For state, virus tests still posing challenge
Rise in numbers seen to fall short
Since Arkansas’ first case of covid-19 was detected March 11 in Pine Bluff, the state has conducted more than 470,000 tests — about 15% of its population — with nearly 38,000 people found positive for the virus as of Saturday.
More than four months after Arkansas’ entry into the worldwide pandemic, testing remains a significant challenge in the state, with access sometimes blocked by pre-screening criteria or simply by where a person is trying to obtain a test.
And then, the turnaround times of results have been affected by a nationwide shortage of testing supplies and equipment, including reagent — a compound used to cause a chemical reaction needed to detect the virus in the testing sample.
In the U.S., more than 700,000 people are tested each day, according to data from the U.S. Centers for Disease Control and Prevention.
As the virus rages through the nation and the state has thousands of new cases each week, health experts say the U.S. should test 1 million to 3 million people daily to get ahead of the virus.
According to the Rockefeller Foundation “Testing and Tracing Action Plan” unveiled July 16, scientists and health experts brought together earlier this month
called for 30 million tests per week by October.
“Testing is our way out of this crisis,” Rajiv Sha, president of the Rockefeller Foundation, said in a letter issued with the plan.
According to a recent report from the University of Arkansas for Medical Sciences, the outbreak in Arkansas is projected to reach its peak by the end of November.
To help fight the spread of the virus, experts say test results need to be returned rapidly. CDC guidelines recommend that test result turnaround times be under four days before states lift virus-related restrictions.
In Arkansas, the rate of return of test results varies from one provider to the next, with some reporting results within minutes and others within weeks. Tests processed at a state laboratory typically take three to four days to get results, said Danyelle McNeill, a spokesman for the state Department of Health.
BY THE NUMBERS
As of Saturday, roughly 15,500 tests per 100,000 people have been performed in Arkansas, which has about 3 million people.
Compared with nine other Southern states, Arkansas ranks third-highest in the number of tests administered per 100,000 population, topped by Louisiana at nearly 26,000 and Tennessee at more than 19,000.
At the bottom were Texas with more than 11,000 per 100,000 population and Missouri with about 10,000.
Other states included in the comparison were Alabama, Georgia, Kentucky, Mississippi and Oklahoma.
Testing in Arkansas started out at 57,000 tests per month in the pandemic’s beginning. By June, that number jumped to 181,688 and so far in July, nearly 145,000 tests have been performed.
June’s numbers for Arkansas included about 50,000 tests performed in nursing homes and other long-term care facilities as a condition of reopening the facilities to visitors.
“Arkansas is doing well in testing and last month alone we tested 6% of our entire population,” Gov. Asa Hutchinson said in an email. “But we can’t let up and we need to do the same level of testing in July.”
Testing, Hutchinson said, is crucial in the fight against the virus.
“Testing is key to identifying those infected by the virus and to have awareness as to extent of spread of the virus in the community,” Hutchinson said. “Testing is our radar system to point us to the infections. Then we trace and isolate.”
GETTING TESTED
Arkansas’ coronavirus tests are performed at the 75 local health units as well as about 200 other sites — such as hospitals, pharmacies, medical clinics and pop-ups.
A map with testing sites — including both health units and other testing sites — can be found on the Health Department’s website at https:// www.healthy.arkansas.gov/ programs-services/topics/ covid-19-guidance-for-getting-tested.
Dr. Jose Romero, the department’s interim secretary, said there are “no limitations for testing” at local health departments.
“In this manner we are expanding testing significantly,” Romero said. “Additionally testing is free when performed at the local health units.”
Still, some Arkansans are finding it difficult to get tested and hospitals and commercial testers say they have to prioritize who gets tested because of a shortage of chemicals to process the tests.
And the wait times at some testing sites are prohibitive.
Laura Young of Springdale said her husband called the Washington County health unit in Fayetteville a few weeks ago after a possible exposure to the virus and was told that the unit was booking a week out.
“He was told his best bet was to try to find a drive-thru testing event over the weekend or to go to urgent care or a doctor’s office to get tested sooner,” Young said. “I have no idea how far out they are booked now. I’m just assuming it’s even worse.”
Visitors to the Walgreens testing website work their way through a screening survey to determine if they’re eligible for testing, only to find appointments booked a week out.
UAMS has a four-lane drive-thru testing site in Little Rock and also operates a mobile triage unit that travels around the state.
UAMS spokeswoman Leslie Taylor said the lines and the wait are long as the teams administer about 400 tests per day.
“We aren’t doing universal testing,” Taylor said. “We are only testing people with symptoms, with known exposure or who are scheduled for procedures and surgery at UAMS.”
The Baptist Health system has 13 testing sites around the state administering about 470 tests per day, spokeswoman Cara Wade said.
The lines are long at the testing sites, with some people waiting as long as four hours, Wade said.
