Texas still struggling to boost testing

Delayed results, drop in demand keep rate behind other states

Richard Roberts began to worry when his favorite turkey salad no longer tasted like much of anything at all. Gardening had also become unusually exhausting.

So on May 12, the 77-year-old drove to the Paws and Taws Convention Center in Fulton, a beach town near Corpus Christi, to get tested for COVID-19 at a temporary clinic set up by the Texas National Guard.

Nearly a month later, he was still awaiting the results.

At this point, Roberts figured earlier this week, “I would either be dead or OK.”

Such delays have become common in a state still struggling to increase testing amid the pandemic. While access is expanding across much of Texas, testing itself has remained flat for weeks, stuck below the goal of 30,000 daily tests set by Gov. Greg Abbott in late April.

It has plateaued even as the governor, a Republican, ordered

widespread testing in hot spots such as nursing homes, meatpacking plants, jails, prisons and minority communities. Some of those tested have reported getting results back after the 14-day incubation period for the virus.

“We are hearing around twoweeks delay for getting results,” said Rebecca Fischer, an epidemiologist and infectious disease expert at Texas A&M. “Which of course is disastrous. Why have you been tested at all if it just goes into a number? That’s not the goal of this.”

She added, “We’re nowhere near testing enough.”

The flattening is especially concerning because COVID-19 cases and hospitalizations are surging since Memorial Day and amid Abbott’s orders reopening businesses across the state. Protests over police violence that drew crowds of tens of thousands have added to the risk that the virus will spread.

“I think the upward trends are real and re-enforced by the rise in hospitalizations,” said Dr. Mark McClellan, one of Abbott’s chief advisers in the reopening. “It’s in a slow burn phase, but it is a real concern. If these trends continue, we could get to a point where hospitals are overrun.”

Without comprehensive data, it’s hard to know what’s driving the testing trend. Experts believe demand is a big issue, with fewer people seeking out tests or realizing that they no longer need to show symptoms to be eligible.

Labs that process the tests have also struggled to keep pace with the volume of samples collected and don’t always report data consistently. Separately, doctors in private clinics may not be administering the test as often as they can.

‘We want to test everybody’

Over the past three weeks, the state reported between 20,000 and 25,000 average daily test results; on Tuesday, the average was 20,400. That data does not indicate when the test was administered or in what type of facility. The state is also slow to match a test to a county, making it hard to determine where testing may be falling behind.

Nationally, Texas is still far behind most other states in testing, administering fewer than 4,000 tests for every 100,000 people, according to an analysis by Johns Hopkins University School of Medicine. Neighboring New Mexico is testing more than 11,000.

Testing is more available now than ever — supplies are easier to come by, new testing sites have opened in neighborhoods across major cities, and the Centers for Disease Control and Prevention now recommends that people without symptoms get tested if they’ve been in close contact with those who are infected.

“In the beginning, it was really rationed,” Fischer said. “We’ve totally blown that out the window. We want to test everybody.”

Last month, the state was required to submit a plan to the Trump administration outlining how it will increase testing through the rest of the year. The governor’s office did not respond to a Hearst Newspapers request for copies of the plan.

The Texas Division of Emergency Management said some labs struggled in early May to process all the samples collected at mobile clinics, such as the one where Roberts was tested. Since then, demand for tests at the sites has tapered off by more than half, down to about 3,600 on Tuesday.

“We don’t see the number of appointments being made that we saw a month ago,” said Seth Christensen, a spokesman for the agency.

Mobile clinics account for 12 percent of the tests collected across the state so far, and Christensen said the majority are processed within a week.

Labs have also had to quickly adapt to new standards. Chris Van Deusen, a spokesman for the Department of State Health Services, said labs normally report only positive results to health agencies; they’re now required to report all results, which has led to some delays.

“We still see some labs reporting inconsistently or in formats that make it difficult to count all of their results and continue to work with them on correcting those issues to ensure all lab results, positive and negative, are reported as required,” Van Deusen said in an email.

Other labs have offered to help but were turned away because they lacked the proper certification.

Bruce Akey, director of the Texas A&M Veterinary Medical Diagnostic Laboratory, said he tried unsuccessfully for weeks to get a temporary federal waiver that would allow his staff to process human samples. Some states have received authority to oversee their own certification process, but Texas is not one of them.

Akey’s lab eventually farmed the facility and equipment out to two smaller labs, but A&M vets aren’t allowed to conduct the tests themselves, which has lowered output.

“What we didn’t realize was that with our educations and backgrounds, we wouldn’t qualify during a national emergency,” he said, adding, “It’s mindboggling to us.”

Fischer said some privatepractice physicians seem reluctant to test more, even as the federal guidelines have relaxed. She herself recently fought with her own doctor to get tested after coming down with a cough.

“Even if we want to check a family member, they could go to their doctor and get turned away,” Fischer said. “There is a breakdown there, and it’s really creating a challenge for public health measures.”

Family docs have latitude

The Texas Medical Association said doctors have latitude to decide when to test a patient and noted that private physicians have been some of the last medical professionals to get masks and other personal protective equipment that was in short supply early on.

Emergency supplies of masks, gloves and gowns were “going to hospitals, not private doctor practices,” a spokesman said in an email. The association “started our own initiative to get more of that PPE to physicians, and it’s ongoing.”

This week, Roberts finally got the results of his test from May 12 — by pure accident.

Earlier this month, a state health employee told him his results and those of everyone else who got tested in Fulton were still pending. Roberts decided to get tested for antibodies instead. He was told in a phone call that those were negative.

But on Wednesday, he logged on to print out the antibody results for his cardiologist. The results from his viral test were posted there instead. The antibody tests were nowhere to be found. Roberts threw up his hands.

“Trying to keep this all straight has given me a headache,” he said in an email.