Minnesota health officials are worried the state’s robust coronavirus testing capacity could be hampered by an increasingly stressed international medical supply chain.
Just a few weeks ago, Minnesotans were able to get the results of their coronavirus tests within about 24 hours. But now, the wait can be three days or more, delaying when contact tracers can begin investigating new infections.
Health officials worry the ongoing national spike in cases could further impact Minnesota’s ability to screen for COVID-19 infections and return results quickly. Minnesota has screened on average about 12,000 samples per day since June 1 and is steadily approaching administering 1 million tests since the outbreak began.
The state currently has about 50,000 laboratory-confirmed cases and more than 1,560 COVID-19 deaths.
In some of the hardest hit parts of the U.S., test results can take a week or more — leaving Minnesota officials concerned about what may be on the horizon if supply chains don’t improve. Quick and precise testing is a key way to fight the virus by isolating positive patients so they cannot infect others.
“The faster the turnaround the better,” said Jan Malcolm, Minnesota’s health commissioner. “We are concerned this does have the potential to interfere with our testing capacity.”
Much of Minnesota’s ability to screen for the virus is based on a partnership between the state Department of Health, the Mayo Clinic, the University of Minnesota and other health care providers. Both the Mayo Clinic and M Health Fairview are reporting wait times for results of about three days.
“Unfortunately, Mayo Clinic is not immune to the shortages we have been seeing nationwide,” said Dr. Bobbi Pritt, a professor of clinical microbiology at the Mayo Clinic. “Some of these big manufacturers, with commonly used tests, are not able to deliver what they had agreed to deliver.”
WHAT’S IN SHORT SUPPLY AND WHY?
Diagnostic testing for the coronavirus — when a patient is screened for virus genetic material present during an active infection — is a materials intense process. Health care workers need protective equipment, swabs are needed to collect the samples, chemical reagents and instruments are used to process the test.
While the state has a modest stockpile of personal protective equipment, or PPE, it is currently awaiting delivery on millions of masks, gowns and N95 respirators.
Health care officials are worried about all types of materials possibly being in short supply, even as state leaders continue to ramp up Minnesota’s stockpiles.
“The state is in a considerably better position than we were four months ago,” said Alice Roberts Davis, commissioner of the state Department of Administration. She also acknowledged challenges with procuring certain supplies. “We continue to model the data to make sure that our purchasing is in line with the anticipated need.”
Dr. Pritt says there already are worrisome national shortages on materials needed to process COVID-19 tests. Large medical suppliers like Roche, Abbott and Hologic rely on the same supply chains to manufacture products and they are swamped with rising demand as cases surge in the U.S. and parts of the world.
Supplies some labs ordered are being shorted or not filled at all, she said.
“It trickles down to all the labs that are using those (products),” Pritt said. “They’re working as hard as they can. I have to give them a lot of credit. They’re obviously putting all their effort into this.”
If shortages continue, health officials say the White House could again use the Defense Production Act to order more companies to produce supplies necessary to battle the coronavirus pandemic. The act has already been used to have automaker Ford build ventilators.
NEW METHODS AND NEW TESTS
Concerned over the short supply of certain tests and the materials to process them, Pritt says the Mayo Clinic has developed three new coronavirus tests that will role out in the coming weeks. That brings the total to 10 tests for the virus Mayo has devised since the outbreak began in March.
Developing new tests is a complex process. But creating alternative screening methods, which deliver the same results using instruments and chemical reagents not in as high of demand, is an important way to keep the state’s testing capacity strong.
These new tests, the first of which was expected to come online Sunday, should help the Mayo Clinic get back closer to the 15,000 test per day capacity it had at its peak.
“We are looking to diversify,” Dr. Pritt said.
Malcolm said that is something health officials are encouraging other labs to do.
“We are really interested in evaluating and actively looking at a number of strategies with respect to new types of testing that are coming on the market that may be easier to deploy with a quicker turnaround time,” Malcolm said.
Another option labs can consider, but currently doesn’t appear to be in widespread use in Minnesota, is pool or batch testing. This method screens samples from several patients at once and saves materials if no virus is found.
If coronavirus genetic material is evident in a pool of tests, then lab workers have to retest all the patient samples to see which ones are positive.
Health officials warn that pool testing can be less sensitive than testing samples individually. It is also most effective at conserving supplies when test positivity rates are low, higher rates mean more samples will need to be tested twice if virus is found.
CONSERVE SUPPLIES BY SLOWING THE SPREAD
State health officials say the easiest way not to have a shortage of coronavirus testing supplies and protective gear is not to have a surge in cases in the first place. After being forced to ration COVID-19 tests early on in the pandemic, Minnesota, as well as much of the nation, quickly grew its testing capacity to meet and even exceed demand.
The loosening of restrictions in place to slow the spread of the virus appears to have led to the surge in cases — first in southern states that reopened earliest and now in other parts of the country. As the need for tests grew rapidly supply chains began to show stress.
Minnesota leaders say they want to continue to grow their testing capacity beyond the roughly 20,000 tests per day the state can now perform. But testing supply constraints could make that difficult, that’s why slowing the spread of the coronavirus continues to be so important.
To that end, Gov. Tim Walz ordered Wednesday that face masks be worn in all indoor public places unless someone has a condition that makes doing so problematic. Some restrictions on businesses and building capacity also remain in place to limit close proximity and larger groups.
“We think masks are a very effective tool. We think it will make a difference in Minnesota,” Malcolm said. “We also need to reinforce those other important behaviors, staying home when you are sick, lots of attention to hand hygiene and social distancing.”