Several Northwest Arkansas health care providers released a joint statement recently saying the testing priorities had to be adjusted because of concerns about the availability of testing material.
The providers included Arkansas Children’s Northwest, Community Clinic, Mercy Northwest Arkansas, Northwest Health, UAMS Northwest, Veterans Health Care System of the Ozarks and Washington Regional Medical Center.
Those with symptoms will be tested first, followed by those who have virus-positive individuals within their households and third are asymptomatic health care workers who have been exposed or possibly exposed to the virus.
“To ensure we are monitoring adequate [protective gear], supplies and resources, we must be good stewards,” Eric Pianalto, president of Mercy Hospital Northwest Arkansas, said in the statement. “While we wish we could test everyone, unfortunately, that is not realistic or wise for our community until we have ample testing supplies.”
VARIATIONS IN RATES
There is also a disparity in the number of tests per person administered from county to county.
As of Saturday afternoon, Washington County had 5,576 virus cases — the highest number of total cases in the state.
Next was Pulaski County with 4,297 cases and then Benton County with 4,156 cases.
The three are the most populous counties.
But testing in Washington County equals about 11.4% of its population of roughly 240,000; 21% of test results have been positive.
That’s compared with testing 14.8% of Pulaski County’s population of about 390,000; 7% of those tested are positive.
And nearly 20% have been tested in Benton County (population 280,000), where 8% of results are positive.
(Some people receive multiple tests.)
Lee County, with a population of 8,857, has tested the highest number of people, equal to about 37% of its population, but that’s been the site of one of the coronavirus outbreaks at prisons.
More than 29% of Sevier County’s population was tested, but that county, too, had an outbreak, among poultry workers.
White County, with a population of almost 80,000 has the lowest percentage of testing, about 7%.
LAWMAKER’S REPORT
When Rep. Nicole Clowney, D-Fayetteville, saw virus cases rapidly rising in her district, she decided to take matters into her own hands.
With no spreadsheet or
data skills, she began collecting information June 21, in the form of a social media survey.
She asked the names of the testing sites, the barriers that people faced, how many times constituents attempted to get tested and whether they ultimately got tested.
Clowney received hundreds of responses.
“We have a problem. Washington County is being grossly under-tested,” she said.
Clowney entered the data in a rough spreadsheet, then compiled a three-page report, complete with pie chart, and sent it to Hutchinson as well as the Health Department.
“As one of the State Representatives for Washington County, I’m writing today because we have to do better,” she wrote in the report’s introduction. “As we started to see Washington County’s percent-positivity rate skyrocket, I began to hear a number of reports of my constituents being turned away from testing for various reasons. Since these anecdotes lined up with the testing numbers and positivity-rates that the data was showing us, I wanted to dig deeper.
“As it turns out, the problem is NOT only that people aren’t showing up to get tests. They are.”
Clowney then outlined the barriers to testing experienced by the respondents.
“By far the most common barrier that people faced was being turned away for testing because they were asymptomatic or hadn’t had contact with a known positive,” Clowney said. “This is frustrating for them, because they hear daily from the state that anyone who wants a test can get one.”
Other hurdles included the lack of information of where to get tested or how much it would cost and the wait time for results.
Clowney said it’s obvious from the governor’s and the Health Department’s response that they share the concerns about Washington County numbers.
Hutchinson said recently that he has received many reports of especially long lines for testing in Washington County.
He recently sent 10 members of the Arkansas National Guard to the area to help with case management.
The Health Department extended hours so that the local health unit will be open from 7 a.m. to 7 p.m. instead of 8 a.m. to 4:30 p.m.
The Health Department also has held a number of free drive-thru testing events in recent weeks in Washington County.
“Bottom line, there is a lot of confusion around testing that is preventing many from getting the services they need,” Clowney said. “Testing needs to be easy, accessible, and free. That’s the state’s job. The best thing that we as a state can do, is create as many opportunities as we can for testing like the [Health Department] drives we’ve seen here this week. Testing needs to be provided close to where the people who need them most live.”
On Friday, the Arkansas Legislative Council refused to consider a request to approve the use of $7 million in federal funds that would go to the Northwest Arkansas Council, which would use the money for contact tracing, testing and case coordination for the region’s Hispanic and Marshallese populations. The money also would be used for these populations in Independence, Randolph, Sevier and Yell counties. Lawmakers complained that the request came when other funds for contact tracing were still available. They also complained that they had not received a full explanation regarding the request.
TURNAROUND TIME
The rate of return on testing results varies from one provider to the next, with some reporting results within minutes and others taking weeks.
Madeline Pyle of Batesville said she attended a Black Lives Matter protest a few weeks ago and then later found out someone there had tested positive.
She said she drove to her doctor’s office at UAMS North Central in Batesville and the whole process from start to finish took less than an hour.
“I waited in my car for about 15 minutes, and they came back to my car with the results,” Pyle said. “I was negative.”
