Thousands more Oregonians may be tested for coronavirus right now, but state leaders aren’t ready to relax restrictive testing guidelines that could help them identify additional infections and better understand the extent of disease.
Strict controls on who should be screened have frustrated people with symptoms but are not among the highest risk groups. Some sick residents have to fend for themselves and risk infecting others, unsure if they do have the virus, even if the tests are not used.
Oregon’s limited test criteria created an access imbalance. Doctors and nurses generally follow the advice of the state but exercise discretion, allowing some people with symptoms to be tested in one place after being turned away by another.
A county in Oregon with the highest rate of infections in the entire state performs fewer total tests than a county with a smaller population and a fraction of the total number of infections. The state laboratory is not using its largely untapped testing capacity to fill this gap.
Seven weeks after the state’s coronavirus epidemic began, testing remains a daunting puzzle for the average Oregon man. There appears to be pent-up demand for more widespread testing – and the ability to provide it – but the state’s per capita testing rate ranks in the bottom half nationally.
Chunhuei Chi, director of the Center for Global Health at Oregon State University, said testing more people in Oregon could now help prevent the spread of the virus among people in a household or when someone infected but with mild or no symptoms goes to a grocery store.
This, in turn, could help reduce the number of active cases and speed up the schedule for trying to reopen parts of the economy.
“In the absence of increased contact tracing, the second best we can do is speed up testing by relaxing the criteria,” he said.
Relaxation of testing constraints to allow doctors to include mild symptoms is likely to occur over time, said Dr. Dean Sidelinger, epidemiologist and state health official.
But first, said Sidelinger, the state needs to build the capacity to test up to 15,000 Oregonians a week – not necessarily to test as many people – to ease restrictions on social distancing. Sidelinger said officials don’t know how close they are to this goal.
Oregon seems to have already reached it.
The state has reported an average of 1,300 test results per day in the past three weeks. The Oregonian / OregonLive discovered in a sample of about half a dozen hospital systems and healthcare providers that their staff and laboratories could perform at least 1,000 additional tests per day.
Add them together and that exceeds 2,300 per day or more than 16,000 tests per week.
Sidelinger said it makes sense at the moment to reserve the tests for people who have symptoms and fall into certain categories. These include first responders or health care workers, residents of nursing homes, people aged 60 and over, Oregonians with worsening symptoms, and those with underlying health conditions.
Testing people with mild symptoms may expose medical workers to the virus, and use supplies that may become scarce, according to Oregon Health Authority guidelines. But limited access to tests or supplies is no longer a barrier, admitted Sidelinger.
“If we made an explicit recommendation to test all mildly symptomatic people and asked them to be tested, yes, that would likely increase the tests,” he said. “But I don’t know if that would change the situation here in Oregon. “
It remains to be seen whether Oregon’s capacity target of 15,000 tests per week, or the equivalent of 60,000 tests per month, is an adequate benchmark, however. Oregon is one of a dozen states nationwide that does not have the capacity to test at least 100,000 people per month, according to data collected by federal authorities.
On a per capita basis, Oregon’s capacity seems even worse – drawing a direct mention from White House coronavirus response coordinator Dr. Deborah Birx at a briefing Friday in Washington, D.C.
“These are the three states in which we are working to build capacity,” she said, referring to Oregon, Montana and Maine by name.
Certainly, Oregon has not been affected as much by the coronavirus as many other states. The house arrest order announced by Oregon Governor Kate Brown on March 23 has undoubtedly helped to fold the infection curve, preventing a surge in hospitals and a rapid increase in deaths.
And extensive testing has shown that the infection rate is low when Oregon is compared nationally, with only one in 20 Oregonians tested finding they are infected. Officials don’t expect that to change dramatically with more testing.
But more infected Oregonians could be found – and other states, such as Utah and New Mexico, have relaxed the criteria for doing so.
A 36-year-old teacher who lives in northeast Portland is among those who are dismayed by Oregon’s mixed messages about the tests.
The professor developed a dry cough in the center of his chest on April 6. Over the Easter weekend, his fever hit the lowest of 100 and he felt tired. He wondered if it could be a coronavirus but doubted that he could get tested.
An online assessment by Kaiser Permanente revealed that, despite his symptoms, he was at low risk for coronavirus. He called a nurse, hopefully hoping to get his name on a list in case his symptoms got worse.
“The big message was that you don’t qualify for the tests, don’t come,” he said.
A Kaiser spokesperson said that people with symptoms of coronavirus are screened for nine defined criteria, none of which include non-essential workers or those without underlying health conditions .
The teacher asked for anonymity to protect his family from possible social reprisals. Because of the uncertainty of his illness, his wife has always left home to work or shop for the couple and their two children.
