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The state laboratory in Augusta is often maxing out its coronavirus testing capacity, though the numbers vary day to day. Maine is still figuring out how to randomly test people in the community, to better detect and trace transmission. And the percentage of people testing positive is still fairly low compared with other states — but it could be lower.
These were some of the takeaways shared on Monday by Nirav Shah, director of the Maine Center for Disease Control and Prevention. Here are more specifics about where Maine stands on testing:
Is Maine testing enough?
The short answer is no. The positivity rate — the percentage of people testing positive for COVID-19 — is one indicator of whether Maine is testing enough. The state’s cumulative positivity rate for the most accurate polymerase chain reaction tests is about 5.1 percent, Shah said. He has said he wants to emulate South Korea, which has gotten its positivity rate below 2 percent.
“By contrast, those nationally remain at about 11 percent, and in our neighboring states some are much higher than even 11 percent. Relative to other states, that gives us a sense that the net that we are casting is a good one. I’ve said publicly that I think we’ve got more work ahead of us to get that positivity rate down even lower. So we’ve still got more to do in terms of expanded testing,” Shah said.
Expanding testing is important to catch not just those with symptoms but people who are asymptomatic, “so that they can be quarantined and isolated safely before they infect others,” Shah said.
For instance, he would like more asymptomatic people who have had close contact with a confirmed case to have access to testing, and he would like to expand testing to different types of facilities, such as to staff at nursing homes, he said.
“We’re on the right road. We just haven’t reached our destination yet. We’ve got more to do,” he said.
Is Maine close to meeting its testing capacity?
Right now, the answer often depends on what day it is. After tripling capacity May 18, the Maine Health and Environmental Testing Laboratory can process roughly 1,000 COVID-19 tests per day, and it has often hit that maximum. Hospital-based and commercial laboratories are able to perform more tests.
“For a few days the week before last, we were doing, regularly, 1,000 tests per day,” Shah said about the state-run laboratory. “The numbers fluctuate quite significantly based on what health care providers send to us.”
The state laboratory is no longer prioritizing tests for the most at-risk patients with symptoms and will now run tests for anyone suspected of having COVID-19. But not all health care providers have been able to keep up with demand. That’s because they haven’t all had enough swabs and other materials needed to collect the specimens that are then sent to a laboratory.
For instance, last Wednesday the state laboratory received about 700 specimens to test, Shah said. On Thursday it received 564, and, on Friday, it got 914.
“That’s the same for any laboratory. We see, nationwide, very strong ‘day of week’ effects,” Shah said.
At laboratories across the state, not only accounting for the state laboratory, Maine has been regularly testing at least 9,000 people per week, or 36,000 per month, Shah said. That means the state has been exceeding the recommendation from the U.S. Centers for Disease Control and Prevention to test approximately 2 percent of its population every month.
“We have far exceeded that baseline recommendation already, and we intend to continue exceeding it,” Shah said.
Hospital-based laboratories have been working to expand. Both NorDx laboratory in Scarborough, which serves MaineHealth hospitals and physicians, and Northern Light Laboratory in Bangor, which serves the Northern Light health care system and six other rural hospitals, are hoping to receive more testing equipment in the coming weeks.
MaineHealth also recently broadened its criteria for testing, which will likely more than double the number of tests it had been conducting.
Why not test all workers in congregate care settings regularly?
The subject of how to regularly test more staff in congregate care settings, such as nursing homes, is “under extremely active discussion,” Shah said.
It’s probably not possible to test 10,000 to 15,000 long-term care workers in one day, “but if we staged and phased the process over a number of days, and then we also looked to other laboratories across the state to assist in that, that’s more of a viable option,” Shah said.
How to test more workers in outbreak-prone environments is not just a function of laboratory capacity but operational capacity, he said, such as whether health care providers have enough swabs to collect the samples and turn around results quickly.
Then, congregate care facilities need to be prepared for what to do when there is a positive case and staff members can’t work.
“We’ve got to think through the chess game of how we address staffing shortages before we go down that path, not while we’re in the middle of it,” Shah said.
What about sentinel surveillance?
Sentinel surveillance is a way to test people in the community, including those who appear well, to discover unseen transmission. The state is working on a couple different avenues to set this up. One may be through what it’s calling “swab and send” sites.
“Individuals who are just generally concerned about their exposure to coronavirus could drive up to a site, get a swab and have it sent to the state laboratory. That is, in effect, a way of undertaking sentinel surveillance,” Shah said.
The state is also getting a broader view through what’s called the syndromic system, a network of providers and others that compiles depersonalized health data to provide immediate feedback on symptoms popping up around the state.
“We’ve created queries. One is a very broad one. The other is a very specific one for COVID-19,” Shah said. They “give us a sense of what types of symptoms people have out there. All of that information is on our website.”
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