Chelsea Jones of Ward had a similar experience at a Walgreens pharmacy in Little Rock, although she had to wait about two hours in her car before being tested.
“The staff came to my car and got some information from me. I then drove around to a tent where they wheeled a cart up to my window and gave me instructions to administer the test myself,” Jones said. “I swabbed both nostrils, placed the swab back in a package and back onto the cart. I had my results three hours later — negative, thankfully.”
Gary Schafer of Fayetteville was still waiting for his results nearly two weeks after being tested June 26 at a Health Department drive-thru event at Northwest Arkansas Community College in Bentonville.
He was mildly symptomatic with coughing and shortness of breath.
They told him the results would take three to seven days.
He received his negative result on July 17 — 21 days later. The virus lasts 14 days.
Results from tests performed at a local health unit typically take three to four days, McNeill said.
“If you are positive for covid-19, you will receive a call from a nurse in three to five days,” McNeill said. “If results are negative for covid-19, a letter will be mailed to the address you provided. Results are typically made available within three to four days, though it can take longer to receive a letter.”
Health Department tests — a small percentage of all the coronavirus tests performed in the state— are processed in the Arkansas Public Health Laboratory, which recently reported a record number of tests in one day of nearly 1,400.
Romero, the interim health secretary, said he believes Arkansas is doing well with regard to testing.
“We currently have two high throughput PCR machines in our public health laboratory. We will be adding an additional two machines in the upcoming two to four weeks,” he said. “We are among the best public health laboratories in the country with regard to capacity for in-house covid-19 PCR diagnosis. In terms of the numbers of covid-19 tests performed daily, our numbers have steadily increased.”
UAMS processes the tests in its own laboratory, but also contracts with outside labs.
Taylor said UAMS has a “strict prioritization process for samples” and results can take from one day for inhouse samples to seven to 10 days for samples sent to other labs.
Because of extremely limited reagent to process the tests, Wade said the Baptist Health system only runs inhouse tests on high-risk inpatients and health care workers with high exposure. The majority of tests are sent to reference labs at various sites across the country.
The turnaround time for test results varies depending on the demand, she said.
“When volumes were lower, we were seeing turnaround times of approximately 48 hours,” Wade said. “It is not unusual to take a week to 10 days for a result, and this unfortunately will probably grow even more. As volumes increase, everyone will see turnarounds potentially slow down.”
Hutchinson said “point of care” testing will be increased in the near future for the state making for a “quicker turnaround.”
Point-of-care testing is done outside of a laboratory, like at a patient’s bedside or at home. Current examples include blood glucose monitors that allow a diabetic to take a small sample of blood — typically from a finger prick — and feed it into the monitor using a test strip to get the glucose level result.
Other examples are home pregnancy tests and rapid strep tests.
CHALLENGES CONTINUE
The Baptist Health system, like others in the state, are struggling to maintain an adequate number of tests, reagent and supplies.
“It is absolutely difficult to locate tests,” Wade said. “Vendors are allocating based on hot spots and in which locations the government feels are in the most need of testing. That changes daily.”
Wade said the Baptist Health system is doing the best it can to meet the patients’ needs and provide the best “patient experience possible in an extremely trying time.”
And challenges continue to present themselves.
“In some cases we’ve ordered testing machines only to find out they were reallocated to other states. And, even when we’ve received machines we do not get enough reagents,” Wade said. “Also, our reference labs are having their own challenges. Staffing is an additional challenge. These drive-thru testing locations are out in the heat and staff must wear all of their [protective gear] for protection. As temperatures rise, we have to limit the amount of time an employee is in that environment.”
Mitchell Nail, the spokesman for St. Bernards Healthcare in Jonesboro, said the problem is a national one that trickles down to the states.
“We have found it challenging to keep enough test collection supplies and testing cartridges. In addition, our sent-out commercial testing lab receives large volumes of test samples from across the country that may delay results,” Nail said. “These delays create understandable frustrations for us, as a medical provider, and our patients.”
To try to combat the problem, the Jonesboro hospital is purchasing another testing platform for its lab that offers more testing capabilities.
“With it, we can more efficiently use testing supplies and meet patient needs. We are also using therapies for patients, such as Convalescent Plasma, to help improve patient outcomes,” Nail said. “Lastly, in clinic settings, we have expanded the covid-19 testing process to include a physical examination that determines if more care is needed with a goal to prevent hospitalizations.”
Romero said the solution to testing also lies in the area of public awareness of the significance of the infection and the public’s understanding of the need for testing.
In her report to the governor and the Health Department, Clowney said the state needs to immediately implement a clear information campaign as well as push providers for quicker and increase the number of Health Department testing drives.
“I understand that there are many good people working hard to make this process more accessible and faster across the state. I appreciate and applaud those efforts,” she said. “But Washington County is being left behind. And the problem isn’t getting better here, it’s getting worse.”