used by physicians across the country.

The QuickVue COVID test kit comes with enough swabs and solution for someone to conduct 25 tests. Participants are asked to swab both nostrils three times a week and then wait the 10 minutes for results — either a blue strip, which means there was no detection of COVID-19, or pink, which means that person should isolate themselves and check with their health care provider about what to do next.

Depending on how many individuals in each household are being tested, some participants could be testing for several weeks.

Collecting data for a clearer picture

Pitt County and Hamilton County in Tennessee were selected because of high local infection rates during the pandemic, the public availability of accurate COVID-19 tracking data, available infrastructure to support the project and previous relationships with the federal agencies.

During Pitt County’s battle against COVID-19, the public health team quickly realized how the virus could sweep through a household and then back out into the community.

“Many of the clusters that we found were family clusters,” Silvernail said. “If we can put this test into the home, identify the source case in the home sooner, then maybe we can prevent transmission in the home. If we prevent transmission to other family members, then maybe we prevent transmission outside of the home, as well. That was sort of the fundamental thinking behind this study.”

Additionally, Silvernail said his public health team and the Say Yes researchers hope to learn from the program whether “this testing can be effectively done in the home.”

Image courtesy: National Institutes of Health

The participants in the program can volunteer to take part in a research study. Through routine surveys of the participants, researchers at the UNC Center for Health Equity Research and the Duke Clinical Research Institute will gather data and compare COVID-19 infection rates from the home testers to similar populations that are not testing at home for the virus.

Those findings are expected in the coming months, perhaps the fall.

“You give an intervention to a large population and compare that population to other populations,” Silvernail explained. “That’s kind of a simple way of thinking about it, where you’re probably more familiar with, like a randomized control trial, where we have a group who gets drug A and a group who gets a placebo and we look for differences between the two groups. Well here we’re looking for differences between populations where one received an intervention and one didn’t.”

The home medicine cabinet

In Pitt County, at least 23,564 tests have been distributed — by community groups, the health department and through online orders.

In Tennessee, 32,000 kits have been distributed.

The tests aren’t just sitting in a box on a shelf somewhere in Pitt County households.

“We’ve had folks actually test positive and call us, and say, ‘What do we do?’”  Silvernail said. “So we know people are using the tests and they are having an impact, at least on an individual basis.”

It’s possible, public health advocates say, that home COVID testing kits could become a regular household item as we ease out of the pandemic and afterward.

“I think we’re going to see more of these things move into the home for self care,” Silvernail said.  “For COVID, I think this probably does become part of the home medicine cabinet at some point. The question of what are they going to cost varies from manufacturer to manufacturer, but as time goes by, I think that cost would go down and there may be some provision of these kits to at-risk groups through health care systems or public health entities.”

Anne Blythe

Anne Blythe, a reporter in North Carolina for more than three decades, writes about oral health care, children's health and other topics for North Carolina Health News.