Expanded testing shows signs of strain

Health officials battling the coronavirus are making the difficult decision to limit testing in an effort to conserve critical resources, even as more test kits become available.

The balancing act means that despite an increase in drive-thru testing sites and point-of-care tests that deliver results in minutes, some of the hardest-hit areas are still restricting evaluations to health workers and the most vulnerable patients.

Instead of broad, community-wide testing, cities in California and New York are focused on making sure only the sickest people and health workers get tested. Doing so also slows the use of personal protective equipment (PPE) like masks, gowns and gloves.

Experts are concerned that shortages of protective gear will lead to doctors and nurses falling ill, thus weakening the overall U.S. response to the pandemic.

“The more we test, the more PPE we need, and that is using up the PPE supply that we need to save for the health care workers right now,” said Michael Fraser, CEO of the Association of State and Territorial Health Officials.

Prioritizing tests for the most vulnerable underscores the concern among health officials that coronavirus cases are already overwhelming the health system and draining resources that are in short supply.

In New York City, the health department is warning that tests will be limited in order to conserve supplies. The department issued a notice to health providers last week that “outpatient testing must not be encouraged, promoted or advertised.”

“Unless you are hospitalized and a diagnosis will impact your care, you will not be tested,” the city’s government said on its website.

In Maryland, Gov. Larry Hogan (R) said the state will require health care providers to prioritize tests for hospitalized and chronic-care patients, symptomatic first responders and symptomatic nursing home patients.

Testing in Los Angeles is now reserved for symptomatic patients 65 and older or those who have underlying health conditions, in addition to those who are quarantined because they’ve come in contact with someone who has tested positive for the virus.

Deciding who does and who doesn’t get a test has created a challenge for officials communicating with an increasingly concerned public. Even though the availability of tests has slowly increased, there still aren’t enough for everyone who wants one.

“We’re in a much different place than we were two weeks ago, and we’ll be in a much different place in a week,” Scott Becker, CEO of the Association of Public Health Laboratories, said. “The supply chain just isn’t there at the moment, so you do have to make those tough decisions about prioritization.”

The message to conserve tests has been amplified in recent days by members of the White House coronavirus task force, who have been urging Americans not to seek out tests if they aren’t exhibiting symptoms.

“We don’t want people who are just worried to go get tested,” task force coordinator Dr. Deborah Birx said Tuesday. “We really want the testing, and the drive-thru testing and the testing that is provided in the cities to be very much still focused on the people who need it.”

Birx said more than 300,000 tests have been conducted in the U.S., with testing now accelerating to as many 70,000 a day.

The message to continue prioritizing tests comes as public and private health labs have finally started to expand capacity after a botched rollout by the federal government.

Drive-thru testing sites are popping up around the country, and the Food and Drug Administration has authorized two new point-of-care tests that can deliver results in as little as 30 minutes — much faster than the current multiday waiting period.

But with the proliferation of testing comes the concern that accessible sites will become inundated with people who just want to be tested for peace of mind. Several sites have had to shut down after running out of supplies just hours after opening.

Stephanie Zaza, president of the American College of Preventive Medicine, said communities with testing sites need to clearly communicate who should be tested. Otherwise, she said, people without the disease or those with mild cases will mob the sites and use up the limited resources.

“There’s this clamor for widespread community-based testing so people know if they’re exposed or not, and that’s not been possible,” Zaza said.

The hardest part, she said, is what to tell people if they test negative, because it can create a false sense of security.

“People want to know [if] they’re negative, ‘can I be near my grandma?’ But that’s not helpful. It’s a false sense of security that you can go out and do something, when you may not be able to,” she said.

In addition, a test may be reassuring to a person with mild symptoms, but the personal protective equipment needed for that test could often be put to better use elsewhere.

“If you’re using PPE for testing of the wrong people, you’re not using PPE to care for and potentially save a life for someone being intubated,” said Becker.