Maine Center for Disease Control Director Dr. Nirav Shah on Wednesday used what he described as an epidemiological axiom to explain a surge of COVID-19 cases in several long-term care facilities. “When you look for things, you find them,” Shah said.
Shah was referring to the universal testing the CDC had conducted at the long-term care facilities, which account for roughly 18 percent of confirmed COVID-19 cases in the state and at least six deaths.
But the agency’s aggressive response to hotspots in those congregate settings also highlighted how the state’s limited testing capacity has hamstrug public health officials' attempts to curb the outbreak here.
It also underscores how efforts to ramp up testing capacity could be crucial to Gov. Janet Mills’ future efforts to reopen the Maine economy.
“It’s a significant factor in how and when, and how quickly, we reopen different sectors and different parts of the economy,” Mills said during Wednesday’s daily press briefing. “And it depends on how tests are deployed.”
Shortages And Thwarted Contingencies
The situation in Maine is not unique. States all over the country have struggled with a shortage of test kits, supplies and even the personal protective equipment needed by health care workers to perform tests on suspected COVID-19 patients.
The shortfall has come against the backdrop of President Donald Trump’s thus far unfulfilled promises of expanded testing capacity and ballyhooed private partnerships that have been slow to materialize.
Last month, the limited federal disbursements of critical testing supplies forced the Maine CDC to purchase a new testing platform to help clear a backlog of tests for high-risk individuals that reached more than 1,000 samples.
And the competition for supplies between states has been so fierce that Shah last month declined to name the type of the new platform Maine is using because he feared other public health officials might make a similar move and drain supplies of testing reagents.
The federal government also thwarted Maine’s efforts to boost testing capacity by obtaining a new rapid test from Abbott Labs. After initially promising a shipment of machines and test kits that could have increased the Maine CDC capacity by sixfold, the feds ultimately delivered 5 percent of what it originally promised.
That forced Shah to seek a donation from Martin’s Point Healthcare, which - without request - had received a shipment of the very same test.
Shah said distribution of the rapid tests was largely being determined by the federal government.
When asked about the state’s limited testing capacity on Wednesday, Gov. Mills acknowledged that she was frustrated that testing supplies had been diverted or shorted by the feds.
“I’ve made the case several times to the president and the vice president (Mike Pence) that we also need greater testing capacity because we don’t want to become a hotspot,” she said. “If you give those to us now, or let us acquire those from appropriate sources, we can break the curve before it becomes a surge.”
Testing The Tip Of The Iceberg
With the exception of aggressive testing at nursing homes and long-term care facilities, Maine is largely following federal guidelines on how to prioritize and ration the available tests.
Shah, whose agency has since cleared the high-risk backlog, says the state now has the capacity to conduct about 3,000 COVID-19 tests, which are prioritized and processed in two tiers. Tier 1 is for high-risk individuals, such as those who are hospitalized, health care workers, and first responders; Tier 2 is for people older than 60 and those with underlying health conditions.
Physicians can order tests for patients they believe might have COVID-19, but those are processed at commercial labs rather than at the state lab. There have been widespread reports that commercial labs have been slow to return results.
That’s left an incomplete picture of the outbreak in Maine. While the CDC’s daily updates on confirmed case numbers are publicized, many Mainers suspected of having the disease have not been tested. Some have settled for a clinical diagnosis, which is not reflected in the state's daily case update. Others might have been infected and are unaware of it.
The U.S. CDC also believes up to 20 percent of people who have COVID-19 don’t have symptoms, meaning they can unwittingly spread the virus.
Shah has described the daily COVID-19 case reports as showing just the “tip of the iceberg,” and he’s encouraged Mainers to assume that the virus is widespread in their communities, regardless of whether their respective counties are showing low numbers of confirmed cases.
“Additional testing is needed,” said Shah on Wednesday, adding that widespread testing would allow the state to take a more aggressive posture against the virus because infected people could be quickly quarantined. Additionally, tracing an infected person's contacts would allow state officials to quickly notify people so they can self-isolate.
Such steps, health officials say, are key to containing the virus while researchers develop a vaccine.
And they say it’s also crucial to reopening the economy without preventing a second wave of COVID-19.
Dr. Anthony Fauci, the federal government’s top infectious disease expert, told the Associated Press Tuesday that the U.S. is currently lacking the capacity to test comprehensively and trace infections, both needed to safely relax physical distancing restrictions and reopen the economy.
“We have to have something in place that is efficient and that we can rely on, and we’re not there yet,” Fauci told AP.
How Maine Ranks
According to the Covid Tracking Project, an independent website run by journalists, the Maine CDC’s testing rate ranks in the top quartile of the country, but lags behind New Hampshire, Vermont and Massachusetts.
The quality of its testing data received an “A.”
Yet the state-by-state rankings might not mean much, given that the U.S. as a whole is still experiencing a testing shortage. It trails countries including South Korea and Germany in terms of available testing and combating the outbreak.
While Gov. Mills says ramping up testing is a key factor in any decision to relax business restrictions and physical distancing measures, she also says universal testing seems unrealistic - at least for now.
“We’ll never have enough to test everyone,” she said Wednesday. “And even if we did, how long is a negative test good for? You might be negative now, but what about next week?”
In the absence of widespread testing, Mills says the best way to reopen the economy is “to continue doing what we’re all doing. And that means staying home, staying apart. I think we’re being successful. I really do.”
In the meantime, Mills said Thursday that her top message to President Trump is for him to assure the equal distribution of testing materials.
“That’s pretty much the consensus of all the governors. We all need that,” she said. “It is step one in maintaining public health, and it is step one in just thinking of turning around the economy. Testing is vital.”
Originally published 6:39 a.m. April 17, 2020