Criticized for withholding public health data, Governor Charlie Baker on Saturday disclosed the state only tested only 475 people for coronavirus, a figure that raised questions about efforts to contain the outbreak in Massachusetts as public health experts warned the shortage of data would obscure the full extent of the burgeoning pandemic. On Sunday, the state said 799 people had been tested.
The scant number of tests Saturday underscored how far behind Massachusetts and the entire country are in trying to contain an illness that has spread rapidly. Until 10 days ago, Massachusetts had reported just three cases; now that figure is up to 138, state officials said Saturday.
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Much of the blame by public health experts has been focused on the Trump administration’s slow and chaotic response, which included significant missteps that have severely limited testing.
But the state has offered differing accounts on the number of tests for Covid-19, the disease that has set off a global crisis. Since the tests initially required using swabs to collect multiple specimens from the same person, the lack of clarity stemmed in part from whether officials were describing the number of people tested or the number of specimens tested.
On Monday, Health and Human Services Secretary Marylou Sudders told the Globe in an interview that the state’s Public Health Laboratory had tested 185 “specimens” since it was given federal approval on Feb. 28. On Tuesday, Public Health Commissioner Monica Bharel said “several hundred people — roughly 400 individuals — had been tested so far.” Then, throughout the week state officials cited larger figures that suggested testing had ramped up, noting the state lab could perform 200 tests a day and that Massachusetts has supplies to screen thousands more.
“It is very important that DPH be completely transparent about the number of tests performed, the number of people tested, and the number of patients who have tested positive," said Dr. John Patrick, a retired emergency medicine physician at Mount Auburn Hospital. “If they are just not releasing information, that could lead to a decline of public trust, and that public trust is a valuable commodity as you hope people will follow your instructions.”
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Also, unlike other states that are providing daily updates, Massachusetts said it will begin releasing figures on the number of tests on the DPH’s website once a week. That is much too slow, according to Dr. Davidson H. Hamer, a professor of global health at Boston University and faculty member of the university’s National Emerging Infectious Diseases Laboratories.
“That just seems crazy. We are in the middle of a serious epidemic in the state, and we should have daily updates,” Hamer said. “To hospitals doing contingency planning, it’s really critical. ... We need to know how this is going to move.”
Dr. Michael Mina, professor of epidemiology at Harvard’s T.H. Chan School of Public Health, said the state needs to release more testing data, more often. The lack of testing, the lack of results, the lack of information means doctors and researchers have nothing to work with.
“It has kept us essentially blind to the state of this epidemic within our own state,” Mina said.
With the right information, the public “would make decisions differently,” Mina said. “They would see just how critical this really is.”
Massachusetts Attorney General Maura Healey has also criticized for administration’s disclosure of information as inadequate.
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The Baker administration on Saturday said Bharel misspoke and incorrectly doubled the number of tests earlier in the week. In a statement, the administration did not address why it did not correct the erroneous information about testing. Instead, the Baker administration laid blame at the Trump administration and the US Centers for Disease Control and Prevention, which many public health experts have also blamed for moving too slowly to expand the nation’s testing capacity and relax the standards for who gets tested.
“The federal government has not moved fast enough to both provide testing materials and clearance for additional lab capacity,” Baker’s communications director, Lizzy Guyton, said in an e-mail. “The Department is aware of and working to address residents’ frustration and concerns, and in the coming days, the DPH will provide the most accurate information possible as DPH increases testing capacity.”
In the past few days, the state and the federal governments have each made changes to public health protocols that should significantly increase the number of of tests kits, facilities that can run the analysis, and people qualifying for a test. Given the testing figures in Massachusetts now, Dr. Dani Hackner,chief clinical officer for the Southcoast Health medical system, said the expanded facilities and protocols will likely result in much higher number of people testing positive for Covid-19.
“We expect that, not only with the new criteria, and the ramp-up in testing capability in Massachusetts, we’ll see a very large increase in testing throughout,” Hackner said. “In the next week or two, if we see a rise in numbers, what that could signal is that we are identifying people better."
