Maine is conducting 30 percent fewer COVID-19 tests daily than needed to safely reopen its economy but is outperforming all but one other New England state, according to Harvard University researchers.
Vermont is the only state in the region, and one of only 19 states nationally, expected to meet the state-by-state testing targets identified in a data analysis published Monday by the Harvard Global Health Initiative and the medical news site STAT.
In mid-April, Maine was conducting about 406 tests a day, state data show. Harvard researchers say Maine should be testing, on average, 583 people a day if it hopes to safely track and contain the virus as it relaxes its social distancing requirements.
The institute used two models to estimate a state’s target testing range.
One model was simple: Take the total number of deaths that had been projected for Maine by May 1 by the Los Alamos National Laboratory, the White House’s preferred COVID-19 model, and apply the World Health Organization’s positive test rate of 10 percent to conclude that Maine needs to do 510 tests a day.
The other model started with the number of new positive tests that Los Alamos predicted would occur on May 1, which was 38. Add to that enough tests to screen 10 close contacts of each, or 380, plus the 160 other people who on a typical year present with flu-like symptoms on that day, and you get 578 tests a day.
The Maine Center for Disease Control and Prevention wants to expand state testing capacity, but its director, Dr. Nirav Shah, has resisted calls to quantify how much is needed before the state can safely reopen. There is no testing backlog, he said. The state ranks 23rd in per capita testing.
The measure of adequate testing capacity in Maine will be “when every medical provider in the state can order tests for patients whenever that provider’s clinical judgment indicates that testing would benefit the patient,” Shah said at a news briefing this month.
There are positive signs in Maine’s testing. The WHO says a positive rate below 10 percent shows that an adequate number of people are being tested, and only 5.7 percent of Mainers who get tested are testing positive, well within the 3 to 12 percent positive range set by the federal CDC.
But like many other states, Maine’s testing capacity is hampered by insufficient supplies of reagents, swabs and personal protective equipment, Shah said. Maine continues to ask the federal government to help it build its capacity while it also looks to buy supplies on the private market.
The state is under a stay-at-home order until Thursday. Gov. Janet Mills is drafting a plan for a gradual reopening that will likely phase in a gradual relaxation of restrictions region by region, industry by industry. She is expected to announce a decision Tuesday about whether to extend the stay-at-home order.
While other states have begun letting their quarantine restrictions expire, and the White House has mapped out a path to getting the economy going again, Mills has insisted that Maine’s reopening timeline will be based on public health readiness, including testing capacity, not economic hardship.
On Monday, Mills called on federal authorities to rethink their distribution strategy for supplies, including testing kits and materials, which are being sent at disproportionately high rates to states suffering the highest number of new infections and deaths.
“I keep making the pitch on our calls, as does Vermont, New Hampshire, Montana, other more rural states, that we want to avoid becoming hot spots,” Mills said at a briefing Monday. “So we need more test kits and test reagents and swabs and the materials that go with those tests to prevent us from becoming a hotspot.”
At an April 17 briefing, White House COVID-19 task force coordinator Dr. Deborah Birx singled out Maine as one of three states that could not meet its recommended testing target of 30 tests per 1,000 people in a month. Maine would need to do about 1,330 tests a day to meet the White House testing target.
The Harvard Global Health Institute and others are recommending the United States needs to do closer to 45 tests for every 1,000 people if it wants to be able to safely contain any outbreaks that will occur after states begin to lift their social distancing requirements.
But institute researchers note that regional variation should be taken into account when calculating testing targets for states. That would mean that Maine doesn’t need to run the 2,000 tests a day the Harvard national guideline suggests to safely contain outbreaks that could occur upon reopening.
“You can’t just take the national number and scale it to states by their population,” institute director Ashish Jha told STAT, the Boston-based health news organization it collaborated with to produce Monday’s state-by-state review. “You have to base it on the size of the outbreak in a state.”
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