Testing shortages make it tough for health officials to understand COVID-19 spread

Samples are tested for COVID-19.
A Mayo Clinic medical professional prepares a drive-through test in Rochester to collect COVID-19 specimens. Public health officials say limited testing has made it hard to understand how widespread the virus is.
Courtesy of Mayo Clinic file

Updated: 8:57 p.m.

In response to a shortage of testing supplies nationwide, Minnesota earlier this week said it would prioritize hospitalized patients, health care workers and those living or working in places like nursing homes and long-term care facilities for COVID-19 testing.

The move — and shortage of testing supplies overall — creates immense challenges for public health officials as they work to understand how widespread the virus is in Minnesota — and try to prevent its spread.

“In an ideal world, that’s why we would like to see more testing. It does give us more information about the spread, more data to understand what’s happening,” said Bonnie Brueshoff, public health director for Dakota County, where seven positive cases have been identified.

“But meanwhile, the reality we are living in is that testing has to be limited because there’s not enough.”

Nationally, public health experts say the United States has been ill-prepared to manage a pandemic of this magnitude. That’s included planning for and stockpiling materials needed to do widespread testing, including reagents and other materials used to take and process samples. Meanwhile, demand for these products is widespread across the globe, putting pressure on the supply.

In the early days of the virus’ spread in Minnesota, the state Health Department was doing the bulk of the COVID-19 testing, with kits from the Centers for Disease Control and Prevention. Hospitals would take nose and throat swabs from patients, and send samples to the state.

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But with a shortage of tests and testing materials, health care providers are forced to focus on highest-priority patients.

The Health Department said Tuesday that all other patients — those who have a fever, cough, shortness of breath and other symptoms associated with a possible COVID-19 infection — should self-quarantine and isolate themselves from others, even family, as much as possible.

Gov. Tim Walz and several governors around the country have put pressure on the federal government for more testing supplies, which have been strained by worldwide demand. But in the meantime, Brueshoff said that prioritizing certain patients makes sense.

“We understand when you have a limited ability to test, there has to be prioritization done,” she said. She added that her department is simultaneously stressing the need for people to stay home if they’re sick, and wash their hands often.

Health officials for weeks have been increasingly raising the alarm over the spread of the novel coronavirus in the U.S. The disease is transmitted through respiratory droplets, coughs and sneezes, similar to the way the flu can spread.

Government and medical leaders are urging people to wash their hands frequently and well, refrain from touching their faces, cover their coughs, disinfect surfaces and avoid large crowds — all in an effort to curb the virus’ rapid spread.

The state of Minnesota has temporarily closed schools, while administrators work to determine next steps, and is requiring a temporary closure of all in-person dining at restaurants, bars and coffee shops, as well as theaters, gyms, yoga studios and other spaces in which people congregate in close proximity.

Shortage of testing supplies limits big-picture look at virus

In Olmsted County, Public Health Director Graham Briggs said an inadequate amount of testing supplies has made it hard to stay ahead of the virus.

“The reason we want to do this testing is for public health surveillance,” said Briggs. “The reason we do that is not to inform the doctor how to treat you — it’s to inform the public health system about where this infection is, or where those who are infected are, where it’s transmitting and how much we’re seeing in the community.”

Briggs said he’s concerned about the backlog of at least 1,700 samples at the Health Department that haven’t been tested yet because the state lacks the supplies it needs to test them.

“The longer it takes to get that testing done, those positives are people who potentially have this virus we’re not able to follow-up on,” Briggs said. “Right now, testing is very important to get ahead of this.”

The situation also raises questions about equity, Briggs said, because an added benefit of what public health officials call “surveillance testing” — monitoring the situation broadly — is that people who don’t have insurance or who are undocumented have easier access to getting tested for the virus.

To fill the gap, the state is asking hospitals to send lower-priority samples to commercial labs.

State officials say that’s one way providers can ease the pressure on the limited resources it has to test samples. Hospitals in Minnesota are using commercial laboratories like Mayo Clinic and Quest Diagnostics to conduct that testing.

Essentia Health in Duluth will be contracting with Mayo Clinic to test samples, said infectious disease specialist Dr. Rajesh Prabhu.

But Prabhu said Essentia will continue to follow state guidance on who they test.

“We’re trying to conserve those resources for the public good,” he said.“People have the question: ‘Are we going to miss cases in the community if we don’t do more testing?’ But what we’re concerned about is actually having a severe case of COVID-19.”

Essentia, along with other large provider networks across the state, including Sanford and CentraCare, say they will see and test anyone who needs testing regardless of whether they have insurance or can pay for those procedures out of pocket.

A new federal law also requires that testing be free.

“We will not let [cost] be a barrier to getting testing,” Mayo Clinic Laboratories president Dr. Bill Morice. “We will make sure that people who need the test can get it.”

Since last week, Mayo has run 800 tests and found 16 positive results. Starting today, Morice said the labs can run up to 4,000 tests daily, and has expanded its testing agreements to eight major health systems around the state.

One reason Mayo has been able to ramp up testing is because its test is different — and uses different supplies and procedures — than the test kits provided to the state by the CDC, Morice said.

Morice said that allows providers a bit more latitude in who they test, but he said Mayo and the other hospitals it is working with will continue to be judicious in their approach.

“We want to make sure the capacity we have is best used,” Morice said. “I completely understand why people want to be tested and need to be tested. But it’s only a small percentage of patients who get seriously ill. But we have to identify them early.”

He said the risk in opening up capacity is that the lab will get behind.

“We want to make sure that the people who really need the test get it back quickly,” he said.