He finally found another supplier who tested it on Thursday and is awaiting results.
“If you don’t know, you don’t know what to do,” he said. “It’s really difficult to be in the gray zone. “
“NOT RECOMMENDED FOR TESTING”
Coronavirus testing has grown significantly since Oregon became one of the first states in the country to identify its first infection.
When a caretaker from Lake Oswego Elementary School tested positive for the virus on February 28, his test went to the state health laboratory – the only place in Oregon with the technology. For the next two weeks, the state lab was essentially the only game in town, and the Oregon Health Authority reported fewer than 100 test results a day.
But then, national laboratories and hospital systems came online. Oregon, like the rest of the nation, has seen a seismic change in the number of people who can be tested – although the United States still lacks per capita capacity in other countries.
The governor of Oregon was clear that not all residents could be tested, but stressed the importance of having more tests.
“It is essential for us to increase our capacity so that we can fully assess the spread of COVID-19 in Oregon,” Brown said on March 18, a week before the state began reporting results on a regular basis. tests for more than 1,000 people per day.
Coronavirus testing has increased rapidly but appears to have plateaued since then, with daily averages of 1,200 to 1,400 results in each of the past three weeks. The tests may have progressed recently, but it takes time for the results to be reported to the state health authority.
On Saturday, the state reported 72 deaths and 1,844 infections out of 37,583 Oregonians tested. Oregon’s ranking a day earlier was 31st nationally, including Washington, D.C., with 8.6 people tested per 1,000 people.
State instructions continue to discourage testing for anyone with fever, cough or shortness of breath – three hallmarks of coronavirus.
In bold, the health authority’s directives to doctors and nurses state: “Asymptomatic people and those who do not require a medical evaluation are not recommended for the test at this time. “
Sidelinger said he realizes that hospitals and other private laboratories could handle additional tests “if they were received”.
But confirming additional mild cases now through testing may have little value in how doctors would otherwise treat the suspected infections, he said, given that the Oregonians are all under control stay to prevent the spread of coronavirus.
“Clinically, if it doesn’t change what the provider tells them to do, or how they treat them, that provider might not order this test,” he said. “And we hear that from several suppliers. “
“TEST ALL INDIVIDUALS WITH SIGNS AND SYMPTOMS”
Some states comparable to Oregon are much more aggressive in screening for infections.
Utah and New Mexico stand out. Both correspond to the low rate of Oregon infections, finding that about one in 20 residents tested has the virus.
The two test about twice as many people per capita as Oregon.
It’s not just that Utah and New Mexico have large laboratories that almost immediately increased the availability of tests. They also relaxed the restrictions.
On April 1, officials from New Mexico gave the green light to tests for symptomless people who had close contact with a known case of COVID-19 or those who live in nursing homes or homeless shelters. -shelter. The state also said that people with fever, cough or shortness of breath who did not necessarily need medical attention could be considered for the test.
“I don’t want to sound like we’re geniuses here. We are not, “state spokesman David Morgan said. “Math worked for us, as did the desire to pursue aggressive testing. “
New Mexico now has the capacity to perform more than 21,000 tests per week, he said. As of Friday, he had tested approximately 35,000 people.
TriCore reference laboratories handle more than half of all tests in New Mexico, and the state’s public health laboratory performs about a quarter. The rest of the tests were analyzed by private companies such as Quest Diagnostics and LabCorp, according to state data that Morgan shared.
Utah, on the other hand, has hosted tech entrepreneurs who have developed a website to assess residents’ symptoms and direct them to testing locations. Public health officials have also launched an aggressive media campaign to encourage testing as capacity increases.
“Health care providers and test sites should test ALL individuals with signs and symptoms (fever, cough or shortness of breath), no matter how mild the symptoms,” the official Twitter account for the state for news on coronaviruses.
On Tuesday, the guidelines were revised again to include one of these three symptoms, as well as three others: muscle aches and pains, decreased taste or smell, or sore throat.
“Do you have a symptom?” Asked an eye-catching graphic. “Get tested. “
Nearly 60,000 people in Utah have now been tested. More than half of the state’s tests have been analyzed at a local laboratory, ARUP Laboratories, while a large chain of hospitals has completed about a quarter, according to data provided to the newsroom.
Officials relaxed the restrictions when they realized that many tests were not used every day.
“Everyone is concerned that we have this unmet request,” said state spokesman Tom Hudachko. “If we can test 5,300 people, we would like to test 5,300 people. “
“Truly restrictive guidelines”
Health care professionals in many parts of Oregon say they have unused coronavirus tests.
It seems that relaxing the restrictions may increase testing, although other factors may be at play, including the possibility that fewer Oregonians will be sick or general confusion among residents as to whether they should be done. screen.
