Earlier this spring, islander Jim Bristow grew frustrated with the lack of coronavirus testing options for his wife, who was sick with a bad cough, and he set about addressing the scarcity of testing on the island. Now, thanks to his efforts and several other people in Vashon’s Medical Reserve Corps, COVID-19 testing for symptomatic island residents and workers is available weekday afternoons at Mukai Farm & Garden.

The Vashon COVID-19 Testing Project launched on April 7 and tested approximately 30 people in its first two weeks. So far there have been no positive tests, and the number of confirmed COVID-19 cases among island residents was still at four as of Monday. Testing at the Mukai site is expected to continue at least throughout the summer, as the state loosens its restrictions and additional people contract the illness. Plans are in the works not only to continue testing, but also to conduct contact tracing when called for, and provide practical support to people who test positive as well as those in their households.

So far, patients have been appreciative of this local effort, with many sending thank you notes after their tests.

“They are glad to have us here, and we are glad to be here, and we are here for the long haul,” Bristow said.

Medical Reserve Corps member Dr. Zach Miller, who had a long career as an infectious disease specialist with Group Health Cooperative, has also been involved with the local testing effort. He cautioned islanders not to read too much into Vashon’s low number of confirmed cases, as the extent of illness is not fully known.

“I think it is very, very hard to make any assumptions about coronavirus from our testing in terms of how widespread it might really be. It has been hard to know that in any community at any given time,” Miller said.

He pointed to hospitalizations and deaths as better markers than testing for the amount of illness circulating, but those figures are not available for the island. He also noted that it is possible for any community to have many people with mild to moderate respiratory symptoms who would not have access to testing or have not sought to be tested, so the disease could easily be present but undetected.

“I would not tell anybody that they should be thinking there is not COVID on Vashon Island and that they should feel fine about not taking precautions,” he said. “You still have to be concerned that it is out there and hope that it will diminish … along with its decrease in the greater Seattle area because of the measures people are taking.”

Self-administered testing is slightly less reliable than the nasopharyngeal swab, with data showing the self-tests are about 5% less likely to detect the virus, Miller noted. He cautioned that no test is perfect and stressed that no matter the test, those who are given a negative result could still have the illness in a small percentage of instances.

Last week, Bristow — retired from his career as a pediatric cardiologist at the University of California San Francisco and as the deputy director at the Joint Genome Institute at Lawrence Berkeley National Laboratory — recounted how this homegrown testing project came to be.

At the same time Bristow’s wife was sick and he looked in vain for a test for her, Dr. Anthony Fauci told Congress that public health testing efforts were failing. Initially, Bristow, a staunch believer in public health, was angry, but then changed course.

“I realized that it was time for me to stop complaining and start working,” he said. “I started calling around to figure out how to make something happen.”

Those calls eventually led him to Rick Wallace, who has long been instrumental in the island’s emergency and disaster planning/response efforts through VashonBePrepared. Wallace connected him with the leaders of the island’s Medical Reserve Corps, part of the VashonBePrepared coalition. That connection was essential in identifying and overcoming obstacles and creating the path forward.

“Their participation was crucial in helping turn my enthusiasm into something that could be done here,” Bristow said.

Miller identified obstacles early on: Bristow’s original plan called for volunteers to conduct tests by administering the nasopharyngeal swabbing themselves. This method, which collects secretions from the back of the nose and throat, was the only one approved at the time. Using it meant they would need abundant personal protective equipment, which was not available. It also would have put the local volunteers at risk of contracting the illness — a particular concern because many of them are over 60. With those issues in mind, Miller suggested self-testing as the best option. That method was not FDA-approved at the time, a complication that made for additional obstacles, including that Public Health- Seattle & King County would not agree to its use.

Soon after the project appeared that it might not move forward, the FDA approved self-collected swabs for COVID-19 testing, based on data from Washington state — and that made all the difference.

