The Trump administration in mid-May dangled billions of dollars in new funding to states to expand COVID-19 testing, then left it to the states to figure out the details.
To meet the federal goal of testing at least 2% of their population monthly, Massachusetts said it is using research institutions to get easier and faster COVID-19 tests, according to plans it submitted to the U.S. Department of Health and Human Services. Connecticut said it developed a dashboard with daily updates on available testing capacity by each lab, as it prepares to test as many as 1.4 million people per month.
But Georgia’s plan has few answers to the dire problems of supplying and processing enough tests to help get the state’s spiraling epidemic under control.
Its strategy depends on the federal government supplying test kits, but the plan says that federal authorities often failed to tell the Department of Public Health when shipments would arrive or what they would include. In one case, the feds sent Georgia testing materials that DPH officials said very few labs in the state could use.
These problems could lead to disaster, the statewide plan warns.
“A reduction or cessation of federally supplied test kits will cripple the State’s response strategy and could inhibit the state from reaching our testing goals,” it said.
Georgia’s testing plan also omits any mention of lab turnaround times, a problem that has battered the state in recent weeks. Commercial laboratories have been overwhelmed by testing demand nationally. As of Thursday, the current turnaround time for most kinds of COVID-19 tests at commercial lab giant Quest Diagnostics was seven days to two weeks for patients not deemed as priorities, the company’s website showed.
Credit: rhorne@ajc.com
Credit: rhorne@ajc.com
The Georgia Department of Public Health said it didn’t include turnaround times because the high volume of testing that began at the end of June, as coronavirus cases surged, strained the testing capacity across the country.
“Had they been submitted, goals for test result turn-around times would have gone unmet given the current situation,” said DPH spokeswoman Nancy Nydam.
Yet even tests that are five days old can have little use, warns Jennifer Nuzzo, an expert on outbreak preparedness at the Johns Hopkins Center for Health Security.
“That test result basically becomes a historical document,” Nuzzo said.
Georgia is far from alone in these problems, according to an Atlanta Journal-Constitution review of a sampling of the state plans submitted to HHS to receive the extra federal funding.
South Carolina warns that it may be unable to reach its goals if federal supplies dry up. North Carolina cautioned that “with continued challenges obtaining PPE, collection supplies, and testing reagents; the State will need ongoing federal support to achieve our expanded testing goals.” Colorado said it was unable to meet its goals, and officials “have repeatedly identified testing supplies as the major limiting factor in scaling up testing and utilizing capacity.”
Thomas Tsai, a health policy expert with the Harvard T.H. Chan School of Public Health, said that without tests, a state cannot figure out who has contracted the virus, which makes it impossible to trace their contacts and keep them from infecting others.
“If you don’t have enough tests, you don’t have a strategy,” Tsai said.
There is no national solution in sight. At Trump administration briefings over the last week, Assistant Secretary of Health Brett Giroir touted the federal government’s testing ramp-up, but said that supplies of reagents, which are the main ingredient in the chemical-based tests labs use, will remain tight “as long as we have infinite demand.
“Which is what we do now,” he said.
In response to a question from the AJC, Giroir did not say when testing supplies would fully meet demand, if ever. But he said states were amply meeting the written plan goals, turnaround times were improving and those who really needed tests were getting them more quickly.
Furthermore, he said, “In terms of controlling the outbreak I want to be clear with this. I’m the testing guy and testing is important.
“But testing will not control an outbreak when you have seventy thousand new infections documented a day. What will control the outbreak is the personal responsibility that we have been talking about for months...That’s how we control the outbreak. Period, full stop.”
Test, Trace and Isolate
Georgia’s latest plan actually pulls back from earlier efforts.
On March 31, Gov. Brian Kemp announced a plan to dramatically increase test processing. The state would use the collective lab resources under DPH, the University System of Georgia and Emory University to process more than 3,000 samples per day.
By April 20, Kemp detailed another plan.
In a speech where he announced he would begin easing the state’s COVID-19 lockdown, he said Georgia would “double down” on testing through Augusta University Health and Georgia State University.
Augusta University and the Medical College of Georgia, he said, had developed a computer solution as part of a “comprehensive plan to screen, test and treat Georgia patients.” Georgians eligible for a test could download the university’s app, ExpressCare, and use it or a related phone number to get medically screened and then tested, Kemp said.