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On Saturday, the Mass DPH said the total cases in the state increased by 15, to 138. Nineteen of those cases are confirmed by the CDC, and 119 are presumed positive awaiting further confirmation, the state said.
Three quarters of the cases in Massachusetts — 104 — can be traced to a single hotspot: a management conference that the biotech company Biogen held at the Boston Marriott Long Wharf in late February. It’s not been disclosed how many of those are Biogen employees, and how many are people who had contact with those at the conference.
It remains unclear how widely the state has tested just to measure the reach of the Biogen outbreak. Many Boston-area physicians have raised alarms about the severe shortage of tests and difficulty in getting patients approved, saying those are forced them to turn patients away who they believe should be tested for coronavirus.
“I feel, as a physician, like I’m pretty paralyzed by this, I think that’s the only word I can use. Paralyzed. I’ve never been in a position like this in my life,” said Dr. Tina Lee, a physician at Southcoast Health who voiced her frustration about the lack of testing in a video posted to Facebook Saturday. "It’s been very strange to want to test for something, and have a high clinical suspicion for something, and not be able to do it. "
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It is clear that 475 tests in the past two weeks is nowhere near enough to track and contain the virus. To replicate South Korea’s successful efforts to slow 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, Mina, the Harvard epidemiologist said.
Baker on Saturday said his administration had set up a new command center to triage issues arising from managing the conoravirus outbreak. The administration also made two changes intended to speed up testing: Doctors would no longer needed to receive testing approval from the state lab prior to submitting specimens for patients that meet particular criteria, Sudders said; and, doctors could also begin submitting a single swab of material, rather than the previously two swabs.
“Far more people are going to get tested over the next several weeks,” Baker said.
Asked about Healey’s criticism of the state testing, Baker said: “We said for the past several weeks that we are deeply concerned about the lack of a response from Washington to make it possible for states like ours to dramatically expand our testing criteria and our testing capacity."
The US testing effort has been hobbled by a series of delays, including flaws with the testing kits first distributed by the federal government and bureaucratic hurdles that held up testing by private labs at hospitals, universities and testing chains.
Public health labs across the country are now running the tests, and large commercial labs such as LabCorp and Quest are ramping up too. Thermo Fisher Scientific, the Waltham-based laboratory equipment firm, late Friday was given approval to provide high-speed tests to hospitals and laboratories that will be able to diagnose the new coronavirus in as many as 5 million people a week. The tests can provide results within four hours of a sample arriving at a lab, Thermo Fisher said.
Swiss medical company Roche also received emergency approval from the FDA to run coronavirus tests on its automated, high-volume testing system.
The Trump administration has also adopted a new testing strategy designed to screen hundreds of thousands of Americans at drive-thru centers based around major retail chains. Countries including South Korea and Germany have been using that approach for weeks, allowing people to quickly provide a throat or nasal swab for testing without leaving their cars.
Baker on Saturday said those changes were welcome.
“The recent changes from the CDC with respect to testing criteria, which we just implemented, and the availability now of other labs ... to be able to test will dramatically increase our ability to test and that’s a really good thing,” he said. "In some respects we have a long way to go on this, but the Feds do seem to be getting much better at providing a path for states like ours to test a lot more people.”
Mina, the epidemiologist from Harvard, said Baker is right to point the blame at Trump.
“It has been inadequate in the state, as in every state, in terms of really being able to monitor this pathogen appropriately. But I don’t think that at the state level it has been a failing," Mina said. “This is something that is happening in every state lab, which makes me think it is overall a federal issue of preparedness.”
Material from the Associated Press is included in this report.
Andrew Ryan can be reached at andrew.ryan@globe.com Follow him on Twitter @globeandrewryan. John Hilliard can be reached at john.hilliard@globe.com. Tonya Alanez can be reached at tonya.alanez@globe.com. Follow her on Twitter @talanez.