Nebraska officials have taken some knocks because the state has trailed some neighbors in the number of people who have been tested for the novel coronavirus.
The state ranked 44th among the 50 states and Washington, D.C., on Thursday in the number of tests it had performed per capita, according to a World-Herald analysis of data compiled by the Covid Tracking Project, a volunteer effort of journalists and scientists.
But at the same time, the state ranked 49th in confirmed cases of COVID-19 per capita, and 40th in deaths. Put another way, Nebraska’s testing rate stood about 60% below the national rate while confirmed cases were 360% below the national rate.
Iowa, ranked 43rd in per capita testing, was 38th for cases per capita and 35th in deaths.
Undoubtedly, lower rates of testing in Nebraska mean some cases are being missed, contributing to the state’s lower case counts. But deaths and hospitalizations, which denote more serious cases, tell a starker tale. By Friday afternoon, 17 Nebraskans had died from complications of COVID-19.
Forty-three patients with COVID-19 were hospitalized at the end of the day Thursday in the Omaha metropolitan area, which includes Douglas, Sarpy, Saunders, Pottawattamie and Washington Counties. In Nebraska, a total of 102 people have been hospitalized with the disease from February through Thursday, the state said.
Nebraska Gov. Pete Ricketts said again in a town hall meeting Thursday night that state officials recognize the need to expand testing.
“No governor feels like they have enough tests for the people in their state,” he said, repeating a refrain from recent weeks.
The state initially prioritized high-risk groups, including those hospitalized with symptoms, the elderly and those with underlying health conditions, and those with a history of travel to coronavirus hot spots. Initially, the travel list stopped at China. It later expanded to include all international and Interstate travel. Also added to the list were health care workers, first responders and residents of nursing homes and other long-term care facilities. All, if they became ill, could seed outbreaks that could be difficult to control.
Dr. Mark Rupp, chief of the University of Nebraska Medical Center’s infectious diseases division, said that out of necessity, the state has had to reserve and prioritize tests for where they will make the most difference.
By the time health officials get through those lists, few tests are left for the young and healthy. Health officials, he said, would love to know whether all those who report symptoms have the virus.
“But we can’t just open the floodgates and test everyone we’d like to,” Rupp said.
Nebraska’s test numbers have increased significantly in recent weeks as the state’s public health laboratory, hospitals and commercial testing companies have ramped up testing.
In the two-week span that ended Wednesday, the total number of tests conducted increased by nearly 5,800. The number jumped again from 8,067 on Wednesday night to 9,474 by Friday evening, according to the Nebraska Department of Health and Human Services.
As Nebraska has ramped up testing, it has been competing with other states for scarce supplies all along the testing pipeline. Ricketts said Thursday that he had been calling manufacturers seeking reagents, the chemicals needed to run the tests. It takes a total of 15 of them.
Working against the state is its relatively low rate of positive tests, which suppliers are considering as they fill orders. Nebraska’s rate is about 6.5%, Dr. Gary Anthone, the state’s chief medical officer, said in a briefing Thursday. New York’s, by comparison, is about 41%, according to the COVID Project data.
Said Rupp, “I’d love to be able to test thousands or tens of thousands a day. But that’s just not the reality of the situation on the ground.”
Whether tens of thousands of tests eventually will be conducted isn’t clear. But state officials can think about beginning to test more of the general population.
“We’re now at a phase where more broad testing is appropriate,” said Dr. Steven Hinrichs, chairman of UNMC’s pathology and microbiology department.
The department includes the Nebraska Public Health Laboratory; a clinical lab jointly operated by UNMC and its clinical partner, Nebraska Medicine; and a research lab. Together, the three labs on the UNMC campus can run between 500 and 600 diagnostic tests a day, Hinrichs said.
CHI Health, which recently launched its own testing, can conduct about 270 a day. Commercial labs also are testing.
Within the past week, Ricketts has deployed the Nebraska National Guard to collect samples for testing from specific groups in areas with flare-ups — Grand Island, Kearney and the Panhandle. Guard members initially swabbed about 150 health care workers and first responders in Grand Island. But local officials announced Thursday that collection would continue through Saturday with the goal of testing 75 people a day.
Hinrichs said the initial goal of testing wasn’t to test every Nebraskan with possible symptoms or catch every case of COVID-19. Instead, he said, the intent was to identify at-risk people and strategically reduce the spread of disease.
Only now, he said, is the state at the stage where public health officials can begin to look at broadening testing, which could help find those without symptoms who are spreading the virus.
“That’s where you begin to turn your resources to that question, after you’ve absorbed the acute blow of the epidemic,” he said.
Officials in Los Angeles this weekend planned to begin to test 1,000 randomly selected residents using one of the new antibody tests that are becoming available, the Washington Post reported. The National Institutes of Health on Friday announced plans to test up to 10,000 volunteers from across the country.
Such “serology” tests look for antibodies in blood that the body produces when it’s fighting an infection. While not considered as definitive in diagnosing the disease, they’re being eyed as screening tools that could give researchers a better idea of how widely the virus has spread.
One factor initially limiting testing in Nebraska was a shortage of supplies — first the extraction kits used to pull out the virus’ genetic material from specimens and then the swabs used to collect the samples from the back of the nose. It’s a complex process and requires accuracy from start to finish, starting with properly collecting samples of cells at the back of the nose where the virus may be replicating.
Dr. Jana Broadhurst, director of the Nebraska Biocontainment Unit clinical laboratory, said more than 30 tests that look for the virus’ genetic material have received federal approval for emergency use.
But questions about who should be tested have to be balanced with the availability of resources, Broadhurst said. That has varied by state and even within states. Uncertainty around availability of supplies has, in turn, made it difficult to project testing strategies more than a few weeks out.
To help ease the crunch at the medical center, lab teams started making the liquid used to sustain any virus on the swabs until it gets to the lab.
Tethon 3D, an Omaha 3D printing firm, recently shifted its production and began printing swabs. The firm donated 1,000 to the medical center and now is selling them at the cost of producing them, said Karen Linder, the company’s CEO.
With the limits on testing, government officials have layered on measures intended to contain the virus and keep hospitals from getting overwhelmed, including asking all but essential workers to stay home, limiting crowds to 10 or fewer and even closing Omaha’s parks.
Hinrichs said he understands that people would like to exchange social distancing for wider testing.
But that’s not a good trade, he said. On a given day, officials could test a group of people and get all negative results. The next day, some of those people could become positive. People who were positive one day also could test negative the next, particularly as they near the end of their illness.
And as with any lab test, he said, health officials also consider whether testing will mean a different course of action for patients. With no treatments approved for COVID-19, those with mild illness have been instructed to isolate and recover at home.
Dr. James Lawler, co-director of the Global Center for Health Security at UNMC, said during Ricketts’ town hall Thursday that wider testing will be key to determining when the state can dial down some of the stricter social distancing guidelines now in place.
Testing also is important for understanding how to isolate people, even at home, and to trace and isolate their contacts, moves that will be a mainstay in keeping the disease in check.
Hinrichs said Ricketts has pushed hard to get new, faster testing equipment, a device made by Abbott Laboratories that can produce results — one test at a time — in 15 minutes. Lab personnel still are evaluating its accuracy.
UNMC also is evaluating serological or antibody tests, which would allow officials to determine whether people have been infected in the past and whether they have acquired some immunity.
Those, however, probably are about two weeks away. Like the diagnostic tests, they would require a doctor’s order.
“Every disease has a progression,” Hinrichs said. “You have to do certain things at a certain time.”