NH seeks to expand testing
BY RICK JURGENS
Granite State News Collaborative
New Hampshire officials and caregivers are struggling to accelerate and expand testing to detect the highly contagious and sometimes lethal COVID-19 disease.
But doctors in the frontline of the COVID fight say they have seen evidence of slippage in the testing efforts. The state “scaled back community testing about a week and a half ago,” said Gary Sobelson, a primary care physician in Concord.
On Monday, there was a hopeful development. Lori Shibinette, commissioner of the New Hampshire Department of Health and Human Services, said that the state had ordered 15 testing machines small enough to operate outside of laboratories with the capacity to show the presence of the virus within a few minutes. That could “change how we respond to this virus in our state,” she said.
Testing has wide-ranging importance for public health efforts to slow the spread of COVID, care for victims, lessen its death toll and minimize the costs and disruption of physical distancing measures that may last for months or years.
But shortages of necessary materials and protective equipment for health care workers have hamstrung testing efforts in New Hampshire and neighboring states. Some observers think organizational woes may also have slowed progress.
As of Tuesday, 9,136 individuals had been tested for COVID-19 in New Hampshire, of which 747 tested positive for the illness. Thirteen victims had died. In Vermont, 7,129 individuals had been tested, revealing 575 cases. The death toll in Vermont reached 23, after the virus spread in two nursing homes in the state.
According to data compiled Tuesday from public health reports from all 50 states and the District of Columbia and Puerto Rico by the Covid Tracking Project, which was initiated by The Atlantic magazine, Vermont’s rate of testing – about 1.1% of the population – was exceeded only by three hard-hit states: New York, Louisiana and Washington.
By comparison, New Hampshire’s testing rate of 0.7% put it in the mid-range compared to other states.
The state comparisons may be flawed, however. Our World in Data, a research clearinghouse based at Oxford University and funded by the Bill and Melinda Gates Foundation, notes that the COVID Tracking Project aggregates data from states that “report testing figures in a range of different ways” and that “many states do not explicitly provide details about these important factors needed to interpret the data they provide.”
Front-line caregivers may be too hard-pressed in the COVID battle to quibble over data quality. They need tests to identify individuals who have been infected with COVID and who need to be isolated to prevent infecting others. Data from tests can also help caregivers prepare for a wave of patients who need intense care as they fight a virus for which no safe and effective treatment has been found.
Testing can also save materials and boost healthcare staffing. By identifying who has COVID, caregivers can conserve suddenly precious personal protective equipment and speed the return to work of health care workers who would otherwise require prolonged isolation after an exposure to the virus.
But New Hampshire recently tightened eligibility criteria for testing. That scale-back was reflected in a March 20 revision to the requisition form that caregivers must use to submit samples for testing at the state-operated laboratory in Concord. A check box identifying a test subject as a “Health Care Worker,” “Inpatient,” “Emergency Responder” or “Long Term Care resident” was added to the new form.
New Hampshire guidelines say that other patients “with mild illness consistent with COVID-19, who are not in need of medical care, do not need testing.”
Vermont has moved to expand testing. “We are much less restrictive in our testing now,” Mark Levine, the state health commissioner, said in a news conference Monday. “Anyone with symptoms that they believe to be COVID-19 is eligible to be tested.” Levine said last week that the state was “asking for as much testing as possible.”
Testing limits have frustrated primary caregivers. “We just haven’t figured out the logistics for how to do them,” said Michael Lyons, a physician at the White River Family Practice in White River Junction,, which also treats patients from New Hampshire.
But bottlenecks persist. An April 3 bulletin from the New Hampshire Division of Public Health Services said that collecting and testing samples “exposes the public and healthcare system to contagious cases and consumes limited personal protective equipment and testing supplies.”
