Connecticut is geographically caught between two hotspots of the coronavirus pandemic but has systematically turned away people for testing over the last, crucial few weeks because — until recently — it was only running 20 tests a day.
The state’s limited testing could hamper its ability to slow the spread of COVID-19 in the general population, experts say.
As of Thursday morning, the state’s public health lab in Rocky Hill had completed just 90 of the 1,200 tests it has received from the federal Centers for Disease Control and Prevention.
“That’s horrible. We are vastly, vastly, vastly under-testing at this point,” Dr. Howard P. Forman, director of the health care management program at Yale School of Public Health, said Wednesday. “Without testing, you don’t know what prevalence of disease you have in the community.”
Four people have been diagnosed to date with COVID-19, according to public health officials, but that doesn’t mean there aren’t many more people infected throughout Connecticut. Because the state lab only had the staffing capacity to run 20 tests a day, a decision was made to only test those whose condition had deteriorated enough to be hospitalized.
State officials do not know how many people with symptoms sought testing only to be told they did not meet the state’s criteria.
“It’s a conversation between people and their doctor and there’s no way we can track that,” Av Harris, spokesman for the state Department of Public Health, said Thursday.
The problem with limited testing, according to Forman and other experts, is that it prevents public health officials from quickly identifying those who should self isolate, raising the odds that people infected with the virus will remain out in the community and infect others.
Nationwide, Forman believes there should be at least 100,000 tests being completed daily, including 1,000 in Connecticut.
“And that’s bare minimum. That’s not to do surveillance testing and go out and say, ‘Let’s figure out if our schools are infected out there. Let’s figure out whether a particular factory is infected.’ That’s really just doing it for people that are presented with illness to be able to send them home with proper information about quarantine or isolation,” he said.
Until the state accurately knows how widespread the problem is, it’s hard for communities to respond and prevent further spread.
“We do not know how large of a risk it is,” said Xi Chen an assistant professor of public health at the Yale School of Medicine. “For Connecticut, I cannot tell whether we should or should not be closing schools based on the numbers. I’m more concerned now about the number and whether it reflects actual cases.”
State leaders have acknowledged the shortfall.
“That’s the choke point right now: being able to identify people to make sure that those that are infected and contagious are quarantined,” Gov. Ned Lamont said Tuesday when declaring a public health emergency. “The biggest issue is, I think, the choke point on the testing.”
Given the state’s limited ability to test, the state’s chief epidemiologist said Wednesday that those who suspect they have the coronavirus should assume they do.
“If you have a cough, for example, and you are in the Southwestern part of the state, you should assume that you have COVID. You don’t need a test to tell you that that’s what you have. You should assume that that’s the illness that you have,” Dr. Matthew Cartter told reporters Wednesday.
Public health labs across the U.S. have tested more than 5,000 people, according to the federal government. And while issues such as supply shortages and faulty testing kits have stymied testing, Connecticut has lagged behind some of its neighboring states.
New Hampshire – which has almost one-third the population of Connecticut – has also tested 90 people. Rhode Island has tested 107 people, Vermont 63. It wasn’t immediately clear how many tests Massachusetts or New York have each done, but there have been 95 and 216 positive tests results, respectively.
South Korea’s ability to test 15,000 people a day is seen as somewhat of a model – and is 14 times the number of tests the U.S. is capable of completing each day, said Forman.
“And Connecticut is probably a little low on the end of what we’re capable of doing [as a nation],” he said.
Testing alone does not save an individual’s life.
“We’ll treat them the same, either way,” said Forman, who is a practicing clinician in the Yale New Haven Hospital Emergency Room and also working with groups in Connecticut and around the country to contain the spread of COVID-19.
The state’s strategy
The state has received two kits with a total of 1,200 tests from the federal government, but that doesn’t mean it has had the ability to test 1,200 people. Until two days ago, guidance from the CDC required states to use two testing kits for each person who met the state’s criteria. Those guidelines have recently been relaxed, which will allow the state to test more people.
But with uncertainty surrounding access to the necessary materials for hospitals to begin running tests themselves and questions about the capacity of commercial testing companies, Connecticut adopted a strategy to protect the services people need the most during a pandemic: the hospitals.
“That testing is for every acute hospital in Connecticut. People get sick with pneumonia and acute respiratory distress all the time – and our hospitals need to know which one of those is COVID-19 so they can take appropriate precautions,” said Cartter, the state’s chief epidemiologist. “This is taking all the resources of our lab right now. The focus of our labratory right now is keep the hospitals open and protect the workers in the hospital.”
Other states, like New York, are taking the opposite approach.
New York Gov. Andrew Cuomo said during a briefing Wednesday that massive testing is the only way blunt the spread.
“When you look at the experience in China, you look at the experience in South Korea, what changed the trajectory of the incline of the number of cases, it was a tremendous amount of testing and investigation,” said Cuomo. “Our testing capacity is nowhere near what it needs to be. … That is the single most troubling point in the state right now.”
The New York Times reports that the state has tested fewer than 2,000 people.
“The more tests we get, the more positives we will get. That is exactly what we are seeking,” said Cuomo. “This is when we find a person who is positive, asking them who they came in contact with and then testing that chain.”
Cuomo said the testing results don’t show the reach of the virus.
“It is much more widespread than people acknowledge,” he said. “My guess is when we go back and we look at this, there were many people who had coronavirus where it resolved and nobody knew about it.”
More testing on the horizon
By next week, the state lab will have more staff trained so it can complete 60 tests daily. A cohort of nine employees will take turns working three shifts, 7 days a week. But that’s the maximum capacity the state lab will have going forward.
The state is also working with 10 hospitals around the state to begin screening those who may be infected and aren’t yet hospitalized, but officials said they are waiting for key materials to become available to begin that work.
“All of our hospitals have the people who are capable of running this test. They’re now waiting to get orders of the test reagents to do it themselves. So we know that Yale New Haven [Health] is pretty far along on this,” Cartter said. “They can all do the test as long as they have the reagents.”
Several hospitals are also waiting for federal approval to begin testing.
“We know a number of Connecticut hospitals are currently working through the FDA process to conduct testing at their facilities. We expect to have hospital testing available soon. At this time, no Connecticut hospital is currently serving as a testing facility,” said Fiona Phelan, spokeswoman for the Connecticut Hospital Association.
Hartford HealthCare executives said they are piloting a drive-through testing program for COVID-19 that will allow patients to pull up at a designated location and provide a sample without stepping out of their vehicles.
Patients would have to make appointments beforehand, and upon arrival they would be swabbed. The samples would then be submitted for testing. The drive-through program could be available as early as next week.
“As you’ve heard, we’ve had mixed signals about the testing capabilities whether through the labs or DPH,” said Dr. Ajay Kumar, chief clinical officer at Hartford HealthCare. “We’re still in the final stages of determining where we are going to be with that. But when the system is ready, we’re going to be offering the service to our community where folks can be directed to a testing center and they can get the sample taken at that time.”
Greenwich Hospital began collecting specimens in a tent outside the hospital Monday and is working with a private lab to begin testing the samples. Before collection can occur a physician’s order is required.
An announcement by Quest Laboratories that they would begin accepting samples from places outside the West Coast was welcomed by the Lamont Administration.
However, Forman said that Quest only has the capacity to run 4,000 daily tests nationwide, according to figures compiled by a former FDA commissioner, and published by the American Enterprise Institute.
“These tests are not simple things to do,” he said.
Connecticut Public Radio senior reporter Patrick Skahill contributed to this story.