ALBANY – It’s been a new drumbeat: the federal government is shortchanging New York State when it comes to the testing of residents for the novel coronavirus.
“The federal government has just fallen down on the job," Gov. Andrew M. Cuomo said early Wednesday on MSNBC.
“Our testing capacity is nowhere near where it needs to be," he later told reporters in Albany.
When it comes to testing, the federal government “remains stuck in the mud," Senate Minority Leader Charles Schumer said Wednesday as he called for approval of more testing labs, automated testing methods to provide more and quicker tests, federal money to pick up the costs of patient tests and a daily account of precisely how many tests are conducted each day in the United States.
But who’s not getting tested who should be tested? The answers to that are vague – one lab in New York said it had processed about 1,300 tests since the end of February – and considerably subjective as guidance from government and private health care experts has been amended as the virus spreads.
Officials like Schumer said he has heard from local government leaders in Westchester County, the epicenter of the coronavirus community spread in New York State, that demand is outpacing supply when it comes to testing of residents.
So far, while there are fledgling steps underway or being considered to quicken testing results time, there is no hue and cry from physicians statewide that they are facing a shortage of ways in which to test their patients.
Also, it’s not insignificant that the state’s main coronavirus testing lab – Wadsworth Center, the widely respected state health department facility a mile from the state Capitol – makes its own coronavirus testing kit, based on U.S. Centers for Disease Control and Prevention protocols, and is not reporting any shortages of tests of any kind.
“I don’t know about the private labs. We are dealing with everything that comes into us, which is in the hundreds range every day," said a senior Wadsworth official who spoke to The Buffalo News on condition of anonymity.
As officials talk of testing shortages, health care facilities are quickly expanding – with federal approval – the number of sites where tests can be performed. Roswell Park Comprehensive Cancer Center is the newest such testing center in Western New York, which follows the recent approval of the Erie County Health Department to do its own testing.
Also, labs such as Wadsworth are moving to automate their testing – instead of some manual aspects now done. The automated process will speed results, which now at Roswell take six hours to obtain once a specimen enters the lab in Albany.
Erie County, unlike Wadsworth, relies on the CDC to supply test kits, which examine the specimens doctors and other health professionals collect from patients. Before it started doing its own testing this week, Erie County had sent the specimens of 12 people from the county to the CDC for coronavirus testing, officials said. As of Tuesday, the county lab conducted two tests this week.
The county has agreed to accept samples from other county health agencies with a physician’s authorization and according to state health department guidelines. Asked if the county’s capacity can meet demand, Kara Kane, an Erie County health department spokeswoman, said: “We will make every effort to have the test kits and supplies on hand to handle demand."
What’s not clear is where a particular specimen might go. Some head to Albany, via a State Police trooper car or special drivers hired to transport the specimens. Others go to Erie County. Soon, Roswell will get some specimens to test. And an unknown number will, or can, go to private labs, such as the big companies that most consumers know from getting their blood tested.
Of the 216 known, reported novel coronavirus cases in New York State, nearly 60% are in Westchester County, home to one of the nation’s hottest hot spots of community spread and where a portion of the city will see mandatory shutdowns of buildings where large numbers of people normally congregate, including nine schools.
An array of officials say testing is so limited in the state that a true picture of just how deep the virus is running cannot be known unless patient testing is dramatically ramped up.
Cuomo has warned that the positive test results he has been announcing every day – sometimes multiple times a day – is a “selective” sampling because most tests now done in New York are of people who have some sort of association with a person who has or had the virus.
As a result, he said, the numbers are “not statistically accurate to the growth or the spread” of the virus. He said he believes the virus is much more widespread than now evident because testing has been forced to be narrowly tailored to meet certain protocols. More testing labs will relax those protocols, which in turn will prod more physicians to test patients.
To that end, Cuomo said New York Wednesday identified 28 additional private labs to begin testing. But they will still need federal authority before that happens.
