California’s coronavirus fight hamstrung by lack of test kits, but help is on the way
Sacramento County’s leading health official thought he had great news Sunday afternoon.
After weeks of being constrained to conducting just 20 coronavirus tests a day, Dr. Peter Beilenson announced the county would dramatically expand the testing of sick people as early as Monday.
“We will go from having the ability to test 20 people per day to potentially hundreds, if not thousands a day,” Beilenson said at a downtown press conference. “Starting Monday, (private-sector companies) LabCorp and Quest will be offering lab testing for the coronavirus.
“We’ll be able to test people quickly and if they test negative, let them go free.”
It turned out to be a premature hope.
As of midweek, the lack of test kits and lab facilities continues to constrain Sacramento’s efforts to fight the virus. It’s not a local issue. Lack of quick testing access has become a key weaknesses in the country’s attempt to slow the spread of the virus, also known as COVID-19.
In Sacramento in particular, Beilenson and others are frustrated that the county can’t quickly test all high-risk older residents at an Elk Grove assisted living facility where a resident died of coronavirus on Tuesday. The approximately 140 residents there are being sequestered in their rooms, and three residents tested thus far have all come back negative, according to Jessica Arnold, vice president of resident relations at Carlton.
Public health officials across the region are hoping to avoid a repeat of an outbreak that has run rampant in a nursing home in Seattle, killing 19.
“That’s the one priority that we’re using our 20 tests a day for,” Beilenson said on Tuesday. “I know they have more than 20 people there, and that’s part of the problem of not having enough tests so we will do circles around the person who initially tested positive.”
The situation has family members of Carlton Senior Living Elk Grove on edge. One, who asked not to be identified, said the family is pushing, fingers crossed, for their elderly and frail parent to be tested quickly.
“I feel if they wait for symptoms, it may be too late,” the person said in a text to The Sacramento Bee on Wednesday.
Even though federal officials had time to prepare, they weren’t prepared to do enough diagnostic testing for this new virus, said Dr. Gerald Parker, a biomedical science official at Texas A&M University.
“We’re blinded a bit about how much disease is in our community because we haven’t had the ability to ramp up the diagnostics,” he said. “We’ve moved into this mitigation phase where we need to have broader testing capability.”
Virus is undercounted
The number of COVID-19 cases in the United States has more than doubled since Sunday, topping 1,000. But that’s only how many had been tested positive. Some health officials estimate that the true number of people with the virus may be 10 times that amount.
Only 15 to 20 percent of people who get the virus are expected to become seriously ill, mainly older people who have other health problems, Beilenson said. That means contagious people can be moving around in public not knowing they have the virus.
Sacramento County officially listed 11 positive coronavirus cases as of Wednesday morning. Beilenson said there is no telling how much the virus has truly spread in Sacramento, and how much more is to come.
“It’s kind of a crap shoot to be able to predict that stuff,” he said. “The only thing I can predict is it’s gone beyond 11 people here so we want to make a more nuanced approach and one that really is out there protecting seniors and those with underlying conditions.”
That’s led to a wave of announcements this week of canceled events and bans on large groups. In San Francisco, Alameda and Santa Clara, officials banned gatherings of more than 1,000. The Golden State Warriors will play Thursday night in an 18,000-seat arena devoid of spectators except for team family members. The Sacramento Kings, in contrast, announced with county health officials that they will allow fans in their games for now.
New testing hope
Dr. Theresa Cheng, senior emergency medicine resident who works at hospitals in Oakland and Los Angeles, said the next few months will constitute a serious test of the U.S. health system.
“Having such a widespread pandemic is definitely going to reveal a lot of our current health system’s shortcomings and some weaknesses,” Cheng said.
The shortage goes beyond testing equipment — limited hospital staffing presents an issue.
Help may be on the way this week, though. On Wednesday, the UC medical center system announced that three of its hospitals have launched in-house testing of their own, and that UC Davis Medical Center in Sacramento and UC Irvine will do so in the next few weeks.
“We are hoping this will aid the state in getting more people tested,” UC Health Executive Vice President Carrie Byington told lawmakers at the Capitol on Wednesday.
Nationally, Vice President Mike Pence said earlier this week that federal government expects to be able to ship out 4 million tests nationally later this week. As of Tuesday, public health officials in California had 7,675 tests available for use, California Gov. Gavin Newsom said. Those test kits can be used for up to 800 samples, according to the U.S. Centers for Disease Control and Prevention.
Private labs are stepping in
The state has turned to private labs as well to help. Beilenson’s comments on Sunday were based on the belief that several private testing companies would be ready to step up their help by early this week in contract with the state.
Expanded capabilities at a Quest Diagnostics lab in Sacramento have been delayed, but another Quest lab began analyzing samples this week for COVID-19 in San Juan Capistrano. Once the Sacramento lab and another Quest lab in West Hills are up and running, Quest should be able to conduct 5,000 tests a day statewide, Newsom said.
“That will allow us to conduct differently our lab diagnostics,” Newsom said. “We’ll begin to shift that burden from our own (state) labs and broaden that burden to our commercial private partners as well as our hospitals.”
Newsom had earlier complained federal CDC test kits had arrived here incomplete “like printers, but without ink.” Newsom said his administration is being “very aggressive” in demanding that the CDC provide state labs the necessary reagents to run the tests.