“All of a sudden, the pieces fell into place, and we were ready to go,” Bristow said.

After that, the rest of the details were about logistics. Public Health-Seattle & King County and the University of Washington did not have enough tests to supply the effort. Ultimately, LabCorps, a national clinical laboratory network that routinely serves the island, provided the tests.

The testing steering committee, which also includes island physicians Ina Opplinger and Bonny and Clayton Olney along with operational and logistical support from Allen de Steiguer and Shawn Boeser, determined just how the Mukai site would work, with patients remaining in their cars throughout the testing process. The plan for traffic flow came about in true Vashon style, Bristow noted. In a discussion about how to proceed, Opplinger had shared that the fruit club had recently distributed mason bees to its members, and it had worked perfectly.

“So pretty much our model is based on the fruit club mason bee distribution model,” Bristow said with a laugh, noting the group made some adjustments after a dry run. “It’s spectacular.”

Now each day, between 3 and 4 p.m. one person at a time visits the site by appointment, assisted by volunteers from the Community Emergency Response Team (CERT), also part of the VashonBePrepared network. CERT Manager Jan Milligan says it is a good partnership — and one that will likely extend into the future, with CERT providing support for other Medical Reserve Corps actions. Currently, 15 of CERT’s 40 active volunteers have participated in the testing effort. That group, too, is prepared to be involved for the duration.

“There are lots of really great people in CERT. This could go on and on,” Milligan said.

For his part, Bristow believes this model for testing could work well for many other rural and tribal communities. In fact, Bristow said he and the Medical Reserve Corps have been working with two tribes already and hope to expand the model well beyond that. He noted that many rural communities share much in common with Vashon: Acute care capabilities are limited; it may take a long time to get to an acute care facility; personal protective equipment is difficult to come by, and medical volunteers may be limited as well. But none of that gets in the way of testing the way it is being done at the Mukai site.

“We realized what we have been able to do was really a very fortunate byproduct of the incredibly talented group of people on the island,” Bristow said, acknowledging the many people who worked to make his initial plan a reality in three short weeks. “I mean no disrespect for rural America. We just have a remarkable collection of people here.”

Island residents and workers are eligible for tests if they have symptoms, including cough, shortness of breath and fever. A doctor’s referral is required. For people without a primary care physician, MRC members can provide the needed testing referral, but they do not provide follow-up care. The cost of the test is $50 and will be billed to insurance. For those without insurance or if their claim is denied, VashonBePrepared will cover the cost. For more information, call the testing project at 844-469-4554, or see testing.vashonbeprepared.org.

Neighborcare clinic offers coronavirus testing

In addition to the volunteer-run clinic at Mukai Farm & Garden, coronavirus testing has been underway for two weeks at the Neighborcare clinic at the Sunrise Ridge facility.

Medical Director Dr. Jessica Wesch said the clinic has its COVID-19 testing and respiratory evaluation tents up and running. When patients call with respiratory concerns or COVID-19 symptoms, Neighborcare providers refer them to the tent for care and testing if needed. The clinic has seen and evaluated two to eight patients a day and has conducted 32 COVID-19 tests on the island. Providers there have seen established patients as well as some who are new and want care on the island, Wesch said. The tents are available Monday, Tuesday, Thursday and Friday.

Wesch urged caution regarding the virus on the island.

“While the positive test numbers and the patients with clinical symptoms of COVID-19 are fairly low, we know COVID-19 is in our community,” she said in a recent email. She added that as the pandemic precautions are lifted, the clinic may see the demand for testing and respiratory care quickly change and will be monitoring that need closely. Neighborcare providers are providing phone visits and some limited office visits for conditions that cannot be assessed or treated by phone.

“We have been surprised by how much we can do over the phone,” Wesch said. “We encourage patients to call for care if they need it — even issues not related to potential COVID-19.”

— Susan Riemer is a volunteer with VashonBePrepared’s Emergency Operations Center and a former editor of The Beachcomber.