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The past two months have meant near-constant work for the staff of Maine’s state laboratory who are testing specimens for COVID-19.
“Our lab staff have been working seven days a week since March. Most of our lab staff have not had a single day off. It’s not the way that we like to do business. It’s not the way to do business. It’s not the type of organization that any of us want to be running,” Nirav Shah, director of the Maine Center for Disease Control and Prevention, said on Thursday.
But while the short-term may be stressful for laboratorians, the coming months are likely to mark a turning point for the Maine Health and Environmental Testing Laboratory in Augusta, which has traditionally operated more behind the scenes in advancing understanding of public health threats.
That’s because it’s getting new staff, new equipment, a new building and renewed recognition of its central role in responding to outbreaks, after three decades that saw staff cuts, attempts at privatization and a deteriorating building and equipment.
Former Gov. Paul LePage cut more than 100 workers from the Maine CDC during his two terms and didn’t hire for vacant positions, including at the lab. When Gov. Janet Mills took office in January 2019, there were the equivalent of 51.5 full-time positions at the lab, Maine CDC spokesperson Robert Long said.
Today there are 56 full-time positions, and the state is looking to hire three more full-time workers, he said. The hiring coincides with a new partnership with IDEXX Laboratories in Westbrook to triple the amount of testing being done at the state lab for COVID-19, an important step in reopening the state.
While the lab is running about 300 tests per day now, accessing chemical reagents and equipment from IDEXX will allow it to turn out about 700 tests per day, Shah said, and eventually permit the state to stop prioritizing testing for just the most vulnerable people.
The lab still needs to install and calibrate its new instruments, Shah said, but when the state can lift its rationing requirements, it “will actually make Maine one of the first state health department laboratories, if not the first, to remove all criteria and all tiers on its testing system.”
The lab has always been an essential part of the state’s ability to prevent and respond to viruses, bacteria, toxins and other hazards to the public’s health, said John Krueger, the lab’s previous director, even as private laboratories claimed it unfairly competed with their ability to make money.
That’s because, unlike a private laboratory, the state lab reports all its data to state epidemiologists to review, which drives decision making and policies that affect not just one person seeking a test result but thousands who might otherwise become ill.
A public health laboratory has a “specific and unique role,” Shah said. “That role can’t be one that can be simply outsourced to someone else. Our public health laboratory often does mass testing in situations that other laboratories might not — for example in shelters for people experiencing homelessness.”
It was testing at the state lab that originally discovered the problem of naturally occurring arsenic seeping into well water, said Krueger, who left the position in 2008 after working at a leadership level in the lab since the 1980s. It’s how the state gained an understanding of where radon, the second leading cause of lung cancer, was reaching dangerous levels in homes.
It was also the lab that tested groundwater for methyl tertiary-butyl ether (MTBE) in the 1990s, finding that likely several thousand Maine households had water supplies exceeding the recommended limit of the gasoline additive. The testing laid the framework for former Gov. Angus King to withdraw from the federal government’s reformulated gasoline program, Krueger said.
It’s the only lab in Maine that tests animals for rabies and the only lab that tests for tuberculosis. It tests children’s blood samples for lead and food for salmonella. It tests urine samples for drugs and alcohol, to be used as evidence in criminal cases. It analyzes environmental samples to detect both man-made and naturally occurring radioactive materials.
The lab was often underappreciated, however, said Krueger, who listened with dismay in 1992 when then-Gov. John McKernan announced in his State of the State address that he wanted to make the public health lab “self-supporting” to save money.
The Maine Legislature defeated a bill to privatize the lab in 1995, but the lab became more dependent on charging fees for its services. Nearly 80 percent of the lab’s budget came from fees by 1995, according to legislative testimony from Lani Graham, director of what was then the Maine Bureau of Health.
Corporate firms fought to have the lab’s water-testing programs reduced. Staff left. The lab got slower in turning around test results, Krueger said, and, when quality diminished, it made it harder to justify investing in its work.
A woman testing for E. Coli in the lab’s microbiology section even died from a lethal strain of the bacteria in the 1990s. Across the street from the lab is a memorial to fallen firefighters and Krueger said he always felt “she should have had her name engraved on stone.”
Particularly after her death, more money and attention came to the lab, but “the basic question is, how much can you fix an old facility?” he said.
