A ray of hope in coronavirus outbreak: Mass. loosens rules on who can get tested

Nurses at a drive-up COVID-19 coronavirus testing station set up by the University of Washington Medical Center wore protective gear as they wait under a heater next to a tent Friday, March 13, 2020, in Seattle.Ted S. Warren/Associated Press

Amid mounting frustration over access to coronavirus testing, the Baker administration on Friday released new guidelines to health care providers that significantly relax rules on who can be tested, a move doctors say should substantially increase access.

But it remains unclear exactly how many tests the state is actually completing. The administration promised to double capacity, from 200 tests daily to 400, by next week, but Baker and his health secretary refused to reveal how many Massachusetts residents have actually been tested each day. They said that information won’t be released until Wednesday, and only on a weekly basis after that.

That sparked the ire of state Attorney General Maura Healey, who chided the administration for a lack of transparency and urged leaders to do better.

“The governor’s statement today that people need to wait until next week to get this information is not good enough. Health workers, school and local officials, and the public need this information to be able to make informed health decisions,” Healey said. “The governor must move with more urgency.”

Healey also criticized Baker for failing to coordinate a response across state agencies to address child care, especially for health workers, as well as unemployment benefits, mortgage and rent issues, and business assistance.

Hours earlier, the state health department issued a memo to health care providers saying many patients who didn’t fit the state’s earlier, narrower criteria for testing would now be eligible for a test.

Until Friday, the health department was guiding doctors to only allow testing for patients who were showing symptoms of Covid-19 illness — fever and respiratory problems ― and only if they had traveled to countries with high levels of the disease, or had been in contact with someone who had a confirmed Covid-19 illness. Doctors were required to call the state health department to get permission to take a nasal and throat swab from each patient who fit that narrow criteria before sending the specimen to the state’s lab for testing.

Health care providers were balking at that, saying some patients appeared to have the illness, but didn’t fit the state’s rigid criteria. More widespread testing was crucial, they insisted, to diagnose the sick, determine who’d been exposed to the virus so they would not infect others, and measure the effectiveness of containment measures.

Under the new rules, health care providers no longer have to get prior state permission to submit specimens for testing in the state’s lab. The rules also dropped the requirement for providers to submit both a nasal and throat swab from each patient; now a nose swab will suffice. And, most striking, patients who have a “mild to moderate” respiratory illness or a fever, but did not travel to a high risk country or have direct contact with an infected person can get tested — if their provider suspects Covid-19 illness.

The state’s expanded guidelines could mean anywhere from a threefold to a tenfold increase in who gets tested, said Dr. Daniel Kuritzkes, the head of the infectious disease division at Brigham and Women’s Hospital.

Kuritzkes said dropping the prior approval of the state health department for each test clears a huge hurdle. That process was causing a backlog, since each case had to be reviewed by a limited number of health department staff, he said.

Kara Keating Bench, a doctor at Lynn Community Health Center, said getting approval from the state health department for testing has been cumbersome. Doctors could call at 11:30 a.m and wouldn’t get a response until 5 p.m., she said.

“It takes hours, it’s ridiculous,” Bench said. Under the new guidelines, "we can use our clinical judgment, which is nice.”

Bench said she had a patient this past week with a history of asthma, who had recently traveled domestically and returned with a persistent cough. Bench said she couldn’t even ask the state for a test, because the woman didn’t meet the required criteria.

Though she’s relieved that such a patient could now be tested, Bench worries that widespread testing won’t proceed quickly enough, because supplies, such as vials, masks, gloves, and swabs are limited.

“I don’t know how we’re going to get that,” she said.

Paul Biddinger, chief of the division of emergency preparedness at Massachusetts General Hospital, hailed the looser guidelines, but he said the real game-changer would be a faster, more efficient, commercially available test for the coronavirus.

The Food and Drug Administration this week gave the emergency green light to Swiss medical company Roche to start mass-producing its test kits, which can provide results in three and a half hours.

But it will take some time to get these kits out into the market, Biddinger said.

Meanwhile Mass General on Friday started deploying its own, in-house tests for the most urgent cases of admitted patients and certain staff, Biddinger said.

It’s labor intensive and takes half a day, but gets faster results than the two- or three-day wait times at the state health department’s facilities and the two commercial labs that have received FDA approval to conduct tests, he said.

Several commercial labs nationwide came online this week to accept large numbers of samples, but it’s unclear whether they will be prepared for the deluge, said Dr. Michael Mina, professor of epidemiology at Harvard’s T.H. Chan School of Public Health.

“A major concern is that as these looser restrictions take place across the country, the commercial laboratories may become overburdened and backlogged as well,” Mina said.

Felice Feyer of the Globe Staff contributed to this report.

Kay Lazar can be reached at [e-mail] Follow her on Twitter @GlobeKayLazar. Deirdre Fernandes can be reached at [e-mail].