Despite assurances from Governor Charlie Baker and top state health officials, Massachusetts doctors say a severe shortage of tests for Covid-19 is hindering efforts to control the local coronavirus outbreak.
State health officials have kept strict limits on who can be tested for the coronavirus, forcing physicians to turn patients away who they believe should be tested, according to doctors and patients. And while the testing shortage is a national crisis that originated with the Centers for Disease Control and Prevention, other states are testing more people than Massachusetts and have been significantly more transparent about the scope of testing — a key component to containing the virus.
Testing is critical to combating infectious disease because it diagnoses the sick, determines who has been exposed to the virus so they do not infect others, and measures the effectiveness of containment measures.
But Massachusetts officials have not routinely disclosed the total number of people tested and the state has urged hospitals not to provide their own numbers. The most recent figure was released at a news conference Tuesday, when Massachusetts Public Health Commissioner Monica Bharel said they had tested approximately 400 people in total since Feb 28 and that the state lab had “adequate supplies and adequate staffing” and was doing a “superb job.”
But at Massachusetts General Hospital, Dr. Monique Aurora Tello described in a Facebook post Wednesday seeing eight people with probable coronavirus, some of whom had recently been on buses and planes — and being unable to test some of the suspected cases.
“Testing pending for some but the State wouldn’t let us test them all,” Aurora Tello wrote. “Not enough tests!!”
In an interview, Aurora Tello declined to provide a specific number of the people that could not be tested because of the directive from the state Department of Public Health, which she said was performing as well as it could under the circumstances. But Aurora Tello described severe limits on testing that have prevented medical officials from containing the virus.
“In the early stages of an outbreak, this is how to get it under control. You test, test, test, test,” Aurora Tello said. “Get the contacts of the people who tested positive and get everybody doing their quarantines. That’s how you get it under control. We never did that here and it’s past the point of containment.”
State officials announced Thursday that coronavirus cases have risen to 108. At a news conference in Pittsfield, Baker urged the federal government hasten approval of private and hospital labs to add testing capacity. But he offered little new information about the state’s testing efforts. The governor said that the state received supplies to test 5,000 more people, but he did not say how long it would take to perform those tests.
Earlier this week, state officials said it had the capacity to perform 200 tests a day, but the Baker administration has not said if that many people were actually being tested.
Even with the new material, it would take the state lab on its own at least 25 days at full capacity to perform 5,000 tests, a number far below what public health officials say is needed to help stem the spread of the virus. A spokeswoman for Baker referred follow-up questions to the Department of Public Health, which is also overseen by the governor.
Thursday night state health officials announced that two commercial labs received federal approval to test for Covid 19 in Massachusetts, which should increase the number of tests processed each day, but they did not say by how much. One of the labs reported its first presumptive positive test, which was included in the numbers released Thursday by the state.
The state has said it follows CDC guidelines for Covid-19 testing, which initially limited the test to those who had traveled to designated international locations and had symptoms, or had known contact with individuals with confirmed cases. Last week, the CDC loosened the guidelines, leaving testing to the discretion of clinicians. But until Thursday in Massachusetts, all tests were performed at the state lab in Jamaica Plain, which has limited capacity and rejected many requests, doctors said.
Officials Monday automated a portion of the test that allowed the state lab to increase capacity from 50 a day to 200. But even that increase seemed inadequate in the face of the pandemic. Dr. Michael Mina, professor of epidemiology at Harvard’s T.H. Chan School of Public Health, estimated that based on the success South Korea has had slowing the virus, Massachusetts needs to be testing roughly 1,000 people a day for the next three months, to achieve what the Koreans did in about three weeks.
Another physician, Dr. David Dildine, wrote on Facebook that he has seen three patients with symptoms and exposure to others who have tested positive for the virus and that, “getting the tests approved is becoming increasingly difficult.”
“Many patients at high risk are not being tested,” wrote Dildine, who declined an interview request and noted in his post he was offering his personal view. “I do not believe we have contained that [Biogen] cluster and expect it to become widespread in MA in the coming weeks. I agree with others who suspect this has been spreading in the community. We don’t know because we aren’t testing.”
There are essentially two different ways of combating the coronavirus — wide-scale quarantining or widespread testing — and the United States and many states, including Massachusetts, have been doing poorly at both, according to Mina.
But Mina said widespread testing is likely to be the far more effective approach, especially in the United States, rather than shutting down large swaths of everyday life. South Korea, with its widespread testing, has demonstrated that it is possible to turn the tide and slow infection rates, he said.
