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For more than two months, the staff of Maine’s two largest hospital systems have been making decisions about COVID-19 testing in an environment of near-constant uncertainty.
While dealing with promised shipments of essential supplies that haven’t shown up and tracking the unpredictable trajectory of a new illness, they have had to ask themselves: Who needs a test most, and how many samples can be collected and tested quickly, with the supplies and laboratory equipment at hand?
Some challenges remain, but both Northern Light Health, based in Brewer, and MaineHealth, based in Portland, are now seeing more signs of progress, an important step as the state gradually reopens its economy.
While even experts disagree on precisely how much testing capacity Maine will need in the future, it is clear that local capacity matters.
“Speed of results absolutely matters with this testing, and the testing capacity that’s the most important is that capacity that’s local, within a short driving distance of where the specimen is collected,” said Brian Jackson, medical director for ARUP Laboratories, based in Utah.
That’s why the Bangor Daily News asked five different laboratories located in Maine this week to share how many tests they are performing, in addition to how many they could perform, to determine their unused capacity.
Three laboratories — NorDx laboratory in Scarborough, which serves MaineHealth hospitals and physicians; Northern Light Laboratory in Bangor; and Cary Medical Center’s laboratory in Caribou — replied, revealing that their equipment can run more than double the number of tests they’ve been producing in recent weeks. Combined, they could do roughly 3,400 more tests per week beyond the roughly 2,700 tests per week they have recently been running.
But the situation is changing rapidly, and those numbers are likely already obsolete.
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For weeks, the equipment at hospital-based laboratories has not been running at full capacity because of uncertainty over supplies such as swabs, vials of transport media and chemicals needed to run tests. Now MaineHealth’s supply chain is at least delivering promised goods, said Joan Boomsma, chief medical officer.
That’s one reason MaineHealth, the largest health system in northern New England, announced Thursday that, gradually over the coming weeks, it will increase the number of tests it’s performing, using up much of its excess capacity. It follows a tripling of testing capacity at the state laboratory in Augusta, which is now testing samples from anyone suspected of having COVID-19.
MaineHealth will now test all patients admitted to MaineHealth hospitals whether they exhibit symptoms of COVID-19 or not; asymptomatic patients getting surgery; and some patients with symptoms of an infection, even if they don’t have underlying health conditions or are not essential workers. It already tests asymptomatic women in labor.
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NorDx laboratory was running at roughly half capacity, at about 1,500 tests per week, under its previous testing protocols, Boomsma said. The broadened criteria for testing will ultimately add roughly 2,000 additional tests per week.
It’s “a big jump,” she said. “We’re pleased with where we are now, and we’re optimistic that we’ll be able to expand even further.” That’s because NorDx is hoping to receive another testing instrument in the coming weeks that will increase capacity even further, up to 250 more tests per day, she said.
It is a slightly different story two hours north. While the equipment at Northern Light Laboratory in Bangor has the capacity to test more, getting enough supplies to collect more patient samples continues to be a challenge, several Northern Light Health staff said.
At the same time, Northern Light Health’s catchment area, mostly in eastern and northern Maine, is not experiencing the same level of outbreak as southern Maine, and testing levels have appeared to remain adequate, they said, though they would ideally like to do more.
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Despite mostly testing symptomatic patients, about 2.8 percent of tests at Northern Light Laboratory come back positive, said Sarah Buss, director of microbiology at the lab. The health care system has 10 hospitals, from Northern Light Mercy Hospital in Portland to Northern Light AR Gould Hospital in Presque Isle, and the laboratory is testing for an additional six other rural hospitals.
“It gives an indication we’ve been doing a good amount of testing for what’s needed in the community,” Buss said.
The Infectious Diseases Society of America does not recommend testing asymptomatic people with no known contact with COVID-19 who are hospitalized in areas with a low prevalence of the virus in the community. In those places, it determined hospitals would miss a low enough number of cases to be acceptable.