Results would come within 72 hours—and a clinician would deliver any positive result directly. Then that clinician “will assist you with enrolling in a self-reporting app by Google named MTX where—with patient consent—the Department of Public Health can use enhanced contact monitoring and tracing.”
“Testing defines the battlefield,” Kemp said. Between the apps and National Guard testing strike teams, Kemp added, “These efforts significantly increase our capacity as we take measured steps forward.”
Georgia reached its early goal of testing 10,000 per day. Augusta University Health and Georgia National Guard-partnered drive-thru sites tested more than 64,000 people.
But the MTX app never ended up working for self-reporting. Close contacts of coronavirus patients wouldn’t enroll. When the state filed its 22-page testing plan, the two-app plan took a back seat. The state remains focused on traditional resource-draining methods of reaching out to contacts themselves, an effort that has lagged.
“If you don't have enough tests, you don't have a strategy."
Augusta and Georgia State universities, which were enlisted to process samples collected at the drive-thru sites, are not currently contracted to help. The sites are now closed.
The plans changed as the challenges posed by the novel coronavirus shifted, Kemp spokesman Cody Hall said.
The new plan relies on private companies to process tests and sell the state supplies. Georgia will purchase supplies with federal funds, “with an assumption that these supplies will remain available to purchase,” it states.
The state is on track to test 7% of the population in July, according to DPH figures, although assessments from Johns Hopkins and Harvard universities show Georgia is testing only a fraction of what it needs to curb the spread of COVID-19.
States need to test many people repeatedly, and Georgia has 10.6 million people. Throughout the pandemic, Georgia testers have administered a total of just 1.5 million tests to diagnose COVID-19, according to DPH figures.
On July 20, after the state plan was submitted to HHS, the governor announced a partnership with Mako Medical to provide testing supplies and services to process 10,000 tests per day, and Kemp said results would be provided within 48 hours on average.
More barriers
Even if the partnership accomplishes that, Georgia’s plan won’t show whether the state is getting the coronavirus under control.
Experts agree that tracking the share of people who test positive for COVID-19 is a far more important measure. Areas grappling with widespread community transmission must conduct more tests, a factor which this measure, called positivity, takes into account. Other states use it to track the success of state efforts.
Nydam said the state is tracking this number daily and providing it to local health departments, even if it isn’t the plan’s key metric.
Georgia’s plan also underscores a chasm officials must cross to use testing to help get the virus under control: “A comprehensive, technically updated, uniform statewide surveillance system does not currently exist...forcing a patchwork approach to collaboration, communication and information sharing.”
Nydam said DPH budgeted $12 million in federal funds to fix this problem.
Potential solutions for other problems raised by Georgia’s plan do exist, said Tsai.
At its core, the problem of providing enough tests is a supply chain issue, he said, and manufacturing know-how exists to begin tackling it.
Public health officials could set up a dashboard to track which manufacturers have test supplies, which labs have capacity to analyze samples, how long it takes to get results back, and other measures. This information could tell officials how to shift supplies to where they’re needed and move tests away from overwhelmed labs to ones that can get results quickly.
Georgia does have procedures to adjust testing loads to address the problem of overburdened labs, Nydam said.
Ultimately, Tsai said, Georgia and other states need regional or national coordination to be effective with testing.
“States can’t go it alone,” Tsai said.
Nuzzo also said that having each state devise its own strategy clouds the issue.
“The fact that 50 different states are doing 50 different things makes very hard to track the virus, which makes it hard to understand what we should be doing with testing,” Nuzzo said.
“This course we are on is not sustainable,” she added.
A SAMPLE OF STATES
To understand how Georgia’s testing plan measures up to those in other states, reporters used the Georgia Open Records Act to obtain the most current version from the state Department of Public Health. Georgia and other states were required to submit the plans to the U.S. Department of Health and Human Services. HHS posts these plans on its website. AJC staffers selected states for comparison by considering factors such as demographics, region and population size, with the goal of sampling a broad spectrum of states with a wide variety of circumstances and resources.
The states reviewed are Alabama, Colorado, Connecticut, Florida, Georgia Iowa, Massachusetts, Mississippi, New York, North Carolina, Ohio, and South Carolina.