South Korea’s robust testing system was forged from hindsight, after a deadly 2015 outbreak of Middle East Respiratory Syndrome there exposed a lack of testing capacity. Afterward, the country created a nimble system that allows regulators to collaborate quickly with researchers to rapidly develop and approve test kits for viruses.
By comparison, the CDC relied on a much more rigid approach, insisting state labs use a CDC-developed test, instead of one already approved by the World Health Organization. That CDC test turned out to be flawed, and the US lost precious weeks in tracking and tackling the coronavirus.
Massachusetts and other states should stop using narrow rules for rationing testing, Mina said.
“We should be trying to test as much as possible and not just our clinically significant patients,” he said.
Boston’s two largest academic medical centers are racing to complete steps that will allow them to test patients for Covid-19, doctors said. Brigham and Women’s Hospital is likely within a week of bringing its test online, while Mass. General should know in days when it can start testing people, they said.
“Everyone is working as hard and as fast as they can,’’ said Dr. Eric Rosenberg, director of the clinical microbiology lab at Mass. General. “If this wasn’t a crisis situation this is the sort of test that would take a couple of months to bring on board for clinical use.’’
The Brigham will be able to test a maximum 100 people a day, while Mass. General expects that initially it could run 20 to 40 tests a day but could increase that number eventually. The hospitals will focus on testing patients at their own facilities, particularly those who are sick and need urgent treatment. If they are able to, they would look to relieve the health department of some of the burden of wider testing.
There have been a number of obstacles preventing hospitals from launching their own tests. The federal government initially limited who could run tests until the US Food and Drug Administration recently relaxed the requirement. That has allowed hospitals to move forward, although they will still need final approval from the FDA.
A chemical needed to extract the genetic material from the virus for testing has been in short supply because of the demand, Mina said. The Brigham has enough of the chemical to get started on testing but it will soon need more, he said.
Then there’s the matter of the test itself. Because the virus is new, companies that would normally manufacture quick tests have not had time to develop the technology and get federal approval. Compared to tests for the flu, the diagnosis of Covid-19 requires more staff and takes longer to produce results.
“We normally use tests for viruses that are akin to microwave dinners. You put it in a microwave and push a button and get a result back," Mina said. With this “it takes hours to run a group of 20 samples.’’
Testing people for the virus has two main purposes: To diagnose sick people, direct their treatment, and protect health care workers; and to test those who have been exposed to the virus so they do not infect others and to measure the effectiveness of containment measures.
“The lack of testing in the United States is a debacle,” said Marc Lipsitch, professor of epidemiology at Harvard’s Chan School and director of the Center for Communicable Disease Dynamics. “We’re supposed to be the best biomedical powerhouse in the world and we’ve been unable to do something that every other country has been able to do.”
The United States has tested a few thousand people since the beginning of the year, Lipsitch said in a telephone briefing with reporters on Wednesday. In contrast, one province in China tested 320,000 people in two and a half weeks.
“We are nowhere near what we need” in terms of testing capacity, and not moving quickly enough to meet the need, Lipsitch said.
Massachusetts’ 400 tests through Tuesday were significantly fewer than the 3,400 conducted by Washington state, where there have been 29 deaths due to the coronavirus. State officials there post the total number of tests on a regularly updated website, which showed nearly 1,000 additional tests in the most recent day, offering a full picture of authorities’ efforts to track the scope of the virus.
Other states do the same on their websites. New Hampshire reported performing tests on 90 people – with five positive results — through Wednesday morning. Vermont’s disclosed 41 tests – and 1 positive case – through Tuesday afternoon.
On Wednesday, Hillary King went to Mass. General at the direction of her health insurance company because she had a cough that kept her up through the night and had trouble breathing.
“The nurses would hear me cough and look at me sideways,” said King, who lives in the North End, where an infected attendee at a Biogen conference last month sparked the state’s largest known outbreak. But King had not had any known contact with someone who had tested positive and based on the criteria outlined by the Department of Health she didn’t qualify for testing. She described her doctors pleading for a test, admitting to her that her symptoms and negative flu and strep tests suggested she might have Covid-19.
“You could tell they really really wanted to test me,” said King over the phone, between coughing fits from her apartment. “But ultimately the doctor got off the phone with DPH and said there were not enough kits for use beyond those that meet the exact criteria.”
Hanna Krueger and Felice J. Freyer of the Globe staff contributed to this report.
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