Six weeks after Maine began lifting its pandemic lockdown measures, the state is poised to achieve the testing abilities recommended by leading national public health experts.
Gov. Janet Mills announced last week that the state laboratory will soon quadruple its testing capacity, allowing it to process tests of asymptomatic front-line workers such as first responders, nursing home employees, migrant farm laborers and grocery store clerks. The boosted capacity – 32,000 tests a week, or 4,571 per day – will put the state at levels that public health experts say are necessary to ensure a phased reopening is successful.
The figures do not include an unknown amount of additional capacity available at commercial and hospital network labs in the state. State authorities do not appear to know what that capacity is, but it amounts to in excess of 500 additional tests per day, providing an additional margin of safety.
Last month Harvard’s Global Health Institute estimated Maine would need to test at least 1,805 people a day to be able to detect new infections quickly enough to contain them and avoid restoring blanket lockdowns. The co-authors of the study, institute director Dr. Ashish Jha and Dr. Thomas Tsai, described this as a bare minimum level to consider reopening. At the time, Maine was testing about 1,563 people a day, but in the week ending Friday it tested an average of 1,148 a day, according to data posted by the Maine Center for Disease Control and Prevention.
The new capacity will put Maine in a good position, Tsai told the Portland Press Herald/Maine Sunday Telegram.
“This is an important first step to get the capacity to the level that lets you have a strategy,” Tsai said. “You are now at a point where you need to assess how the strategy is performing.” He recommended the state begin disclosing what percentage of daily positive COVID-19 tests came via contact tracing efforts, which serves as an indicator of how well authorities are doing at isolating the infection.
State officials have recently been touting compliance with a second, less stringent standard, the Trump administration’s May 27 recommendation that each state should aim to test at least 2 percent of its population a month in May and June – 26,880 tests for Maine, or 867 a day. In its announcement Monday, the governor’s office touted that the state’s existing testing capacity “already far exceeds” this recommendation, noting nearly 37,000 Mainers had been tested in May, or 1,193 a day.
A detailed interdisciplinary report organized by Harvard’s Edmond J. Safra Center for Ethics and updated May 12 set a higher bar. To test broadly enough to detect asymptomatic carriers of the disease – based on the state’s daily COVID-19 deaths and epidemiological indicators at the time – the researchers advised that Maine would daily need to test between 2,500 and 5,000 people, and have an army of 300 to 500 contact tracers to quickly identify people who came in contact with the infected. (Maine had about 30 contact tracers in early May.)
The expanded testing, the result of a continued partnership between the state and Westbrook-based veterinary medicine manufacturer Idexx Laboratories, puts Maine in an good position in regard to testing capacity, said the report’s co-author, Divya Siddarth of Microsoft Research.
“Congratulations to Maine, as there aren’t that many states that are hitting our recommendations at this point,” Siddarth said in an interview. “With low prevalence of the disease and these testing capacities, I’d say ‘great job.’”
Like Tsai, she said the state now needed to focus on maximizing the performance of its contact tracing system, whereby investigators try to rapidly determine who a newly confirmed COVID-19 patient was infected by and who they may have infected in the interim, so that they can also be tested.
“Contact tracing is even more important than testing numbers now, because given the low prevalence the real trick is to be testing the right people,” Siddarth said. As of May 26, the Maine CDC only had about 30 contact tracers, but Gov. Mills announced that day that the agency would be begin training 50 volunteers June 1 who would assist the Maine CDC for at least two months. In a news release, her office said it would “begin hiring up to 124 contracted staff over time” for up to a yearlong stint.
But Siddarth said her program suggests Maine needs closer to 500 trackers to succeed, so the state would need to boost its efforts further. “But overall Maine is moving in a direction of prioritizing tracing and that’s really encouraging,” she said.
State Sen. Geoff Gratwick, D-Bangor, a retired physician who co-chairs the Legislature’s Health and Human Services Committee, said much the same. “Contact tracing is absolutely pivotal if we’re going to get around this,” he said. “We’re getting there, but you need to have the contact tracing right in order to find that one individual in, say, Piscataquis County who has the disease and isolate them before that one person becomes the origin of another epidemic.”
Mills also announced Monday that the new capacity – which will come on line in July – will allow the state to establish 20 “swab and swipe” testing locations strategically located across the state to ensure 90 percent of Mainers can be tested within a half hour’s drive from home, and that tourists, seasonal workers, and summer visitors can also be tested.
Her office also said that the Department of Health and Human Services was issuing a standing order that would allow “most people in Maine with elevated risk to get a COVID-19 test without the need for a separate order from a health care provider” even without experiencing symptoms. She said such individuals would include “health care workers and first responders, seasonal and migrant farm workers, people experiencing homelessness, visitors from other states with a higher prevalence of the virus, and employees of congregate living facilities such as nursing homes, lodging establishments, grocery stores and other businesses who have direct, daily contact with the public.”
State Sen. Ned Claxton, D-Auburn, a retired physician, said Maine’s response has been hampered by limited testing capacity. “Having this much testing available will be hugely important in terms of quickly tracking and tracing and managing our response to the virus,” he said.
Dr. Jennifer Horney, founding director of the University of Delaware’s epidemiology program, said the measures announced by the governor last week were good ones, but she emphasized the importance of regularly testing asymptomatic individuals with a higher risk of exposure. “Ongoing testing would be needed to continue to identify and isolate those who are infected and conduct contact tracing,” she said via email.
Dr. Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health, also emphasized that regular testing of essential workers would be essential for Maine going forward, as it would reduce the likelihood that those of them who became infected with the virus would spread it to others. “Finding and isolating infections in this manner will be essential to keep case numbers from accelerating,” Nuzzo said via email. “I encourage … Maine to continue its efforts to expand testing.”
Maine CDC’s director, Dr. Nirav Shah, was not available last week for an interview to discuss the expanded testing regimen. Spokesman Robert Long said via email that the expansion “is key to protecting public health and parallels the Mills administration’s expansion of COVID-19 contact tracing” and that the progress of the state’s phased reopening would be determined by a review of a range of metrics – case trends, positivity and hospitalization rates, and the burden on the health system – “in their totality and in context, as opposed to the daily change of a single metric.”
The agency also recently introduced a number of improvements in the way it collects and releases information about the pandemic. Since June 3 it has posted cumulative negative testing data on its website in a way that allows the daily calculation of the number of tests performed and the percentage of them that are positive. Until then, Maine had been the only state in the country unable to produce this widely used pandemic tracking metric. On June 3 it also started posting cumulative cases by ZIP code instead of only by county and has said it intends to update this information weekly.
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