In addition to Quest Diagnostics, LabCorp also has the capability to run tests with its commercial kits at its labs.
Hospitals and healthcare providers will be able to send samples to private labs “the same way they order any other test from Quest,” Rachel Carr, a spokesperson with Quest Diagnostics, said in an email.
Quest did not confirm when its existing Sacramento labs will commence testing. Carr could only confirm that labs in Marlborough, Massachusetts, and Chantilly, Virginia, will process tests “within the next couple of weeks.”
“We are ramping up capacity and expect to be able to perform tens of thousands of tests a week within the next six weeks,” Carr said in an email. “We are scaling up capacity at this performing laboratory (in San Juan Capistrano) and anticipate we will have performed several thousands of tests for patients by the end of this week.”
These are laboratory developed tests, pending review by the U.S. Food and Drug Administration under emergency use authorization, which expedites the development and availability of COVID-19 testing.
Placer, other counties scramble to step up
Currently, Placer County hospitals and healthcare centers take samples from a patient suspected of having the virus using a swab to collect specimens from the back of patient’s throat or up their nose.
Placer County has been sending those samples over to Sacramento County’s public health lab, which it contracts with to process its tests and get results.
But those tests can only be processed by Sacramento County if they meet a specific criteria, such as the patient traveled overseas, is seriously ill and displaying symptoms, or is living in a congregated living setting, such as a nursing home. It’s part of an effort across the region’s health departments to prioritize tests for high-risk groups.
That means a person who is displaying symptoms but doesn’t have underlying health conditions and doesn’t have known exposure to the virus could be swabbed for a sample, but they would be very low on the priority list for public testing.
Now, private labs will be able to test people who don’t reach the locally mandated threshold for public testing. If there’s a positive test, the private lab would then notify the county’s public health agency for further investigation.
“We feel comfortable prioritizing those who meet the (county’s) criteria,” said Dr. Aimee Sisson, Placer County’s health officer. “Anyone else can get tested. We’re not denying anyone a test, we’re just saying they need to go to a commercial lab.”
Solano ‘begged for weeks’ for a test kit
Yolo County has also had limited access to testing, relying on a state public health lab in Richmond the last few days. Yolo County health officer Ron Chapman said the additional commercially available tests will be a significant relief for public health officials, but he warned that “those tests need to be limited to the appropriate people.”
“We’re getting a lot of calls, emails and texts from health care providers asking about a variety of different cases and individuals who are concerned,” Chapman said. “It’s not necessary for someone with a mild cough and a runny nose to go in to their doctor and get swabbed and tested.”
A public health lab in Solano County, which serves that county as well as Yolo, Napa and Marin counties, only just got their test kit from the CDC — which will be good for analyzing the samples of about 800 people, said Solano County health officer Bela Matyas.
“It wasn’t so much we asked the CDC” for a test kit, he said, “as we begged for two weeks and got one.”
That lab will notably be able to turn in test results in just one day. The public or commercial labs will take five to seven days, Matyas said. Solano, like other counties in the region, is narrowing the scope of public testing to people in high-risk groups, Matyas said. Those include people already hospitalized with symptoms, people in long-term care facilities, homeless individuals or people who work at daycare centers.
Matyas said the different labs can be used based on the degree of urgency. A normally healthy person may not need an immediate diagnosis.
“But if you have a person in long-term care (who’s sick) then I might have to jump on that nursing home with all hands on deck,” Matyas said. “I would want that answer the same day if I can get it.”
Sacramento’s new ‘mitigation’ strategy
Faced with a lack of testing resources, Sacramento County and others stopped attempting to track down and quarantine anyone who has had recent contact with a coronavirus sufferer.
They also are advising people who feel ill to treat themselves at home as they would if they had a cold or the flu, and only go to a doctor if they feel very ill. If they decide to go to urgent care, they should call ahead so that the office can prepare to take care of them.
County health officials also are asking the public also to refrain from calling 911 or going to a hospital emergency room unless “they believe that they are extremely sick or their life is in imminent danger.”
“Other emergencies are still occurring, and emergency resources must be available to address all of them, not just COVID-19,” Sacramento County health officials said in a statement.
Who covers the cost of tests?
Federal Medicare officials say the cost of a coronavirus test is covered in the Medicare Part B medical insurance plan for patients 65 and older who have signed up for the Medicare program.
Newsom’s administration and California’s top insurance official issued orders last week making coronavirus tests free for about 24 million Californians if doctors decide they are medically necessary.
The departments of Insurance and Managed Health Care directed commercial and Medi-Cal plans to waive co-pays and deductibles for medically necessary tests for COVID-19, the illness caused by the new coronavirus.
California Insurance Commissioner Ricardo Lara also directed insurers regulated by his office to waive testing fees.
“Californians shouldn’t have to fear a big medical bill just because they took a test for COVID-19,” Newsom said in a written statement last week. “This action means that Californians who fit the testing requirements can receive the test at no cost. We’re all in this together, and I’m grateful to those health providers who have already stepped up and heeded our call.”
This story was originally published March 11, 2020 at 4:46 PM with the headline "California’s coronavirus fight hamstrung by lack of test kits, but help is on the way."