In addition to often working 12 hours a day, he described being on call 24 hours a day to respond to problems, such as if a ventilation system shut off. He recalled the fire department telling him that it wouldn’t respond if there was a fire because the design of the building was unlikely to properly contain the chemicals present. State officials have been talking about building a new lab since when he was director, he said.
“I’d say the system has been under strain and has survived only because of some real dedication of staff and people,” he said.
The expertise of the workers ensured the lab could respond to the pandemic. That’s because many people in the clinical microbiology section had been cross trained to perform the type of testing used to detect the presence of COVID-19, Long, with the Maine CDC, said.
Krueger is pleased to know the state is now building a new laboratory in the Greenlaw building on the Augusta Mental Health Institute campus. Construction is underway, Long said. It is expected to be completed in December 2022.
The extensive renovations will nearly double the square footage of the current laboratory, increasing the space to 46,000 square feet, up from 28,000. Last year, the state awarded $28 million to Cianbro for the project, which will be paid for with a Maine Governmental Facilities Authority bond.
“We are in a cramped space in a building that is old and lacks adequate power for adding new instruments,” Ken Pote, the current director, said.
At least one lawmaker tried to propel the state to invest more in its lab five years ago.
In December 2014, Sen. Geoffrey Gratwick, D-Bangor, a retired rheumatologist, read a Bangor Daily News article describing a report from the Trust for America’s Health. In the wake of the ebola outbreak, it had analyzed each state’s preparedness for an infectious disease outbreak and given Maine a score of four out of 10, in part because the state had cut funding for public health services.
At the same time, the report credited Maine for the fact that its state lab performed drills to handle emerging threats.
Under the LePage administration, Gratwick had been told he wasn’t allowed to visit the lab in the basement of the Maine Department of Health and Human Services building across from the state capitol but he went anyway, he said.
“They were very kind. I spent an hour and a half,” Gratwick said. “It was a rabbit warren — overstuffed, small offices, with some antiquated and some very good equipment. There are no corridors. It truly was a rabbit warren with rooms off of rooms, with minimal if no outside lighting or windows, old linoleum on the floor, peeling paint,” Gratwick said, “But very impressive employees down there doing their thing.”
He submitted a bill, LD 211, that proposed giving the state lab a boost of $10 million, to better prepare Maine to respond to a disease outbreak, with a new lab building, better lab equipment and “good outreach,” he said.
“We’d just come out of one epidemic already, and it seemed to me we needed to be planning for the next,” Gratwick said.
But when he sought information from DHHS, under whose auspices the lab operates, to learn more about its needs, he was met with silence, he said. Without knowing details about what machines or space the lab required, and without the engagement of the LePage administration, he pulled the bill in June 2015.
“It wasn’t going to go anywhere, so I turned my attention elsewhere. With hindsight, that was obviously a grave error,” Gratwick said.
In 2017, however, under the LePage administration, the government bureau tasked with maintaining state buildings began the current effort to find a new home for the lab, according to its website. The lab’s home at 221 State St. had reached the end of its useful life, state officials have said. The years-long project has continued under the Mills administration.
At the time, however, the LePage administration deprioritized certain public health initiatives. In July 2015, lawmakers rebuked then-DHHS Commissioner Mary Mayhew who didn’t reapply for a two-year federal grant of $300,000 to increase well water testing for arsenic.
Mayhew said the government shouldn’t compete against private firms that test wells, calling it “a textbook example of an inefficient, wasteful, unnecessary government project.”
As early as last year, the lab had a backlog in urine samples needing to be tested for drugs or alcohol, delaying the prosecution of some criminal cases for as much as six months, according to the Portland Press Herald. At the time, Long attributed the delay to vacancies at the lab.
“While I could argue that the state’s public health system was left in a position to fail — given insufficient funding and staff size — I believe we now have impressive leadership and a public health workforce that is very smart, capable and strategic, and committed,” said Rebecca Boulos, executive director of the Maine Public Health Association.
Ken Albert, who resigned as director of the Maine CDC under LePage in 2016, also agreed with the direction in which the state is heading.
“I left the LePage administration, right? There you go,” said Albert, when asked if he had supported eliminating positions at his agency. “The trajectory of where the CDC is currently going with regard to building the public health infrastructure is the right direction to go in.”
Watch: Janet Mills announces partnership to triple testing capacity