For comparison, MaineHealth’s positivity rate is about 4 percent, Boomsma said. Overall, the state’s positivity rate has been below 6 percent. Nirav Shah, the director of the Maine Center for Disease Control and Prevention, has said he’d like it to get down to 2 percent.
As such, Northern Light Health has not yet expanded testing as much as MaineHealth or the state laboratory. It has expanded testing to some patients, however, such as women about to give birth, those undergoing procedures that might generate aerosolized particles, and asymptomatic people who might be exposed to COVID-19 in congregate settings, said Dr. James Jarvis, incident commander for the health system.
Its top priority for testing is still hospitalized people with symptoms, symptomatic health care workers and first responders, symptomatic people in congregate settings, and other patients who show symptoms and a test could help with the course of their treatment, he said.
While Northern Light Health has capacity to test more — its laboratory is running more than 1,000 tests per week and could run roughly 3,000 with the machinery it has — the health care system is still having trouble finding a steady supply of swabs, which are used to collect secretions at the back of the nose.
In addition, some chemical reagents are not being shipped on a reliable schedule. “It’s very difficult to know what is a sustainable capacity,” Buss said. “We’re hopeful we can meet that 3,000 capacity.”
On one hand, it is good that the lab has the capacity, “but unfortunately there will always be some amount of limitations simply because it is a large process, and the supply chain continues to be a concern for us,” Jarvis said.
“Even if we had unlimited testing supplies we still want to do it in a fashion that makes clinical sense and will be useful to our community,” he said, but the health system is “looking at every avenue we can,” through the government and private industry, to get more swabs and transport media.
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Despite the uncertainty, the laboratory is processing its current samples quickly, within 24 hours, said Karen Pomeroy, vice president of the laboratory. It has also been training local university students with the aim of soon hiring them to run COVID-19 tests. And similar to NorDx, it’s hoping to receive an additional testing instrument in June.
The situation was far more dire in the recent past.
In a small, white room within Northern Light Laboratory, situated within the health care system’s flagship hospital in Bangor, is a testing instrument that looks like a futuristic photocopier. It is a Panther Fusion machine.
The laboratory had ordered the machine many months ago to run a variety of other tests, Buss said. It was supposed to arrive in March.
But when the pandemic hit, the company producing the Panther Fusion system sent Northern Light Health’s instrument to Walter Reed National Military Medical Center in Maryland instead, just one example of how quickly long-made plans can change in a pandemic. Northern Light Laboratory relied on its machines with less throughput until it received its Panther Fusion several weeks later. It went live April 24.
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Meanwhile, important supplies weren’t coming through either as the number of COVID-19 cases continued to grow.
Northern Light gets most of its swabs and vials of transport media, essential for collecting and storing samples of COVID-19, through its distributors, which buy from private manufacturers that have struggled to keep up with demand.
But on Thursday, the health care system got its first shipment of swabs from the state, which had received them from the federal government.
Northern Light Health had ordered 3,000 swabs from the state nearly a month before, on April 30, Pomeroy said. But it got one third of that, 1,000 swabs, for a system with more than 1,000 health care providers.
About 130 miles to the south, NorDx laboratory experienced similar shortages as the crisis was worsening. MaineHealth frequently placed orders for supplies such as the chemical reagents needed to run COVID-19 tests, received word that they were coming, and then learned they had been rerouted to other states, such as New York, Boomsma said.
“The government was intervening with the manufacturers and saying, ‘This area is a hot spot. They have the highest need right now,’” she said.
That’s not happening to MaineHealth today.
“In the last week or two, things have really been coming through as ordered, which means we now feel much more comfortable that we can expand,” she said.
It’s important to test more people to learn more about the disease, which will help make Maine safer, Boomsma said. There’s still room to improve.
“We know that some folks are asymptomatic who want to be tested,” Boomsma said. “Regrettably we don’t have that much capacity yet.”
Watch: Why Maine is tracking number of tests instead of people tested