Oregon’s coronavirus testing capacity is about to get a big bump.
Through December, Oregon will receive enough kits to do up to 80,000 “rapid antigen" tests a week, more than double the state’s current capacity. The Oregon Health Authority says these tests will go a long way to help control the spread of COVID-19 in Oregon, and aid in quarantine and contact-tracing efforts.
“Testing isn’t magic. It’s a tool, but testing by itself doesn’t get rid of COVID-19,” said OHA director Patrick Allen. When combined with contact tracing to find others who may have been infected and quarantining those who could spread the coronavirus, testing can make a dent. Provided, of course, that Oregonians continue to practice social distancing and to wear face masks.
The new tests come from 150 million purchased from Abbott Labs by the federal government. Fifty million of those tests will be sent to nursing homes and historically Black colleges and universities across the country. The remaining 100 million will be parceled out and sent in installments to individual states. How many tests each state receives depends on the population. Although each state can use the tests however it chooses, the Trump administration strongly suggested that new testing capacity be used in ways that help open schools. That’s what Oregon plans to do with their new tests — but not necessarily in the way some might think.
So instead of trying to screen for COVID-19 at schools — there are about 750,000 students in Oregon, according to Allen — or survey a small portion of students to get an idea of prevalence in the population, the Oregon Health Authority has a different strategy: use these tests to ramp up contact tracing efforts. By catching more cases before they spread, Oregon hopes to get COVID-19 somewhat under control. And lower case numbers mean it’s safer for schools to have in-person education.
“Getting cases down is the right way to open schools,” Allen said.
The tests
Abbott Labs says its latest “BionaxNOW” tests are more accurate than other commercially available consumer tests. They take 15 minutes to give results, they cost $5 per test and they don’t require any special technology to work.
These tests are a lot like the ones commonly used to test for the flu. It’s a piece of cardboard about the size of a credit card with a chip on it. The tests look for viral antigens, which are proteins unique to a virus. When chemicals in the test detect the antigens, they bind to it and change color. It’s the first COVID-19 test approved in the U.S. that doesn’t require additional machinery to work.
According to the U.S. Food and Drug Administration, they correctly identify COVID-19 positive samples 97% of the time and correctly identify negative samples 98.5% of the time.
Related: What False Negatives Can Tell Us About Oregon's COVID-19 Numbers
While those accuracy rates are high, they do leave room for false negatives and false positives. As the COVID-19 outbreak in the White House has shown, a negative test does not mean you did not have the coronavirus. It just means you didn’t test positive at that moment.
“A negative COVID-19 test is not a hall pass to not wear a mask or have big group gatherings,” Allen said.
In the past, the Centers for Disease Control and Prevention asked that all positive antigen tests be confirmed with a more accurate, slower-to-process type of test called an RT-PCR. Oregon isn’t going to require that, because it lacks the capacity. But state officials said they hope doctors will order second tests if they have reason to believe the first result is inaccurate.
That being said, Abbott’s rapid tests are still an important tool. If you have COVID-19 and get this test, there’s a good chance that it will confirm your diagnosis. And that gets you on the radar of public health departments, so they can start the contact tracing process, and you and your close contacts can isolate and self-quarantine.
The plan
The tests won’t be sent to Oregon schools themselves — unless the school has a health center that’s certified to handle tests from human subjects by the FDA.
“The regulatory requirements make it a little hard to just send the tests to a classroom,” said Kristen Donheffner, the testing strategy manager at the Oregon Health Authority.
And, as OHA director Allen noted, there aren’t enough COVID-19 tests to screen every student regularly. The only way to ensure that COVID-19 isn’t transmitted in schools, or, at least, to make transmission less likely, is to try to reduce the number of undetected cases in the community.
To do this, Oregon’s tests will be sent to university health care centers, rural hospitals and federally qualified healthcare centers across the state. Donheffner said OHA has reached out to different counties to see which ones need the resources the most. They plan to target at-risk and vulnerable populations, like migrant farmworkers and people in aggregate living facilities.
OHA plans to roll out the tests slowly — initially starting with places that already test for COVID-19. “They already have the waivers and regulatory requirements, and know how to do the reporting,” Donheffner said.
Then, they’ll track to see how they’re being used and identify other sites that might be equipped to test for COVID-19, and help them get the proper certifications. “Those might include aggregate living facilities, the department of corrections and other testing locations,” Donheffner said.
“It’s not going to replace our metrics for reopening schools. In order to reopen schools, we have to reduce the amount of COVID-19 in our communities,” Donheffner said.
Who gets them?
These tests will change Oregon’s COVID-19 response in one huge way: contact tracing. The capacity of any state to mount an effective contact tracing plan has been limited by the number of tests it has available. In Oregon, that meant that if you had close contact with someone with COVID-19, you would only get a test if you showed symptoms, or if a medical professional thought you needed a test.
Now, Oregon has updated its guidance: every close contact of a confirmed case will get tested, regardless of whether or not they’re showing symptoms.
“That’s a huge change, the inclusion of all close contacts, even asymptomatic ones. It aligns with the new CDC guidelines,” said Dr. Melissa Sutton, senior health advisor to the Oregon Health Authority.
While it’s may be a boon for the OHA, Sutton said it doesn’t solve everything.
“I do want to highlight the limitations of testing. Testing is a snapshot in time,” she said.
“I think we’ve all just had a kind of an object lesson on why, you know, you can’t just test everybody every single day. It turns out to maybe not be as effective as you think it is,” Allen said. Like Kellyanne Conway, a person might test negative for COVID-19, but test positive later, even if they’ve been self-isolating.
These tests are arriving just as Oregon is seeing a big post-Labor Day spike in COVID-19 cases. The most recent model released by OHA predicts that cases, hospitalizations and deaths will continue to rise during the first weeks of October. Initially, Oregon’s expanded testing capacity could make it look like cases are rising. But in the long term, Sutton says, it should help curb the spread in Oregon.
More confirmed cases also mean more contacts to trace. And the effectiveness and speed of contact tracing has varied across the state, and only works if infected people answer the phone and cooperate with contact tracers.
Related: Here's How Oregon's Reopening Depends On Testing And Tracing Benchmarks
Whether a county’s contact tracers will be able to keep up with the increased caseload is anyone’s guess.
“I think that question is the number-one concern counties have about having this much testing,” Allen said. “Some are better off than others and are much better able to handle that than it was before.”
Allen pointed to Oregon’s Clatsop County, where a large outbreak was reported at a seafood processing facility. Although the initial outbreak was significant, Allen says very few additional cases there have been documented over the last several days. He says that’s a testament to Oregon’s increased testing and contact tracing capacity. In comparison, an outbreak at a seafood processing plant in Lincoln County in June led to widespread community transmission.
Some counties are doing better than others, but “we’re continuing to hire both at the state level and in various locations,” Allen said. He said OHA just completed another round of hires and is prepared to deploy them around the state when outbreaks arise. He also noted that OHA now has contacts (and has given grants to) hundreds of community organizations that have multilingual contact tracers and provide community-appropriate services. That had been a big barrier to testing and contact tracing in the past.
Allen thinks that the biggest takeaway of the last seven months is that Oregon’s COVID-19 numbers are very dependent on individual behavior. It just takes one super-spreader event to start an outbreak.
As testing continues to rise, Allen said he is worried that negative tests will give people a false sense of security.
“You know, that they don’t have to wear masks, or those kinds of things,” he said.
Correction: Oct. 6, 2020. An earlier version of this story incorrectly stated the number of rapid test kits coming to Oregon. The state is getting up to 80,000 kits a week to test people for COVID-19.
