By RICK JURGENS

Granite State News Collaborative

New Hampshire officials, intent on reducing death and illness among nursing home residents who have borne the brunt of the state's COVID-19 pandemic, have launched a testing program that relies on a small North Carolina company founded by young entrepreneurs with deep roots in that state's conservative establishment.

The goal is to limit the spread of COVID inside nursing homes. “We’re hopeful this will give us a leg up with catching (the virus) before it gets too far into the building,” Lori Shibinette, New Hampshire’s health and human services commissioner, said recently.

Officials estimate that about 80% of the more than 300 COVID related deaths were among residents of nursing homes and other congregate living facilities.

The new “sentinel surveillance” program aims to identify nursing home employees and residents who have the COVID virus but haven’t displayed symptoms. That will enable public health officials overseeing the state's long-term care facilities to “provide informed infection prevention and control response recommendations to limit transmission,” according to the program’s purpose statement.

The initiative applies lessons from the nationwide scramble to respond to COVID. In that battle, so-called asymptomatic transmission has emerged as “the Achilles heel of COVID-19 pandemic control through the public health strategies we have currently deployed,” a May 28 editorial in the New England Journal of Medicine declared. “A new approach that expands COVID-19 testing to include asymptomatic persons residing or working in skilled nursing facilities needs to be implemented now.” 

At the onset of the pandemic, New Hampshire public health officials prioritized for testing, in nursing homes and elsewhere, individuals who displayed symptoms or had been exposed to the contagious virus. The new program consists of 10-day testing cycles during each of which the goal is to test all nursing home employees and a randomly selected 10% of residents. 

“Our strategy has changed through the months … as we’ve learned more about the virus,” Shibinette said recently. State officials and nursing home operators were surprised by the number of patients with the virus but no visible symptoms, she said. “We’re still fighting the invisible enemy.”

Forces are still mustering for that fight. As of Wednesday, 15 New Hampshire nursing homes had signed up to begin sentinel testing, 44 were still completing paperwork and 25 had not yet contacted program operators, according to Aaron McIntire, a health and human services representative. A separate testing program will continue aimed at so-called “outbreak” facilities – nursing homes where more than one COVID case has been found.

Testing for sentinel surveillance will be done by Mako Medical Laboratories, a limited liability company with its headquarters in Raleigh, N.C., that was incorporated in 2014. Mako posted $92 million in revenue in 2017, according to a North Carolina technology publication. In a video message posted on the website of a supportive North Carolina bank, Chad Price, Mako's chief executive and co-founder, said: “We believe that in the next five years we can be a billion-dollar privately held company and have thousands of employees.”

Mako currently employs 450 and has conducted more than 125,000 COVID-19 tests, according to Josh Arant, the company's chief operating officer and co-founder. With 150 employees working around-the-clock shifts, Mako processes more than 10,000 tests each day, Arant said. The daily rate is expected to reach 25,000 by the end of July, he added. 

Arant said Mako operates seven machines that detect the presence of the COVID-19 virus, and has added eight machines that detect blood antibodies that show a subject previously had COVID.

The company's characterization of those blood testing machines became an issue last month, after the Raleigh News & Observer reported that a Mako sales representative had emailed a state official promising that the lab company was about to offer blood antibody tests that would “tell whether somebody has had the virus and developed immunity.” The newspaper said that similar claims had been made in social media posts by the company. Antibody tests have yet to be proven to demonstrate immunity. 

The News & Observer reported that Arant, Mako’s chief operating officer and co-founder, later acknowledged that the immunity claim was erroneous and said that it resulted from a mistake in word choice by a social media consultant and “an honest mistake in what is an ever-evolving understanding of COVID-19."

Heather Matthews, a public relations consultant to Mako, said in reply to written questions: "As for the 'immunity' mistake, that is on my team. As the COVID situation was evolving in May, we innocently used the term immunity in a social post instead of antibodies."

Mako has grown and transformed itself rapidly. Arant described the company as "a diagnostics partner for businesses, physicians, urgent care facilities, and hospitals around the United States." The company's roots are in conservative political circles in North Carolina. Political contributions have marked its growth. 

"Josh Arant and Chad Price met at a Bible study," Matthews noted. That study was organized by North Carolina Supreme Court Justice Paul Newby, according to press reports in that state. Newby, who is currently a candidate for chief justice, has spoken regularly at meetings of the conservative Federalist Society, according to the website of its North Carolina affiliate.

In February, the News & Observer described “hundreds of thousands of dollars in campaign money flowing predominantly to Republican candidates” from Price, discrepancies in his reporting some of those contributions and mistaken claims in the resumes Price submitted to support his applications for an appointment to a public education board and for a state contract to make license plates. 

Matthews said that Price's political donations were "his personal donations. They do not have anything to do with the operations of Mako Medical or the quality of service from this highly skilled team."

Mako’s website discloses a “COVID-19 Diagnostic Test Cash Price” of $125. The News & Observer reported that in April Mako had agreed to conduct 20,000 onsite tests of North Carolina prison employees with a unit price ranging from $80 to $83, and 1,400 tests in one North Carolina county for a unit price of $70.

North Carolina officials, citing “logistical and personnel concerns,” later shelved the Mako program and switched to another vendor to offer tests to prison employees. 

Depending on its financial terms, the New Hampshire program could generate $15 million or more in annual revenue for the company. 

Matthews referred questions about the contract terms to New Hampshire officials.

The Mako contract has been submitted to Gov. Chris Sununu for approval, and will be made public when it is “provided to (the Executive Council) as an informational item,” said Jake Leon, a spokesman for the New Hampshire Health and Human Services Department.

Arant said the New Hampshire tests will be analyzed in a recently renovated Mako laboratory in Henderson, N.C. 

In 2017, Mako announced plans to invest $15.4 million in the Henderson testing and warehouse space where it would employ 153 “scientists, chemists, lab technicians and logistics personnel” with average wages of $52,000 a year, according to a release from the Economic Development Partnership of North Carolina. To support the project, North Carolina awarded Mako a “job development investment grant” of up to $3.2 million that would be paid out over 12 years. 

And how will a North Carolina lab test samples from New Hampshire? The new program will rely on nursing home employees to gather samples from other employees and residents and send them by Federal Express to Mako’s Henderson laboratory, according to program summaries by Mako and New Hampshire officials.

Contact Rick Jurgens at 802-281-6641 or rjurgens_2000@yahoo.com.

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