In southern Oregon, the Asante hospital system has helped propel tests in Jackson County to enviable levels by opening a driver service in mid-March, where more than 2,100 people have now been tested.
At its peak, nurses collected nasal samples from about 200 people a day, said Lauren Van Sickle, spokesperson for Asante. Now it’s about 60 people.
“I would say the news has dissipated fairly quickly,” she said of the buzz on the road in a parking lot in the mall.
Van Sickle could not determine the cause of the dropout, but suggested that the number of county residents seeking testing may have decreased as fewer people had symptoms.
Oregon’s largest healthcare system, Providence Health & Services, is also experiencing a slowdown.
The internal lab processed about a quarter of all tests for the Oregonians, according to data provided by spokesman Gary Walker.
But Providence could analyze samples for about 600 people a day, taken from tests done in its hospitals and walk-in clinics. Instead, it’s about half a day on average.
Walker said Providence would like to be much closer to its full capacity “and we are looking at ways to do it”, including “how to relax” the test criteria.
Legacy Health can process approximately 750 coronavirus tests per day between its internal laboratory and the use of the new Abbott ID Now rapid tests in emergency care centers. But over the past week, total tests have averaged about 270 a day, said spokeswoman Sarah Ericksen.
It’s a similar story for the Virginia Garcia Memorial Health Center, albeit on a much smaller scale. Driving locations across Washington and Yamhill counties test about 20 people a day, which is below the target of 28. Officials have now posted targeted ads in hopes of encouraging testing with their mainly Latin American customers.
“This is something we discuss every day,” said spokeswoman Kasi Woidyla. “How do you get the word out to everyone?” “
The same goes for Oregon Health & Science University. Two transit locations could accept each of the 100 patient samples per day, said spokeswoman Tamara Hargens-Bradley. Instead, it averages around 35 people a day.
“We are trying to make it accessible to as many people as possible without being overwhelmed,” she said, adding that some patients who were not members of the OHSU network had even been accepted.
Erik Vanderlip, chief medical officer of ZOOM + Care, said that the company’s clinics in Oregon are sitting on fewer than 1,000 test kits that could be used at a collection site by car.
Releasing the guidelines on who to test would allow the company to test more people, he said, expressing optimism about the changes ahead.
“We are subject to very restrictive guidelines as to who can get tested,” he said.
“MORE PEOPLE SHOULD BE TESTED”
As Oregon seeks to reopen parts of its industry, possibly as early as next month, it looks like more testing options will be available.
Last week, the University of Oregon announced that it would soon run tests for the McKenzie-Willamette Medical Center in Lane County, starting with 100 tests per day and increasing to 300.
The Oregon State University veterinary laboratory has partnered with the WVT laboratory in Benton County to perform up to 1,000 tests a day, according to the Lund report.
The state of Oregon is also launching a four-week effort to collect random samples from nearly 1,000 residents of Corvallis. The study will assess the spread of the virus and obtain a benchmark for the rate of infected people without symptoms – which will be a major and revealing discovery.
State officials also say they are also looking to improve the testing capacity of the public health laboratory, which can now test up to 200 people a day. One day this week, state officials conducted only 20 tests.
Additional state testing could potentially help resolve testing problems across the state, such as in Marion County.
Data shows that one in 10 people tested has coronavirus – the highest rate in the state – although this is partly due to outbreaks in nursing homes. Marion County identified 335 infections but fewer residents were tested there than in Jackson County, which had only 49 infections until Saturday.
Marion County health officials did not agree to be interviewed or discuss the difficulties local providers face in expanding the testing.
“We think more people should get tested in Marion County and the state as a whole,” county spokeswoman Jenna Wyatt said in a statement.
Oregon Health Authority officials said they were not aware of the insufficient availability of tests in Marion County, but would assess how to help if the county requests it.
Sidelinger said testing capacity will play a key role in when and how the state will relax Oregon’s home stay order. He recognized that the figure for testing capacity of 15,000 per week is a rough estimate of what public authorities consider necessary.
“Part of that is back from the envelope, but that is also our goal,” he said. “Part of our planning now is to see how close we are and how much additional capacity we need.”
Public health officials would like to see fewer active infections and fewer hospital admissions before lifting restrictions on staying at home, so there are fewer people at risk of spreading the virus. The latest modeling suggests that this might not happen before the end of May at the earliest.
The plan is to have a more robust effort in place to test not only those suspected of being infected, but also do a much better job of identifying their close contacts for testing and quarantine.
“This is why we want to have the testing capacity,” said Sidelinger, “… so we can identify people early, track contacts, analyze hot spots, and see who is potentially exposed and the keep it at home – so we can limit the spread. ”
Mark Friesen contributed to this report.
– Brad Schmidt; [email protected]; 503-294-7628; @_brad_schmidt
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