As More COVID-19 Testing Becomes Available, Will Maine Test Asymptomatic People?

Apr 3, 2020

Like many states, Maine has experienced very limited capacity to test for COVID-19, first because of the number of tests available and later because of a nationwide shortage of a critical element needed to produce a result. Now, with the introduction of a new rapid testing platform, the Maine Center of Disease Control says it is poised to pick up the pace.

And that's raising questions about whether the CDC should begin testing people who don't exhibit COVID-19 symptoms, but who could unwittingly spread the disease.

Maine CDC Director Dr. Nirav Shah has for weeks lamented a testing backlog that has given state health officials just a rough sketch of the coronavirus outbreak, rather than a complete picture.

[What Mainers Need To Know About The Coronavirus]

Those vague outlines have real impacts, not only in understanding the breadth of the outbreak, but also because it's forcing health care workers to burn through critical supplies of personal protective equipment, or PPE, which must be worn in administering COVID-19 test or caring for someone showing symptoms, but who has not received a test result.

But Shah was more optimistic Wednesday because of the imminent rollout of a new rapid test from Abbott Labs in Scarborough that can produce results in minutes.

"The availability, and soon to be the rollout, of rapid testing in Maine is something that … we're excited about because it will help conserve PPE and get people quicker results. And … it's something we hope to expand," he says.

Shah says Maine will soon have 15 new Abbott testing machines and more than 2,400 new tests that can be performed at a doctor's office.

Physicians that already have an Abbott machine, which has been previously used to test for flu and strep throat, could also soon get a boost in testing capacity with the delivery of COVID-19 test cartridges.

Increased testing could give health officials a better sense of an outbreak that, right now, is defined by a steady escalation in confirmed cases — from one case 20 days ago to 344 cases as of Wednesday.

But it could take a tweak in state guidelines determining who gets tested to actually help curb transmission of COVID-19.

"Although we have been urging the public to only get tested if you're symptomatic, we are changing that today," says New Mexico Public Health Commissioner Kathy Kunkel.

On Tuesday, Kunkel announced that the state was expanding its testing regimen to include people who are not showing symptoms of COVID-19, but who are in close contact with someone who is, as well as asymptomatic people in congregate settings such as nursing homes. Kunkel says the change is partially spurred by New Mexico's new testing capacity, which has been bolstered by drive-up sites at hospitals.

But she says there's another reason why the state wants to test asymptomatic people. "And also because there's evidence that early detection of asymptomatic people can help us contain the spread of community transmission of COVID," Kunkel says.

New Mexico's decision to test some asymptomatic residents is a departure from the federal CDC guidelines that Maine health officials are currently following. Those guidelines essentially allow physicians to recommend tests, but results from the Maine CDC are prioritized in two tiers: tier one for high-risk individuals who are already hospitalized, health care workers and people exhibiting symptoms who are in congregate settings such as nursing homes; and a lower tier for people showing symptoms who have an underlying health condition or who are older than age 60.

Shah explains one reason the federal CDC didn't advise testing asymptomatic people: "The hesitancy around testing asymptomatic people … perhaps was driven initially by concerns about the availability of testing."

But there's growing concern that excluding asymptomatic people from testing poses a risk. Federal CDC Director Robert Redfield recently explained why in an interview with public radio station WABE in Atlanta.

"A significant number of individuals that are infected actually remain asymptomatic," he says. "That may be as many as 25 percent. That's important because now you have individuals that may not have any symptoms that can contribute to transmission. And we have learned that, in fact, they do contribute to transmission."

If the federal data are accurate, and up to 25 percent of people infected with COVID-19 are asymptomatic, then those same people could unknowingly spread a disease that's up to three times more contagious than the flu.

Shah says nobody is against testing asymptomatic people, particularly those in congregate settings where they might have come in contact with someone who has tested positive for COVID-19. "But in my own mind there are now equal concerns, or questions, about what the public health response should be for a negative test and whether we re-test, whether we isolate anyways, etcetera," he says.

Shah says his counterparts at the federal CDC are analyzing data that could provide answers to those questions, and potentially alter the testing guidelines for the states that follow it.

In the meantime, he says the state is focused on ramping up testing.

Originally published April 2, 2020 at 6:37 a.m. ET.