A similar constraint has arisen at Dartmouth-Hitchcock Health, which has the capacity to conduct 1,000 COVID tests daily at its Lebanon campus but has done only 82 tests a day since beginning analyses on March 22, according to spokesman Rick Adams. “We are still limited by critically short supplies of (personal protective equipment) for providers obtaining samples and of testing materials including nasopharyngeal swabs and viral transport medium,” he said.
The turnaround time for tests at D-H is 12 hours, Adams said.
On March 27, ClearChoiceMD, a New London-based urgent care provider, announced that it would test for COVID but “high-risk patients only, as supplies are available.” The tests are available at the care network’s New Hampshire offices in Lebanon, Alton and Tilton and at Vermont locations in Brattleboro and South Burlington, according to the ClearChoiceMD website.
Health care corporations have developed new test products. Abbott Laboratories, a large medical products maker, announced on March 27 its release of a kit that would adapt for testing for COVID small devices currently used to detect strep throat and influenza. The testing platforms cost about $4,500 each, while each testing unit – a cartridge with a swab and reagent – costs about $40, said John Koval, an Abbott spokesman.
The federal government has agreed to supply New Hampshire with 15 of the Abbott test platforms, according to Health and Human Services Department spokesman Jake Leon. They will be placed at sites outside of the state laboratory, he said.
At a news conference on Wednesday, Levine said Vermont is also getting 15 rapid testing machines made by Abbott from the federal government, with material for 1,800 tests in total. He said the state will use a “strategically targeted” approach where they will be deployed, including at some rapid testing sites. Levine also said the state will try to develop a “supply pathway to have more materials to keep using them” after the 120 tests kits per machine have been used.
Such tests aren’t perfect, according to David Louis, chief pathologist at Massachusetts General Hospital in Boston. They depend for accurate results on the skill level of the tester and may not always show a positive result when the virus is present, he said in a webcast Friday. Small, independent testers also may not do the reporting needed for public health monitoring, he added.
Corporate fanfares don’t always herald rapid progress, as was shown after Quest Diagnostics, a multi-billion-dollar laboratory testing giant, announced in early March that it would begin offering COVID tests. As demand soared, the company quickly built up a backlog of 160,000 untested samples and saw testing turnaround times reach a week, according to company releases.
On April 6, Quest, which has a lab in Marlborough, Mass., said it had a daily testing capacity of 35,000 and had completed 550,000 COVID tests. The company said it had cut its backlog of untested samples to 80,000 and its national average turnaround time to two or three days. Turnaround on tests from New York, Chicago and Miami and other COVID hotspots “may experience turnaround times of three or more days,” the company added.
Tests for COVID have proliferated since the virus surfaced as winter began. “The purposes of tests vary,” Louis said. “You can have the same test that is useful in one situation and not as useful in another.”
Most currently available COVID tests analyze samples swabbed from inside a subject’s nose to determine the presence of a genetic marker of the novel coronavirus. But still-mostly-on-the-drawing-boards blood tests will generate more data and information on COVID.
Blood tests will be tremendously important but very complicated to develop, Louis said. They could measure the volume of antibodies fighting the virus in each currently or formerly infected individual and be used in research. That data could also help public health officials execute a comprehensive COVID response that follows testing with contact tracing and isolation of disease carriers. South Korea used a similar strategy to fight off the disease.
Until a vaccine is developed – a prospect that remains at least a year away in experts’ rosiest scenarios – such a public health program will be needed to complement social and physical distancing.
Public health agencies in northern New England have beefed up. Last week, Vermont officials announced that the state had added 40 law enforcement and public safety employees to its public health effort to fight COVID. The state aims to implement a “containment strategy that includes contact tracing to go along with the mitigation strategy of social distancing,” Levine said.
New Hampshire has added 50 state and contract employees to its 72-employee Bureau of Infectious Disease Control to help “conduct epidemiologic surveillance, case investigations, and contact notifications and monitoring” during the COVID crisis, Leon said.
Rick Jurgens can be reached at rjurgens_2000@yahoo.com or 802-281-6641.
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