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After crises and confusion, health officials are closing the coronavirus testing gap

Assembling coronavirus test kits
Workers assemble coronavirus test kits in a warehouse in Tumwater, Wash. (Washington State Department of Health Photo)

Ten days after Washington Gov. Jay Inslee took the Trump administration to task for failing to send enough supplies for coronavirus test kits, public health officials say the gap is closing — and the day is coming closer when anyone in the state who wants a test will truly be able to get one.

There’s still a gap: In his tweet from May 15, Inslee said the state received only 60,000 of the 580,000 nasal swabs that were promised for the month by the Federal Emergency Management Agency and the Department of Health and Human Services. With a week to go, Washington state officials report receiving 211,800 swabs so far this month.

Charissa Fotinos, deputy chief medical officer for the Washington State Health Care Authority, said supplies are also tight for other items that have to go into every test kit — ranging from the vials of transport media into which the sample swabs are placed, to the little pads that are supposed to absorb any leakage. The items are assembled into kits in a warehouse in Tumwater, Wash., by teams that include state employees as well as National Guard soldiers and volunteers.

“Right now we do have most of those things to keep us for a couple of days of making specimen collection kits, and we’ve ordered more,” Fotinos told GeekWire. “So we’re definitely in a better place than we were two weeks ago. But I can’t tell you that the supply stream will continue as strongly as it is.”

Over the weekend, the Trump administration doubled down on its pledge to provide testing supplies. In a report to Congress obtained by The Washington Post, the Department of Health and Human Services said 100 million nasal swabs would be purchased by the end of the year for distribution to state public health agencies.

But the report also made clear that states will continue to bear primary responsibility for carrying out coronavirus tests, and that the federal government would act merely as the supplier of last resort.

Fotinos and other public health experts say widespread testing is one of the essential elements of a strategy for getting the coronavirus pandemic under control, and for relaxing the social distancing guidelines that have been in place for the past two months.

The other key elements of the strategy are contact tracing and the ability to isolate those who are infected. But testing has to come first. “It is not ethical (or expeditious) to tell an individual ‘they may have been exposed to COVID’ without the ability to get them tested,” epidemiologists who are developing a contact-tracing system called NextTrace said last month in a working paper.

Previously: Coronavirus contact tracing is ramping up, along with online training

During the early stages of the pandemic, the lack of testing capability was severe and contributed to the COVID-19 crisis. Conducting a test required sticking a specialized nasopharyngeal swab far up into the nasal cavity. To streamline the procedure, researchers worked with technical support from the Bill & Melinda Gates Foundation to verify that tests could be done with just as much accuracy using a polyester-based Q-Tip-type swab. The emergency measure won the Food and Drug Administration’s blessing last month.

That procedural change led to some initial confusion this month when Washington public health officials received their first shipment of the shorter swabs from U.S. Cotton. Due to the rush to deliver supplies, the polyester-based swabs arrived packaged in boxes that erroneously described them as cotton swabs for babies.

Fotinos said the confusion has been ironed out. Now the testing labs have the option of using the shorter nasal swabs or the longer nasopharyngeal swabs, depending on what they’re comfortable with.

Weekly levels of testing have been tracking upward ever so slowly, in Washington state and across the nation. During the last week of April, the tests done by more than 25 labs in the state amounted to an average of 4,962 tests per day. For the week of May 15-22, that daily average was at 5,040 — with raw daily numbers that have ranged from a little more than 3,000 to a little less than 8,000.

The state’s goal is to do 20,000 to 25,000 diagnostic tests per day. That would help identify people who are carrying the virus but don’t have symptoms, which will be necessary once the state’s contact-tracing system fully kicks in.

About 316,000 COVID-19 tests have been conducted in Washington state to date, which represents about 4.2% of the state population, according to data compiled by Johns Hopkins University. That compares to 1.7 million tests conducted in hard-hit New York state, accounting for about 8.7% of that state’s population.

“In terms of feeling like we have the ability to respond to people with symptoms, that is feeling better,” Fotinos said. “I think there are still glitches for people who might have symptoms getting a test, in part because of the shortages to date. Not all provider offices have been able to test.”

Even though the supply situation is better than it was a couple of weeks ago, the distribution situation is still uneven. “We have to make sure that we direct these new testing supplies to all the places where people would normally go to get tested. That’s a piece we need to work on,” Fotinos said.

Generally speaking, the process of getting a test starts with a conversation with your regular health care provider. But that may not be an easy option for people who don’t have an existing relationship with a health care provider, and especially for the most vulnerable populations.

Charissa Fotinos
Charissa Fotinos is deputy chief medical officer for the Washington State Health Care Authority. (WSHCA Photo)

Last week, public health officials for Seattle and King County laid out a list of low-cost and no-cost testing locations for those who can’t get access to a test through their regular health care provider. Most of the sites are non-profit community health centers, but the list also includes T-Mobile Park in Seattle as well as the Tacoma Dome.

As more tests become available, the messaging to health care providers and the general public is changing.

“Before, we said, ‘Unless you’re really sick, just stay home and take care of yourself. Don’t go out, and you don’t need a test,'” Fotinos said. “But now, we want to identify people who are infected so we can keep them from spreading it to other people unknowingly. … We want to find this, so we can contain it.”

We’re all likely to hear more about coronavirus testing in the weeks to come — not only because the test kits are becoming more widely available, but also because of more widespread contact tracing and the advent of serological tests that can detect more reliably who’s recovered from an infection.

“This is a marathon, and it’s going to require patience and grace,” Fotinos said. “You know, we’re all in this together. And so I think we need a little grace, trying to understand that we don’t have all the answers, but we want to be as informative and thoughtful as we can moving forward.”

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