Basic supply shortages still hold back Maine coronavirus testing, even as capacity grows

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While Maine is generally outperforming much of the country in its testing for the coronavirus, some health care providers are still struggling to reliably obtain the nasal swabs, transport vials and other supplies necessary to conduct those tests.

Those supply shortages are holding back some of the gains that Maine otherwise hopes to make with the rollout of 22 new testing collection sites around the state and an ongoing expansion of the state laboratory in Augusta that processes many of the tests.

Hospitals, clinics and communities have partnered with the state to operate those 22 new “swab and send” testing sites stretching across the state, including ones in Westbrook, Skowhegan, Lincoln and Sanford that were just announced Tuesday. For a limited time, those federally funded sites will facilitate free testing to people who qualify for it under a standing order the state issued early last month.

But the organizations that run the sites are still struggling to obtain all the supplies they need to collect samples from patients, which has partly prevented them from offering widespread testing to all the people who qualify for it under that June 8 standing order.

That standing order allows testing without a doctor’s order for several broad categories of people — including health care workers and residents of congregate living settings — who had a possible exposure to COVID-19, the illness caused by the coronavirus, regardless of whether they show symptoms. It also extends to people at higher risk from the disease regardless of whether they have symptoms, including people regularly exposed to members of the public in their jobs or those who have recently come to Maine from states with higher COVID-19 rates.

But in practice, providers have had to prioritize who from those categories they can actually test based on the availability of resources.

Northern Light Health, which operates testing sites in the 10 communities across the state where it has hospitals, hopes that it will be able to loosen the criteria for who it tests through the pending expansion of the state’s labs in Augusta, but that will hinge on the system’s ability to obtain materials that have been in short supply throughout the pandemic, according to the organization’s COVID-19 incident commander, Dr. James Jarvis.

The organization has been particularly challenged in its efforts to secure testing swabs, the vials that are needed to send them to labs and some types of protective gear, according to Jarvis. Now, it has gotten used to receiving orders that are either incomplete or include faulty parts, such as leaky vials.

“We are hopeful that in the next week or two, we will be able to open up more expansive collection of specimens to be able to send them to the state,” Jarvis said. “We are still always at the beck and call of the supply chain. It is still difficult for us to get confirmed sourcing.”

While the organization is now testing people included in the state’s standing order when they show symptoms of COVID-19, it only tests those without symptoms if their possible exposure to the virus was significant or they are having certain medical procedures performed at the hospital, according to Jarvis.

The housemate of someone confirmed to have COVID-19 would qualify, for example, but a symptomless person who shopped in the same store as someone who tested positive for the disease would not, Jarvis said.

And while Northern Light Health officials understand the importance of tourism to Maine’s economy, the organization does not yet have the resources to test out-of-state visitors who are required to undergo a two-week quarantine in Maine unless they can present a negative test result, he said.

“People need to be patient with us,” Jarvis said. “We’re doing the best we can with what’s in front of us. If you get on that phone call and we say we can’t swab you, it’s for a reason. It’s not that we’re hoarding anything. We’re utilizing everything we have.”

Penobscot Community Health Care, a group of primary care practices in Greater Bangor that is running three of the state’s new testing sites in Old Town, Brewer and Belfast, has started to loosen its criteria on who it will allow to be tested, according to Chief Medical Officer Dr. Noah Nesin.

When it can, it has been testing people who have come from out of state and are hoping to avoid the quarantine, Nesin said. It has also allowed tests based on more individual circumstances, such as a person who was about to have a small wedding and wanted a negative test before their parents visited from outside of Maine.

But Penobscot Community Health Care has struggled to secure test collection supplies such as swabs, Nesin said. It has also seen slow turnaround times of some samples it has sent off to state labs in recent weeks, but Nesin said that was probably related to changes in the organization’s shipping and weekend processing.

At Northern Maine Medical Center in Fort Kent — another of the state’s new testing sites — officials have struggled to obtain a different material: the cassettes that are necessary to run samples through the hospital’s in-house COVID-19 testing machine, according to Chief Operating Officer Alain Bois.

The representatives from all three health care organizations expressed hope that the state’s ongoing testing expansions will help them secure more resources and smoothen the process for people to get tests. Widespread testing — with generally quick turnaround times for results — is generally considered to be critical for states to quickly identify and contain new outbreaks of COVID-19, particularly now that it is flaring up in so many other parts of the country.

Officials from the state health department have touted the testing capacity here, pointing to steady gains in the volume of tests completed by public and private labs throughout the pandemic, as well as to the fact that Maine is one of only 11 states considered to be conducting enough tests based on an analysis by the Harvard Global Health Institute.

On Tuesday, Nirav Shah, director of the Maine Center for Disease Control and Prevention, said that the state’s standing order for who can be tested “is already quite broad” and that the state lab in Augusta can turn around samples within two days.

But those officials have also said that the capacity still needs to grow so Maine can suppress rather than just manage the virus. To that end, they have opened the new “swab and send” sites and are still working to complete an expansion of the state lab in Augusta that was announced last month.

Shah said that the state is working “pretty aggressively” to help provide more testing swabs and other collection materials to Maine health care providers, and that the opening of the new testing sites around the state should improve the efficiency of those providers when they collect test samples, send them off and receive the results.