New Haven Register (New Haven, CT)
CT’s plan to get to a million coronavirus tests a month
State will have to more than double amount of diagnostic screenings to reach target
WASHINGTON — By this December, Connecticut’s goal is to test 1 million people — about one third of the state’s population — every month for coronavirus.
That’s according to a testing plan filed by the state with the U.S. Department of Health and Human Resources in July.
Connecticut will have to more than double the amount of diagnostic testing it performed in August to meet that target. So far, the state has fallen short of each of the monthly testing targets it set in its plan, but not by much.
The state testing plan indicates that Connecticut will focus diagnostic testing this fall on schools, nursing homes and other congregate settings. The state is exploring using sample pooling for the first time to expand its reach and is part way through a statewide serology survey, intended to see how many people had the virus in the past.
Like diagnostic testing, the state also fell short of its July and August goals for serology testing, blood tests that indicate the presence of virus antibodies. Connecticut plans to ramp
up serology testing to 500,000 per month by December, up from last month’s 8,335 serology tests.
But according to the Harvard Global Health Institute and the Brown School of Public Health, Connecticut is one of just a handful of states that’s completing enough diagnostic testing to actually suppress the virus: proactively identifying cases and isolating new cases before the start of a wider outbreak.
“Connecticut continues to do really well,” said Thomas Tsai, professor of health policy and management at the Harvard T. H. Chan School of Public Health and a surgeon at Brigham and Women’s Hospital. “It has been averaging 302 tests per 100,000 on a seven day moving average. That is above our mitigation target and above our suppression target as well. Connecticut had very sustained levels of testing over the course of the pandemic.”
The state’s testing plan shows the road Connecticut will take to 1,000 diagnostic tests and 500,000 serology tests in December: expand testing sites, hire more personnel and obtain more testing equipment and loads of swabs and media.
The plan, made public by HHS last month, was required of Connecticut and other states by law in exchange for receiving billions in coronavirus testing money from the Centers for Disease Control and Prevention this spring. In lieu of one national testing strategy, the plans show that the nation has 64 unique testing schemes governing every state, territory and some cities.
This fall, Connecticut’s plans to test symptomatic and asymptomatic individuals, despite the CDC’s new guidance that people exposed to the virus who don’t have symptoms may not need a test. The state testing plan shows the Connecticut will focus on testing educators and students at universities and schools, expand testing for nursing home residents and incarcerated people and increase community testing in targeted neighborhoods.
Most laboratories now processing COVID-19 samples in Connecticut are now “reviewing the possibility of pooling,” said Lora Rae Anderson, director of communications for the governor’s chief operating officer. Pooling means combining respiratory samples from several people and conducting one laboratory test on the combined to check for coronavirus; it allows labs to test more samples with fewer testing materials, according to the CDC. If the pool result is negative, the whole group is cleared; if positive, individual samples would be tested to identify patients with the virus.
A statewide serology survey is underway in Connecticut. A study of the results from 505 Connecticut adults residing in non-congregate settings found 18 had COVID-19 antibodies, resulting in a state level weighted seroprevalence of 3.1, according to a paper published in early August.
So far, Connecticut has under-performed its goal for serology testing. Connecticut conducted 8,335 serology tests in August and 14,384 in July, according to data shared by the governor’s office. The state’s targets for each month were 50,000 tests, the plan shows.
Anderson said Connecticut did not receive assistance from HHS in setting its testing targets, but the plan was reviewed by the CDC.
"Each jurisdiction must ensure their testing plan provisions are in place to meet current and future surge capacity testing needs, federal support for point-of-care testing in nursing homes and any other tactics in place designed to maximize the entire testing ecosystem," said Mia Heck, a spokesperson for HHS. "In addition, a multidisciplinary team of experts from HHS has completed a technical review for each jurisdictions' plan to ensure that it is sufficient to mitigate the spread of the virus, protect vulnerable groups, and account for adequate testing supplies and reagents to reach jurisdiction testing goals."
The nation now is at a "critical moment" for testing, Tsai said. It finally has the resources to shift from a reactive testing strategy — testing the symptomatic only — to a proactive strategy that layers on asymptomatic testing. It's a "paradigm shift" in thinking from a focus on simply testing more, to deciding who test, when to test them and with what tool.
How to test and who to test has at times been the subject of conflict between the federal and state governments. In late August, the CDC changed its testing guidelines to say people who have been in close contact with a COVID-19 patient may not need to be tested if they do not have symptoms. That was a reversal of the CDC's earlier guidance that close contacts should be tested even if asymptomatic.
Gov. Ned Lamont said Connecticut would not follow the new CDC recommendation, calling it "reckless" and not sciencebased in a joint statement with the governors of New York and New Jersey.
On Thursday, the Trump administration's testing czar, Adm. Brett Giroir, assistant secretary for Health at the US Department of Health and Human Services, also contradicted the CDC guidelines and told CNN "We do need to test asymptomatic people.
There is no doubt about that. Full stop.”
The 14-page state testing plan highlighted the limits created by the availability of testing component supplies, the capacity of laboratory machines that run the tests and personnel to run the process.
Manufacturing shortages and expense both play a key role as states try to expand testing, said Ben Linville-Engler, industry and certificate director at the Massachusetts Institute of Technology, whose been involved in analyzing coronavirus testing with Harvard Global Health Institute, among other work on the coronavirus supply chain.
“Who’s paying for the testing? There’s CARES
Act funding but there’s not necessarily confidence that more funding is going to get passed and so states have to figure out how they are going to utilize that money through the rest of the year," he said. "What other funds can they draw on? That’s where the connection to this economic impact we’re having is really hitting cities and counties really hard. The budgetary shortfalls for cities and counties across the U.S. for sales tax is going to be huge. These places aren’t in a position to throw large amounts of money into increasing testing unfortunately.”
The CDC awarded Connecticut $202.9 million in coronavirus testing money to fund its efforts. The state has used the money on “testing basics” like supplies, but also investing in contact tracing to target testing most efficiently, Anderson said.
"HHS and FEMA are meeting all state needs for COVID-19 testing supplies like swabs and media," Heck said. "As of September 2, the federal government has distributed 80 million swabs, 66 million media and over 40 types of other resources."
Meanwhile, HHS is “sitting on” more than $8 billion in funding Congress earmarked for coronavirus testing, said U.S. Rep. Rosa DeLauro, D-3, who oversees appropriations for the agency.
“If HHS is not going to use those funds to support testing, the Department should distribute those funds to the States,” she said.
HHS responded that the agency has obligated over 90 percent of $100 billion in coronavirus funding it received. As of September 8, only $265 million out of $10.25 billion made available to states for testing purposes has been drawn down by the states, said HHS spokeswoman Kate Migliaccio-Grabill. The agency has used $8.3 billion in flexible funding to make testing and supplies available to states, nursing homes and vulnerable populations.
“HHS continues to strategically and responsibly hold some funds in reserve to support any emergent needs or new technologies, especially as we head into flu season,” Migliaccio-Grabill said.
Tsai said he worried the administration’s decentralized testing strategy was creating a new system in which states would compete for testing resources like they did with PPE and potentially be limited in their testing by their struggling budgets.
“It doesn’t make sense to sit on $8 billion for a rainy day, when that rainy day is here and the sun is not out yet,” he said.