SALT LAKE CITY — Utah government officials and health experts are using telehealth triage, drive-thru testing and greater lab capability to detect COVID-19 and slow its spread.
But health experts say there are other barriers to testing beyond just getting the test itself. Supply chains are sluggish for everything from chemicals used to run the test to the protective gear health workers wear. Even the test is in too-short supply.
It’s a challenge playing out across the nation.
“It’s well-documented that getting testing supplies from the federal government has been a slow process,” said Utah Lt. Gov. Spencer Cox, chairman of the Utah Coronavirus Task Force, during a press conference Thursday.
As of 10:40 a.m. Thursday in Utah, 136 patients had been tested by the state public health lab, Cox said, with 24 more tests underway. An additional 18 already had been processed by the Centers for Disease Control and Prevention before the state lab was certified.
Private labs have also started testing. ARUP Laboratories at the University of Utah had tested 100 people Wednesday and will increase its capability to about 500 patients a day in coming days. Intermountain Healthcare’s laboratory services are in the process of being certified and will likely soon begin testing. So testing capability is growing exponentially.
Once everyone’s on line, they’ll be able to ramp up and do “far more” surveillance testing to try to determine if community spread is happening and to what extent, Cox said.
So far, Utah does not have a case of community spread. Other states like Washington, California and New York have reported person-to-person spread in the community.
“Admittedly, we wish we were testing more,” Cox said, adding that would happen in coming days.
But having enough tests isn’t the only challenge. Clinics and labs need staff and supplies to get the job done. And that has also been challenging.
Testing is still restricted to those who have traveled to areas with an outbreak or who are in close contact with those who did such travel and those who have symptoms of the illness: fever, cough and shortness of breath. A doctor has to order the test.
Besides making sure the right people get tested, it’s very important to make sure the health care providers who must take care of the sick are protected from the virus, Amanda Smith, an epidemiologist with the Utah Department of Health and task force member, told the Deseret News.
She said they’re trying to prolong the supplies they have for testing while reducing risk to staff, patients and the public at large.
A number of states, including Utah, have begun to use drive-thru testing. University of Utah Health has three sites already and another will be ready in a matter of days. Intermountain Healthcare will do drive-thru testing in Salt Lake and at its Cottonwood clinic soon. Cox said Utah’s also working with the Utah Hospital Association and others to look at mobile testing places in rural Utah.
Mobile testing exposes far fewer people to someone who might have the respiratory illness. In a drive-thru, just one individual swabs the nose and throat of someone who drives in with a doctor referral and an appointment. It avoids the possibility of infecting people in a waiting room.
Colorado, Illinois and Washington are among states with some drive-thru testing, and new sites are being added nationwide.
But a shortage of supplies is problematic to testing capacity, Smith said.
People concerned about exposure to the respiratory illness contributes to shortages as they have snatched up large quantities of items like hand sanitizer, masks that aren’t particularly helpful to them, gloves and other equipment. Meanwhile, hospitals and health care providers around the country have all been ordering the same kinds of supplies, used not just with COVID-19, but other illnesses including influenza, which is also going strong.
The person doing the swab collection is supposed to be wearing a gown, gloves, a respirator and eye protection. The N95 respirators are in short supply, so some are substituting face shields and googles. They change gowns and gloves after each test and carefully wipe down or change the face gear.
Labs around the country that run the test also have another challenge: They are trying to ensure a consistent supply chain for the chemicals, called reagents, that are vital to running the tests.
Dr. Robert Redfield, CDC director, told Politico that keeping adequate access to those chemicals is vital to testing. “The availability of those reagents is obviously being looked at,” Redfield said. “I’m confident of the actual test that we have, but as people begin to operationalize the test, they realize there’s other things they need to do the test.”
And then there are the tests themselves. The Boston Globe reported Thursday that Massachusetts is among the states with a “severe shortage” of tests, even as the number of cases of COVID-19 keeps growing. “State health officials have kept strict limits on who can be tested for the coronavirus, forcing physicians to turn patients away who they believe should be tested, according to doctors and patients,” the article said.
While the public clamors for more testing, those directly involved urge more caution and wise use of resources.
“That puts a tremendous strain on our capacity to be able to test the ones we need to test first,” said Dr. Julio C. Delgado, chief medical officer and director of laboratories for ARUP. “Some do not require immediate testing.”
Health officials say that includes people who can manage mild symptoms themselves and avoid spreading illness by social distancing and good hygiene.
How testing should go
Experts say 80% of those who get symptoms will have mild symptoms, 15% will need more attention and 5% will likely need hospitalization and extraordinary health care measures. By slowing the spread of the illness through the community, which is now deemed all but inevitable, officials believe they can prevent overwhelming the health care system.
Of great concern is saving those who are most vulnerable, including those over 60 and people with compromised immune systems or chronic conditions like heart disease. Cox said the mortality rate decreases if people get the best health care possible — and the one thing that could prevent that is “if we overwhelm the system.” The only way not to do that is to slow down the velocity with which this disease spreads.
An individual in Utah who was diagnosed with the COVID-19 did things exactly right, providing a look at how testing should go: The individual contacted a physician through an online app and was screened. Because of a travel history and symptoms that made COVID-19 testing a good idea, that person was directed to a drive-thru location, where he or she was swabbed and then sent home to wait for the results in self-quarantine.
Testing isn’t available without a doctor’s order and doctors are careful to screen for likelihood that testing is needed, health officials said.
A presumptive positive test is confirmed elsewhere. For example, ARUP is a national reference laboratory, so they serve not just the University of Utah health care system, but other clients nationwide. Their presumptive positive results will be confirmed by the state public health lab. The state lab sends samples to CDC for confirmation.
People who have possible symptoms — which are nearly indistinguishable from cold and flu — don’t all need testing. And health officials say over-testing is as bad as under-testing because it uses resources that are in short supply for those who need it.
With triage, “those with serious symptoms will absolutely get tested,” Cox promised. But those who don’t need to go to a doctor don’t need to be tested. “Stay home. Use the hygiene we talked about — which is good if you have a common cold or flu, too.”