NH still lags on testing capacity

  • On March 23, 2020, Concord Hospital medical staff perform coronavirus testing at one of two undisclosed sites in the Concord, N.H., area. The site is an evaluation and testing location for Concord Hospital Medical Group patients only. Patients must call their CHMG provider first and a clinician will triage the patient via phone and determine the need for further evaluation and testing. Should testing be appropriate, an appointment will be made at one of the two testing sites. (Concord Monitor - Geoff Forester)

Granite State News Collaborative
Published: 4/8/2020 9:05:46 PM
Modified: 4/8/2020 9:05:35 PM

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 on the front line of the coronavirus 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 the state had ordered 15 testing machines small enough to use outside of laboratories and that could 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-19, 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, 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 at midrange compared with 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 health care staffing. By identifying who has COVID, caregivers can conserve suddenly precious personal protective equipment and speed the return 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.

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 take small devices currently used to detect strep throat and influenza and adapt them for COVID testing. 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 state Health and Human Services Department spokesman Jake Leon.

At a news conference on Wednesday, Gov. Chris Sununu said New Hampshire had received the 15 machines, but only 120 test cartridges, with the capacity to run about 100 tests after the machines are calibrated. As a result, only two will be deployed until more test kits can be obtained.

“I’m banging my head against the wall,” Sununu said. “It’s incredibly frustrating.”

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 initial test cartridges have been used.

Such tests aren’t perfect, according to David Louis, chief pathologist at Massachusetts General Hospital in Boston.

Accurate results depend 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.

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-board 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.

These articles are being shared by partners in The Granite State News Collaborative. For more information visit collaborativenh.org.

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