Testing delays and shortages playing out across the country are impacting Kentucky, and could hamper local health departments from tracking down and boxing in community spread of coronavirus.
In the last few days, Norton Healthcare pleaded with members of the state's congressional delegation for help in tracking down critical testing reagents after the federal government reallocated supplies. In addition, Kroger plans to stop drive-thru testing statewide. Meanwhile, national laboratories are struggling to turnaround test results in seven days or less.
The testing supply chain is under increased pressure as cases of COVID-19 surge in Kentucky and around the country. Nearly 150,000 Americans have died from the virus.
Kentucky is one of 30 states where cases are currently increasing, according to data collected by the New York Times.
The rise in new cases, contacts and people not following best practices strains local health department contact tracing programs, making it harder to track the community spread of COVID-19, Dr. Sarah Moyer, director of the Louisville Metro Department of Public Health and Wellness said Tuesday.
Moyer said that even as testing capacity increased in July, it could not keep pace with the number of new infections.
"We’re seeing tests take seven to 10 days to come back, which makes contact tracing not possible or feasible, and so it actually makes it seem like why was the test even worth doing in the first place,” Moyer said.
Testing Troubles
The national testing lab Quest Diagnostics is currently performing around 135,000 tests per day and hopes to do even more by next week, but the lab is still struggling to reduce its backlog, according to a statement.
For the first time since June, demand has outstripped capacity and tests for all but the highest priority patients are taking an average of seven days to receive testing results. The lab says its largest hurdle is purchasing enough chemical reagents to perform the tests.
Kentucky’s Norton Healthcare is facing a similar problem. This week the hospital system won’t receive any reagents for nasal swab testing because the federal government reallocated the vendor’s supplies, according to a Norton letter to Congress.
Norton Chief Medical Officer Steve Hester wrote to Kentucky U.S. Rep. John Yarmuth and Sen. Mitch McConnell asking for help last week. By its own numbers, Norton has conducted about 10% of all nasal swab tests COVID-19 tests in the state.
“This will leave us vulnerable in our testing capacity and much more reliant on sending out testing to an outside laboratory, thereby greatly delaying appropriate therapy and procedures for our patients,” Hester wrote.
Additionally, Gov. Andy Beshear announced Monday that Kroger plans to halt its drive-thru testing in the state. Beshear hopes to have a partner in place by early next week to avoid disrupting capacity.
The state’s primary testing lab, Gravity Diagnostics, has for the most part maintained its 48 hour turnaround time with testing, said Mark Carter, executive policy adviser to the Kentucky Cabinet for Health and Family Services. It’s the national labs, and the access to materials, that need to expand in order to manage the growing number of coronavirus cases, he said.
“We need more labs. We need more testing capacity in the country,” Carter said.
Without adequate testing, new cases of COVID-19 can go unnoticed and create new virus clusters. And when testing is available but results are delayed for seven days or longer, it can create a tidal wave of potential contacts for tracers have to find.
“If you can’t get with contacts within about 48 hours, after that it dramatically reduces the effectiveness of that, of contact tracing,” Carter said.
Contact Tracing
More than 800 contact tracers are already at work in Kentucky tracking the spread of coronavirus and the state hopes to bolster that to more than 1,000 staff, Carter said.
The state has hired about 370 new contact tracers using CARES Act funding in addition to the 430 who were already working around the state prior to the pandemic.
So far, local health department data suggests contact tracers are reaching about 70% to 75% of an infected person's potential contacts, Carter said. Anecdotally, he said Kentuckians have been mostly helpful with the effort.
“We have encountered some resistance but, by and large, so far folks have been very cooperative, especially when they understand it’s a tool that’s protecting their family, loved ones and neighbors,” he said.
The state’s plan to hire more tracers should allow Kentucky to stay ahead of the virus, but it won’t work without buy-in from the public, according to Carter.
“A lot depends on how people behave and how the virus behaves as to whether we can continue to do that,” he said.
To help control the virus, medical experts recommend wearing face coverings in public, washing your hands thoroughly and following social distancing guidelines.
Additionally, Carter said people should be aware of the potential for fraud in contact tracing. Contact tracers and local health departments will not ask for financial information, only addresses, names and phone numbers.
