Maine CDC Director On The Future Of Coronavirus Testing In The State

As Maine Gov. Janet Mills considers reopening the state economy, a key consideration is the state's ability to test for COVID-19. But it's a difficult task. Maine Public's chief political correspondent Steve Mistler discussed the way forward with Maine CDC Director Dr. Nirav Shah, who acknowledged that the state has so far been forced to ration testing for the virus:

Ed note: interview has been edited for length and clarity.

Shah: We do have to focus on certain higher risk groups of patients because the supply of reagents from the federal government and from manufacturers is not as robust as we'd like it to be. We're not happy about that. And, ideally, we'd like to move toward getting rid of those focus areas, and just throw our doors open to be able to allow testing for any doctor who wishes to send it to us. That's our plan, we'd like to move in that direction. But before we can throw open our doors in that manner, we've got to make sure that we've got this predictable supply of the chemicals that we need, or otherwise we could throw our doors open and not actually be able to run tests and end up with a backlog. But, Steve, I want to be really clear about one thing: although that focus on the highest risk patients does exist at the Maine CDC lab, it does not necessarily exist at commercial laboratories. So physicians are still able to send samples to commercial laboratories, if they've got patience, they'd like to get tested.

But the reason we have that in place at our laboratory is so that doctors can get results on patients where they need to make an immediate treatment decision. Or a patient who might be in the hospital. Or a patient who's a healthcare worker, for whom the result of the test might determine whether they can go back to work the next day and start serving patients again, or whether they need to stay home for 14 days. And that's why we've got those areas of focus because we know that rapid result is really essential and critical for decision making.

Mistler: The idea behind more expansive testing is that it would allow public health officials to effectively swap these broad shutdowns and stay-at-home orders for more targeted quarantines. If that's true, what can Maine do to expand its capacity?

So right now, our focus is on both expanding the amount of testing that we can do, our so-called testing capacity, that's point number one. And step two is making sure that doctors know that once we've eliminated all these tiers, once our doors are completely wide open, they should start sending us samples, not just on patients who are showing symptoms, but, now, in this next phase, we'd like to start offering testing for patients who are not showing symptoms.

The third thing we need to do to make this strategy really come together is to ensure we've got a broad and wide base of contact tracers. Right now Maine CDC has dozens of people that are undertaking this process of touching base with everyone who's tested positive, but we're going to need more because as you say, this swaps out the broad strategy for a targeted one, where we basically draw a box around every single person who we test positive, and try to contain the disease that way.

A recent study by Harvard called "Roadmap to Resilience" said states need to test between two and 6% of their respective populations every day. That means testing between 26,000-80,000 Mainers a day. Is that even possible?

That was the high bound of their estimate. The same group has also estimated that where we need to go, compared to where we are right now, is doubling or tripling the capacity at the state level.

The New York Times editorial board recently advocated for the federal government to centralize a testing program, specifically in the procurement of supplies. Do you think that's a good idea?

It is one approach. There are benefits of moving toward a centralized model, one of which is that it might help eliminate some of the competition by and among states to get our hands on different pieces of equipment. Steve, you and I have previously talked about, in some situations, how states are reluctant to share what they're doing for fear that another state might swoop in, and that's clearly a problem. On the other hand, centralization might mean a central point so such that, if one problem arises, the ripple effects would be felt across all 50 states.

Governor Mills recently indicated that the White House has overestimated Maine's current testing capacity. And you also took issue with those estimates. Now, I understand that the White House documents were not supposed to be shared publicly. But can you tell me how off the estimates were?

You know, you raise a good point — the document itself, the documents that we were furnished by the White House, did not actually provide an overall estimate of the state's testing capacity. What they did was provide a list of different machines that were available in the state that, according to the White House, could be used to conduct tests. To the outsider, it gave the impression that there was a vast amount of machinery in Maine that could be marshaled in order to conduct testing, but it's not quite accurate. It's a little bit like going to the manufacturer of stoves and ovens and asking them, 'how many ovens have you sold in Maine?' and then from that, concluding how many professional bakers there are in the state. It doesn't quite add up that way. There's a lot of machines out there in Maine that are used in the testing process. But it doesn't necessarily mean that can they can be immediately converted in order to do Coronavirus testing.

So it was concerning because it could lead to the impression that there was actually more capacity that was being unused and made. And why that was concerning for me, was that, I stand up every day and chat with people in Maine about where things are, and have expressed concerns about our overall capacity. And our plans to beef it up. A document that comes out and says 'there's plenty of capacity out there' seems to fly in the face of what I've been saying. And one of the words that I live by came out of the financial crisis, which is that in a crisis, in an emergency, your credibility is the only thing you've got. And I've always tried to be straight with people about where we are and where we want to go. And so documents that suggests otherwise cause confusion, and I'm glad to be able to have the opportunity to give it to people straight in an opportunity like this.

Ed note: you can find an archive of Maine CDC daily briefing videos here.

Originally published 5:45 p.m. April 24, 2020