Copyright © 2020 Albuquerque Journal
Braving long lines at some COVID-19 testing sites, and sometimes long waits for results, New Mexicans have undergone more than 1.1 million coronavirus tests this year, earning the state kudos nationally for its approach to combating the deadly virus.
More testing means more cases detected and opens the door for early treatment, contact tracing and quarantines to stop the spread.
But the rate of positive tests in New Mexico has soared “way, way out of bounds,” the state’s top medical COVID-19 adviser to Gov. Michelle Lujan Grisham said late last week.
And that’s important, partly because under public health orders, resuming in-person school, college sports and nursing home visitation depend in part on low positivity rates.
While the increase in positive tests could mean higher infection rates, it also could be a function of not enough testing, which is a problem in parts of New Mexico.
“It means we’re missing cases, we’re not testing enough, and hence, we have to put on a full-court press now to get testing resources available,” said Dr. David Scrase, the governor’s top medical adviser and secretary of the state Human Services Department. He believes the state needs to more than double the number of New Mexicans tested each day.
New advances in technology could soon boost coronavirus testing options. Rapid tests are now available, as are those that offer the convenience of spitting into a tube in the privacy of your own home.
At-home saliva testing kits are available commercially online nationwide.
But it isn’t clear how effective any of the new options will be at producing solid, fast results.
“I think more testing is good, but more accurate testing is better,” Scrase told the Journal last week. “Anything we can do to substantially increase reliable testing throughout the state will help us fight this pandemic.”
As the state experiences a severe increase in daily positive tests, testing capabilities and challenges vary around the state.
For instance, last week, Luna County, in southwestern New Mexico, had the highest test positivity rate in the state, at more than 30%.
A receptionist at the state public health office in Deming reported a “huge demand” for tests. “We’re all booked up until next week,” she said Wednesday, adding that a COVID-19 testing drive planned for over the weekend was also “completely full.”
Scrase said that only about 5% of New Mexicans live in counties, mostly rural, with low positive test rates and low positive tests per 100,000 people.
Convenient testing
New Mexico is studying tests that use saliva. And state health officials have been verifying a new rapid test furnished by the federal government.
Such rapid tests promise results in as little as 15 minutes but currently are authorized only for people already experiencing COVID-19 symptoms.
Some states, including Minnesota, have adopted limited saliva testing, and in Colorado and elsewhere, health officials have authorized rapid tests for routine screening of health care workers.
But New Mexico health officials say the rapid tests aren’t producing as accurate results as the “gold standard” nasal swab polymerase chain reaction, or PCR, test used since the beginning of the pandemic.
Those who take rapid tests and get a negative result are advised to follow up with the PCR test and to quarantine.
The University of New Mexico has invested in rapid testing technology but isn’t deploying it for now because the standard PCR test has a turnaround time of as little as 24 hours through TriCore Laboratories of Albuquerque, UNM spokeswoman Cinnamon Blair said. And the rapid tests aren’t as effective at detecting the virus as the PCR, she added.
Scrase said he didn’t know the specifics of the new at-home saliva test now advertised for online sale at www.costco.com for about $130 each. A Costco spokesman declined to respond to Journal questions about the test last week. Other mail-order tests are available online.
In general, Scrase said, “The ones where you just mail it in, I worry, because that could add four or five days … to get the result. Nobody has studied doing this through the mail yet, that I’m aware of.”
There is no federal authorization for at-home tests that combine saliva tests with rapid results, and it’s unclear how states could ensure reporting of the results.
But with the holidays approaching, the idea of getting a quick test before gathering with family and friends can seem attractive, said Karissa Culbreath, TriCore chief medical director, at a recent public COVID-19 update.
“I hear the needs that people have,” Culbreath said. “They want to have some test at home and then have a family gathering and say that everybody is safe. Unfortunately, right now the rapid tests that are available are not indicated for the asymptomatic persons that would be coming to gather.
“Right now, it is still important we follow the same guidelines we’ve been working with. We don’t have a testing method that would avoid the need for masks and social distancing.”
Adoption in Minnesota
The potential benefits of saliva testing for the coronavirus prompted Minnesota on Oct. 22 to launch a pilot program that allows Minnesotans in two dozen counties or tribal nations to receive free testing at home.
A spokesman for the Minnesota Department of Health didn’t return requests for comment.
A press release from the agency says that residents who believe they need to be tested can order a saliva test online, to be performed “in the comfort of their own home.” Such at-home testing is likely to be offered statewide soon.
Through the mail order program, the at-home tests will be supervised by a health care professional during a video telehealth visit. Once completed, the test will be shipped to Minnesota’s new saliva lab, where results are then emailed to the person in 24 to 48 hours.
Proponents of saliva testing at home say it would help protect health care workers who risk exposure to the virus when administering the tests.
And such testing is considered a good way to reach remote rural areas where people may have to travel long distances to a test site.
Dr. David Gonzales, chief medical officer at Christus St. Vincent Health System in Santa Fe, said last week at a public state update that he was especially concerned about the underserved communities of New Mexico.
For instance, he said, his health system is looking for ways to bring drive-through COVID-19 testing closer to the rural area south of Santa Fe, “but people (there) may not have cars, so getting out to people is something we’re going to aggressively push in the upcoming weeks.”
TriCore’s Culbreath said that saliva testing for the virus will be an option in the coming months but that people would “still need to go through a provider.”
Scrase said The New England Journal of Medicine recently reported that saliva was just as good as a nasopharyngeal swab for “isolating a specimen.”
“Everywhere in New Mexico, people are looking at how to adapt to that, such as we need the right vials to put the saliva in,” Scrase said.
Collecting saliva also would be less invasive than the deep swab currently used for PCR, which is collected from the nose.
BinaxNow rapid antigen tests distributed by the federal government across the country last month are also less invasive, say New Mexico health officials. The rapid tests rely on swabs of the nasal cavity.
False positives
The Trump administration said it would be sending 630,000 BinaxNow tests to New Mexico, to be distributed at the discretion of the governor. Before the tests are put into widespread use, they are being compared with the standard PCR tests for accuracy, Scrase said.
One reason: Two different antigen rapid tests issued by the federal government to Nevada led that state to immediately suspend their use in nursing homes because of the high number of false positives reported. Scrase said healthy people who didn’t have the virus were erroneously reported as infected.
Nevada reversed its decision after the U.S. Department of Health and Human Services issued a letter Oct. 8 threatening “swift punitive actions” if the ban wasn’t revoked, according to The New York Times.
The ban was lifted with the recommendation that all antigen rapid test results, positive or negative, be confirmed by the slower but more reliable testing technique, PCR.
Boosting testing
With a surge in coronavirus cases over the summer, some testing sites had to close early because of the hundreds of people seeking tests.
Waits for results depended on where people were tested. The state-run testing sites were providing results in 24 to 48 hours, health officials said, but privately run testing sites had turnaround times of up to 14 days.
Currently, New Mexico conducts 9,000 tests a day, nearly double the 5,000 daily state benchmark considered among the criteria for safe reopening. Nevertheless, some New Mexico counties with the steepest increases weren’t seeing enough people coming out for testing, Scrase said.
That has improved, he said, with the help of community leaders, advertising and social media, he said.
More campaigns to get people tested are planned, and he said the state is now considering how to get testing up to 20,000 a day.
“I think the gap is how do I get New Mexicans to embrace the idea that when we talk about the health of the public, it includes them,” Scrase told the Journal last week. “When we talk about avoiding large gatherings, it includes them. When we talk about testing, it includes them.”
Positivity is a critical metric in determining virus response
