Texas is moving into a new phase in the coronavirus outbreak: managing transmission while partially reopening non-essential businesses. And still, the rate of testing for the disease remains low.
The state’s seven-day average is about 17,000 test results a day, according to the last week of data compiled by the COVID Tracking Project. That includes tests analyzed at county public health labs, hospital labs, and commercial labs.
Government officials and disease experts in the state and nationally want more tests. They say it’s a crucial part of fighting the spread, although estimates and models differ on how many tests we should be doing.
Two weeks ago, Gov. Greg Abbott’s stated goal was 25,000 tests a day.
“Getting up to 25,000 tests is something that should occur early on in the May timetable that we’re looking at, as we work our way through Phase 1,” he said on April 27. Abbott had just announced a partial reopening of some businesses. “The additional tests will be coming in part from the massive increase in the amount of tests being provided by the private sector.”
Why was Abbott confident in a “massive increase” in private sector tests? He said President Trump and White House coronavirus response coordinator, Dr. Deborah Birx, told him it was coming.
Laboratories, however, are still scrambling to meet demand.
Jondavid Klipp, president of the industry newsletter Laboratory Economics, recently completed a national survey of over 150 labs. The clear conclusion: there are still not enough testing supplies.
“Laboratories still report that they can’t get key supplies they need to do the COVID-19 testing that they’re being requested to do,” Klipp said.
Supplies include Personal Protective Equipment (PPE) like masks, gloves, and gowns; materials to collect and mail samples; and chemicals to process a test.
Of the 159 respondents to Klipp’s question about shortages, 92 labs, or 57.8%, reported a shortage of collection swabs or “specimen transport media,” which preserves a sample as it’s headed to the lab. The number reporting shortages of PPE was almost as high.
Pathologist Joe Saad, medical laboratory director at Methodist Dallas Medical Center, told KERA that after a lot of labs jumped into coronavirus testing, he saw a shortage in reagents, the chemicals used to process tests. That bottleneck has since eased, but others haven’t.
“What has been in short supply is the viral transport media that’s used to put the swab in,” Saad said. “We’ve actually resorted to making our own VTM at the hospital, and that’s worked quite well. The CDC has a formula on their website, and there’s also a [World Health Organization] formula that’s been widely used.”
Another vital component, the nasal swab used for collecting a sample, is a specific type of product.
“The swab itself has to have a flexible plastic handle so that it doesn’t break off in a person’s nose,” Klipp explained. “There are other wooden-handled swabs that are out there, but they can’t be used to collect these samples.”
And there are really only two main companies worldwide that make that particular swab.
“The manufacturers of those supplies are ramping up production. It just doesn’t happen overnight,” Klipp said. “Over the next few weeks, some of the supplies shortages should be starting to disappear.”
If that happens, an increase in testing capacity would come at the end of May or beginning of June, a couple weeks after the date Governor Abbott put forward.
“If we’re honest and we’re doing an honest look back, our ability to increase has lagged behind where we felt we should have been at each stage,” said Dr. Mark Casanova, head of the Dallas County Medical Society. “That’s not a slight, that’s not meant to be a criticism. That’s just reality.”
Testing rates have improved somewhat. Texas was well under 10,000 tests a day at the end of March. Over the last week, the average has been about 17,000 tests a day. There are occasional days with over 20,000 tests, including 28,873 on May 2.
Because public policy has shifted Texas towards reopening, Casanova thinks the need for testing will extend beyond diagnosing people, towards tracking down those who’ve come into contact with the infected. He called contact tracing “tantamount.”
Expanding tests to a broader subset of people is also what Dr. Sharon Davis thinks must happen. Her clinic, Los Barrios Unidos Community clinic in Dallas, sends patients to Parkland Hospital for testing.
Tests results are back within a day or two. The clinic hasn’t had a problem getting patients tested thus far, but Davis thinks patients are going to start coming in at higher volumes.
“As we increase our outreaching to the neighborhood here and the patient population we see, I think the need for testing will go up,” she said. “I anticipate that we are gonna have to start doing our own testing here fairly soon” because they will exceed what Parkland can process for them.
Another unknown is whether the virus will spread more widely now with Texas reopening some nonessential businesses.
According to Casanova, with the testing rate still below recommended levels, the number of hospitalizations becomes a key indicator to follow.
“We need to rely on the next best thing, which is also [a] very telling thing: how sick are folks, how many are landing in our hospitals in the region,” he said.
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