Testing protocols change
As federal testing guidelines have been amended over the weeks, so, too, have some of the confusion among patients and providers. Some medical offices are still trying to understand who should get tested when a patient calls with possible symptoms.
For now, the state health department has various suggestions for testing, such as people who have a fever and cough and have met other conditions, such as being a health worker exposed to a virus patient or a traveler to certain hot spot countries or contact with someone who has the virus.
Importantly, the CDC and state health testing guidelines are just that: guidelines. “The testing protocol is really up to the physician to decide on the appropriate testing algorithm for the patient in question," the state Wadsworth official said, noting an array of factors may affect whether someone is tested.
Not everyone can, or wants to, be tested. Even if 1,000 people were tested a day, it would take 52 years to test the more than 19 million residents of New York. Moreover, some health officials say that if the virus becomes endemic in a community, there is no point in trying to test everyone in that area. Instead, the focus then becomes on mitigation: getting people to engage in social distancing and isolation from others, said the Wadsworth official.
For now, the focus in New York has been concentrated on testing people who have contact with someone who is a known positive case, such as the Westchester County lawyer who appears to be at the center of a community-spread case in New Rochelle, where National Guard troops are being deployed to a containment area 1 mile in radius and some buildings are being shuttered for 14 days.
“It’s certainly a public health desire to do more testing so we can understand the population situation," the Wadsworth official said.
What officials in New York State can’t say, unlike some other states, like California, is how many people have been tested this year for the novel coronavirus. The Wadsworth lab has processed 1,300 tests since the end of February. As of Tuesday, the Erie County lab did two on its own this week and, previously, sent 12 specimens out for testing before it was okayed as a coronavirus lab. In the past two weeks, the state, local and private labs have conducted a total of 1,983 tests, officials said Wednesday evening.
But there is capacity for far more tests, officials say. Various test numbers have floated from various federal agencies. CDC says 8,554 “specimens” have been tested at its lab and public health labs in the states. But more than one specimen can be collected for people; the number also does not include private lab testing. A big downstate lab was recently approved and it can do up to 80 samples a day; if the manual element is removed and testing is permitted to be automated, the state says that one lab could process thousands per day.
Western New York testing gears up
Dr. Joseph Chow, president of Western New York Immediate Care, which has five urgent care facilities in the Buffalo area, said a number of factors are affecting coronavirus testing levels.
For starters, individual doctors’ offices don’t have “point of care” testing like they do for the flu or strep cases, where specimens are taken and results gotten in minutes. Such quick tests for coronavirus have not yet been developed for the new strain.
Also, many people are hitting a pause button and not immediately going to a doctor if they have certain symptoms but aren’t very ill and haven’t met certain protocols, like travel to some countries. While all the news about coronavirus may be raising anxiety levels, many people are heeding advice to call a doctor’s office first to be screened for possible coronavirus exposure.
It means doctors at his facilities must call the local health department where discussions take place about whether the patient should or should not be tested. For now, he said, it means unless certain screening thresholds are met, a patient likely won’t be tested for the virus.
Erie County has set its own COVID-19 testing standards, saying tests will be authorized by health providers if an individual has “proximate” contact with a person known to be positive or if a trip was taken to one of several countries with high virus rates, such as China, South Korea and Italy. People symptomatic and who has not tested positive for any other infection can get tested.
Roswell Park expects to begin testing in two weeks in a High Street facility not accessible to patients or any direct clinical care staffers. Workers wear protective gear and swabs they test are self-contained and pose no risk to patients, staff or the public, hospital officials said. Dr. Charles LeVea, Roswell’s pathology and laboratory medicine director, said the COVID-19 testing doesn’t require any changes to various testing already performed at the lab. “It’s all work that requires an exacting level of care and attention that our staff are specially trained to provide," he said.
Roswell officials noted that individuals can’t go to Roswell to request a coronavirus test; those have to be ordered by a patient’s physician or other health provider.
Story topics: Covid-19