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Testing Bottlenecks Keep States From Tamping Down Virus (1)

July 11, 2020, 1:45 AM

Testing plans released by the U.S. Department of Health and Human Services on Friday provide a window into efforts by states now seeing surging Covid-19 numbers to build up their infrastructure -- and show shortcomings that may well be playing out now as test-takers complain of long lines and delayed results.

The state plans, which were due May 30 and underwent federal review in June, highlight the ongoing supply-chain challenges that labs face in procuring key supplies like chemicals, rapid diagnostics and protective equipment for personnel. They also show the $11 billion in funding distributed in May may not be enough to solve these persistent problems.

Covid cases are surging across the U.S. and testing capacity has again been a key bottleneck. Mass testing is essential to identify positive patients so they can be isolated and their contacts notified of their exposure risk. Delayed results set back those efforts, allowing the virus to continue on a path of explosive spread.

The testing woes of several states now shouldering some of the heaviest caseloads demonstrate that while screening has improved since the virus’s early days, U.S. capacity remains severely strained. This week, the federal government set up eight emergency testing facilities in Texas, Florida and Louisiana to bolster their capabilities.

States set their own testing targets in partnership with the federal government, and in their submissions were required to detail the number of tests needed, estimates of laboratory and testing capacity and how they planned to use the resources.

The “supply chain has continued to increase with time,” HHS spokeswoman Mia Heck said. States could spend the funds as they saw fit, while HHS and the Federal Emergency Management Agency covered the costs of requested supplies, she said.

The Trump administration “has provided billions in resources dedicated to Covid testing, as well as has corrected an almost non-existent supply chain,” Heck said in an emailed statement.

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The $11 billion was distributed according to a formula that reflected the burden of Covid-19 as well as population-based estimates. But the brunt of the pandemic has shifted significantly since then, from the northeast to Sun Belt states, raising questions about whether additional funding may be required.

“It can’t possibly match need,” said Howard Forman, who directs the Yale School of Public Health’s health-care management program. “They were using a formula that made a lot of sense then and makes no sense now.”

In Florida, which is witnessing record deaths and hospitalizations, the health department planned to invest in more diagnostic testing equipment, but at the time of the filing was still awaiting delivery of many items. The state reported a 4.9% increase in cases on Friday, while its test positivity rate dropped to 12.8%, from 18.4%.

A positivity rate above 10% implies that not enough testing is being done to keep pace with the rising number of new cases.

Back to March

Forman said that some states, like Florida, are succeeding in expanding their testing capacity, while others, like Arizona, aren’t catching up as much. Part of the challenge, he said, is that most states have been outsourcing their tests to commercial labs, which are now reporting extended wait times for results for many patients.

“They’ve relied tremendously on the private sector to be able to deliver testing capacity. And up until recently that seemed to be a successful strategy,” he said. “We’re now almost to where we were in March, lacking the capacity to do the tests we naturally should want to do.”

Texas described how testing machinery can make a major difference for a lab. One new platform in Laredo, for instance, “will increase testing capacity there by 50%,” while new equipment for labs in Lubbock and Tyler “will increase testing throughput from 100 per day to 650 per day and from 50 per day to 500 per day, respectively,” according to the state’s filing.

Key testing chemicals called reagents had become easier to access, but what’s available doesn’t always work on the equipment that labs have, Texas said in its HHS submission.

Virus hospitalizations in Texas topped 10,000 Friday, the first time the state has reached that benchmark. The state has added close to 10,000 new infections for each of the last four days, and deaths have begun to spike, with another 98 fatalities reported Friday.

CVS Partnership

To bolster capacity, Governor Greg Abbott announced Friday a partnership with a CVS Health Corp. unit and pharmacy-services provider Omnicare Inc. to screen patients and staff at assisted-living facilities and nursing homes throughout the state.

“These test sites help enable a goal of processing up to 100,000 tests in the first month alone,” Abbott said in a release.

In Arizona, which reported 4,221 new Covid-19 cases Friday, the surge has filled hospital intensive-care units. But it said that even as of late May, facilities didn’t have enough rapid tests for patients. That was hurting their ability to triage patients and maximize protective equipment for providers.

Arizona has been working with the federal government to use machinery already in labs more effectively, including by getting “test kits which are in short supply and backordered,” according to the state’s plan.

It also said the current supply of materials, including swabs, may be insufficient for the fall and winter, when Covid-19 collides with flu season. The state health department was looking at ways to manufacture swabs and other types of materials.

‘Through the Roof’

Governor Doug Ducey said Thursday that Arizona would seek to increase testing after reports that it was taking a week to get back results. The positivity rate has hit 11.7%, exceeding the threshold that suggests more screening is needed to catch positive cases. The state will partner with Arizona State University to offer free saliva-based testing in under-served communities. And it’ll work with Sonora Quest Laboratories and PerkinElmer Inc. to increase testing to 35,000 daily tests by the end of July and 65,000 by the end of August.

“There were weeks in May and June where we didn’t hit capacity of testing because we didn’t have demand,” Ducey said. “Today, demand is through the roof.”

In hard-hit California, which reported its second deadliest day Friday, with 140 deaths and cases topping 300,000, the state said in its HHS filing that it gathers information across public-health, academic and commercial sectors, then “actively orchestrates how test processing capacity is used across testing needs” and different settings like rural areas or nursing homes, and contact tracing.

To set up collection sites, process tests through partner labs and report results, California is working with partners like UnitedHealth Group’s OptumServe and Verily, Alphabet Inc.’s life-sciences unit.

No National Strategy

The most-populous state also described efforts to get and distribute supplies, including alternative types like 3D printed swabs, to cover testing needs after reopening. California has a group tracking the supplies that are available and modeling future needs, it said. The plan outlines efforts to purchase additional swabs, preservatives and chemicals, but says that no additional staff are needed to expand testing, and virtually no new equipment.

Though California has faced its own testing crunch as cases rise, its plan showcases practices that could guide other states in their decision-making. Notably, despite its efforts to plan ahead, the state cautioned that its “ability to acquire supplies, reagents, test kits and collection materials required for expanding testing is dependent on federal supply.”

The shortfalls in U.S. testing highlight the Trump administration’s failure to execute a cohesive national strategy, even as the country reopened and Americans increasingly going back to work, eating out and gathering socially clamored for the screenings.

The burden instead shifted to states, which were provided over 36 million swabs and 27 million tubes of transport media in the last two months, according to Assistant Secretary for Health Brett Giroir’s office, but have continued to face supply limitations.

(Updates with statement from HHS in sixth and seventh paragraphs)

--With assistance from Shira Stein, Renata S. Geraldo and Paul Stinson.

To contact the reporter on this story:
Emma Court in New York at ecourt1@bloomberg.net

To contact the editors responsible for this story:
Timothy Annett at tannett@bloomberg.net

Heather Smith, Kara Wetzel

© 2020 Bloomberg L.P. All rights reserved. Used with permission.

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