FILE PHOTO — Providence medical personnel are on standby inside the command center at Hawks Prairie Clinic in late April in Lacey.
A dramatic ramp-up of COVID-19 testing and contact tracing called for by Gov. Jay Inslee this week in his plan for gradually ending the lockdown faces stark and daunting obstacles, from the practical to the political.
Inslee this week said his goal is to see Washington performing from 20,000 to 30,000 tests a day, and to establish a rapid response team of about 1,500 workers who'll track down those who had contact with someone who tests positive. The plan would require obtaining scarce medical supplies on a massive scale and expanding a thin, specially trained workforce.
But while Inslee underscored that a lack of test kits and lab supplies remains a nagging barrier to widespread diagnostic testing, what's less clear is how, whether and when Washington could actually achieve such ambitious testing goals.
To attain even the low end of Inslee's target, Washington would need a sevenfold increase in its current average of tests per day (about 2,845 since Feb. 29). The state also may have to achieve the feat with limited federal support, as the Trump administration has said this week that testing capacities were sufficient nationwide.
Figuring out how to overcome such challenges has prompted Inslee to seek answers from private and public labs, medical suppliers and diagnostics firms, big-time Washington employers, and even its West Coast allies, California and Oregon, according to his office. But as Inslee takes stock of the available options, solutions remain elusive.
And so, social-distancing measures, which have put Washington's economy in a catastrophic deep freeze, remain in effect. Experts agree the steps taken so far have helped flatten the epidemiological curve of Washington's outbreak.
But it's no time for the state to drop its guard -- especially with fall flu season looming, Dr. Jeff Duchin, health officer for Public Health -- Seattle & King County, said this week during a webinar held by Life Science Washington.
"Teasing out who has flu, who has COVID is going to require a huge amount of testing and it's going to put a tremendous burden on our health care system," Duchin said.
Building a robust testing system that can process 30,000 tests per day is "a long-term goal" for the coming flu season, not Inslee's "hard and fast number" for lifting all restrictions, said Reed Schuler, a senior adviser to the governor.
"It's not the case that you need to hit 20,000 to 30,000 tests per day in order to modify some of the physical distancing restrictions in place now," he said.
Still, some conservative lawmakers contend Inslee's plan to expand testing of patients showing symptoms omits a vital component to effectively weighing when and how restrictions can be eased: blood tests that can detect coronavirus antibodies.
Such antibody tests -- which the UW Medicine began in earnest this week -- can detect whether people who've never been tested for the virus were infected with it. If sampled broadly statewide, data from antibody test results might help provide a more accurate picture of Washington's infection and mortality rates linked to COVID-19, the illness caused by the novel coronavirus.
"This is a key step to knowing whether we can safely open up parts of our economy and society," said Sen. John Braun, R-Centralia, the GOP's budget writer and one of three dozen conservative lawmakers who recently called on Inslee to push for expanded antibody testing. "I'm trying to be supportive of the governor, but frankly, this is an area where I think we can improve."
Antibody testing, which has had reliability problems, is but one item on a long list that Inslee's office is reviewing as it assesses the gaps in Washington's testing landscape, Schuler said.
Closing testing gap
Aggressive testing, often combined with contact tracing, has been credited with containing and limiting the novel coronavirus' spread in Germany, Iceland, South Korea and several other nations.
Since the U.S. stumbled out of the gate in its testing response -- a botched federal roll-out meant testing was largely nonexistent as the virus spread in February -- Washington, like all states, has struggled to catch up.
Lab capacity hasn't been an issue recently, but hospitals and clinics still face shortages of testing kits and materials, including nasopharyngeal swabs and reagents, the chemical compounds used to detect the virus' genetic fingerprint in patient samples.
Experts say new saliva tests and other methods could be game-changers by reducing the need for hard-to-come-by testing supplies, although it remains unclear when they could be in widespread use.
The UW Medicine Virology Lab, which has handled about half of the roughly 148,000 tests performed statewide to date, runs four different tests with a combined capacity for 7,500 tests per day. But the lab has averaged only about 1,484 tests per day since March 1.
Part of that gap is a "mismatch" between areas that need testing and labs with capacity that aren't getting samples, lab director Keith Jerome said this week.
"When we look at the results of the tests that have been done, they don't necessarily reflect the prevalence of disease throughout our community," Duchin added. "They reflect the prevalence among those populations that had access to testing."
About 30 labs statewide are now "running some scale of testing," Schuler said,ranging from small, private labs in clinics and hospitals conducting tests in the tens of tests per day, to larger labs like the UW's. State officials have been assessing both current and potential capacities for each lab, he said, as well as adding other labs that aren't currently testing for the virus.
"We think if all of these labs are fully supplied and running at a fevered pitch, we likely have a capacity already of 20,000 tests per day," Schuler said.
Building capacity further will require outside help, Schuler said. Inslee has held or scheduled discussions with several national private companies, including laboratory and diagnostic testing firms Roche, Abbott and Quest Diagnostics, and with medical swab supplier Puritan Medical Products, he said.
"But we don't know exactly where we can get to over time if the federal government fails us," he said.
Washington will receive more than $15 million in federal money approved last month for coronavirus relief, including $12.75 million for testing, contact tracing and containment, Sen. Patty Murray's office announced Friday.
But in a letter this week to Vice President Mike Pence, Inslee disputed what he described as some Trump officials' views "that testing in the U.S. is already adequate for states to begin initiating recovery plans."
"Simply put, this view is not consistent with facts on the ground," Inslee said in the letter, which called on the federal government to provide more funding and lab supplies.
Shortage of investigators
The governor's plan for increased contact tracing also faces a shortfall -- in personnel. Only about 700 people are now trained to carry out contact tracing investigations in the state's 35 health districts. Inslee wants to more than double that workforce to 1,500.
To do that, the state will tap 500 Washington National Guard soldiers and 300 health care workers and volunteers, said Washington Secretary of Health John Wiesman.
Although contact tracing and testing work together, there is no reason to delay tracing efforts because of a lack of testing, said Dr. Crystal Watson of the Johns Hopkins Bloomberg School of Public Health, during a webinar Friday with reporters.
There needs to be a national strategy for contact tracing with 100,000 people trained to do the work, which would cost $3.6 billion, Watson said.
Locally, contact tracing broke down in King, Pierce and Snohomish counties last month after the public health departments were overwhelmed by the crush of cases. Each department stopped performing the investigations, instead asking patients who'd tested positive to, on their own, warn anyone they might have exposed.
The abandoned investigations are slated to resume by the middle of May under Inslee's strategy. The Tacoma-Pierce County Health Department estimated it would need between 110 and 150 trained investigators, said spokesman Steve Metcalf. It had 60 trained investigators heading into the pandemic, but only 15 to 18 have been doing the work lately, he said.
"We haven't seen the likes of this level of contact tracing needs before in our region," said Sharon Bogan, a Public Health -- Seattle & King County spokesperson.
As with testing expansion, costs for expanding contact tracing remain unknown, Wiesman said. But such investigations are going to be an integral part of what the state health department and local health districts do "until the time that we have a vaccine or have herd immunity in a way that really stops this virus from having such a hold," he said.
