A healthcare worker watches as a patient uses a swab at a mobile testing location for COVID-19, Tuesday, Dec. 8, 2020, in Auburn. Credit: Robert F. Bukaty / AP

AUGUSTA, Maine — COVID-19 testing has lagged in Maine this fall as virus cases have soared, challenging the state’s public health response by leaving many in the dark for days on whether or not they have the virus.

The lower testing rate compared with earlier in the pandemic comes as Maine reported a record 361 COVID-19 hospitalizations on Monday, while the seven-day infection rate remains higher than it was during any previous surge. Lack of testing and long wait times can inhibit contact tracing efforts, making it harder for the state to tackle high case levels.

The shortage has been driven in part by pharmacy staffing problems, a factor that also led some providers to cancel COVID-19 booster shots last week. In response, the state has placed greater emphasis on swab-and-send sites that rely on the Maine Center for Disease Control and Prevention’s Augusta laboratory, while the federal government has looked in recent days to make at-home tests more accessible.

In the week after Thanksgiving, the Maine CDC reported just shy of 63,000 COVID-19 tests conducted statewide. That is about 20 percent lower than the testing peak amid a surge last January, when Maine performed more than 75,000 tests per week for three weeks in a row. When cases rose again in April, Maine surpassed 88,000 tests in a week.

Backlogs in scheduling testing at chain pharmacies central to the state’s testing strategy are one reason for the slower pace. As of Monday morning, for example, Walgreens pharmacies in Bangor and Brewer could not schedule COVID-19 tests until Friday, even for patients who reported being exposed to the virus or experiencing symptoms.

Other options are available in Greater Bangor. As of Monday morning, a patient experiencing symptoms could schedule a drive-thru test at Northern Light Health’s site near Bangor International Airport for later that day, while in-airport testing from Curative, a health care start-up, was also available on a walk-in basis.

But many more rural areas do not have large-scale testing sites and rely on pharmacies. In Farmington, where Walgreens is the only testing provider listed on Maine’s official COVID-19 testing website, the earliest day to schedule a test as of Monday morning was Friday.

Dr. Peter Millard, a Waldo County physician and former U.S. Centers for Disease Control and Prevention epidemiologist, said delays in testing were a “big handicap” for Maine, as tests are necessary to identify those exposed to the virus through contact tracing to advise quarantines.

“The pandemic is as bad as it’s ever been in Maine right now,” he said, “so to be hampered by lack of testing is even worse.”

Maine is still testing for the virus more than most U.S. states. Only seven states performed more PCR testing per capita than Maine in the week after Thanksgiving, according to U.S. CDC data. There was still a significant gap, however, with Vermont, Rhode Island and the District of Columbia all testing their residents at more than twice the rate Maine did.

State testing numbers both in Maine and across the U.S. do not account for the increased use of at-home COVID-19 tests, which provide results within 15 minutes and are most effective for symptomatic patients.

But there are limitations. While testing is free at state swab-and-send sites, at-home tests often cost between $14 and $24 for a pack of two. Although President Joe Biden announced last week that people with private insurance can get that reimbursed, they will still have to pay up front. The tests have also been quick to sell out in pharmacies.

Maine CDC Director Nirav Shah said last week that high demand and staffing challenges were the primary factors contributing to the long wait times for testing. He said the agency is working to set up more testing, similar to a swab-and-send site in Westbrook that opened in October. The site was one of only a few locations in the Portland area that, as of Monday morning, had openings for patients looking for a COVID-19 test as soon as Wednesday.

“Testing and testing access remain a challenge nationwide, as well as here in Maine,” Shah said. “We’re working tirelessly to try to increase that.”