LOCAL
The tight controls on who should get tested have frustrated people who have symptoms but aren’t part of the highest-risk groups.
Thousands more Oregonians could get tested for coronavirus right now but state leaders aren’t ready to ease restrictive screening guidelines that could help them identify additional infections and better understand the breadth of the disease.
The tight controls on who should get tested have frustrated people who have symptoms but aren’t part of the highest-risk groups. Some sick residents are left to fend for themselves and risk infecting others, unsure if they actually have the virus, even as tests sit unused.
Oregon’s limited testing criteria have created an access imbalance. Doctors and nurses generally follow state advice but exercise discretion, allowing some people with symptoms to get tested at one place after being turned away by another.
One Oregon county with the highest rate of infections statewide is doing fewer total tests than a county with a smaller population and a fraction of the total infections. The state lab isn’t using its largely untapped testing capacity to fill that gap.
Seven weeks into the state’s coronavirus outbreak, testing remains a confounding puzzle to the average Oregonian. There appears to be pent-up demand for more widespread testing – and the ability to provide it – yet the state’s per-capita testing rate ranks in the bottom half nationally.
Chunhuei Chi, director of the Center for Global Health at Oregon State University, said testing more people in Oregon now could help prevent the spread of the virus among people within a household or when someone who’s infected but has mild or no symptoms visits a grocery store.
That in turn could help reduce the number of active cases and speed up the timeline for trying to reopen parts of the economy.
“In the absence of increased contact tracing, the second best we can do is to ramp up testing by loosening the criteria,” he said.
Relaxing testing constraints to allow doctors to include mild symptoms will likely happen eventually, said Dr. Dean Sidelinger, the state’s epidemiologist and health officer.
But first, Sidelinger said, the state needs to build the capacity to test up to 15,000 Oregonians per week – not necessarily to actually test that many people – to soften social-distancing restrictions. Sidelinger said officials don’t know how close they are to that goal.
It appears Oregon may already have reached it.
The state has reported an average of 1,300 test results a day over the past three weeks. The Oregonian/OregonLive found in a sampling of about a half-dozen hospital systems and health care providers that their staff and labs could handle at least 1,000 more tests each day.
Add them together and that tops 2,300 a day or more than 16,000 tests a week.
Sidelinger said it makes sense for the time being to reserve testing for people who have symptoms and fall into certain categories. Those include first responders or health care workers, nursing home residents, people 60 years old and over, Oregonians whose symptoms are getting worse and those with underlying medical conditions.
Testing people with mild symptoms risks exposing medical workers to the virus and uses supplies that may become scarce, according to guidance from the Oregon Health Authority. But limited access to tests or supplies is no longer an impediment, Sidelinger acknowledged.
“If we made an explicit recommendation to test all mildly symptomatic individuals and asked them to go in for testing, yes, it would likely increase testing,” he said. “But I don’t know if that would change the situation here in Oregon.”
It remains to be seen whether Oregon’s capacity goal of 15,000 tests a week, or the equivalent of 60,000 tests a month, is an adequate benchmark, however. Oregon is one of about only a dozen states nationwide that lacks the ability to test at least 100,000 people a month, according to data collected by federal officials.
On a per-capita basis, Oregon’s capacity looks even worse — drawing a direct mention by Dr. Deborah Birx, the White House coronavirus response coordinator, during a briefing Friday in Washington, D.C.
“Those are the three states that we’re working on building capacity in,” she said, referencing Oregon, Montana and Maine by name.
To be sure, Oregon has not been hit as severely by the coronavirus as many other states. The stay-at-home order announced by Oregon Gov. Kate Brown on March 23 has unquestionably helped bend the curve of infections, preventing a surge in hospitals and a rapid increase in deaths.
And expanded testing has shown the rate of infection is low when Oregon is compared nationally, with just one out of every 20 Oregonians tested finding they’re infected. Officials don’t expect that to dramatically change with more testing.
But more infected Oregonians could be found – and other states, such as Utah and New Mexico, have loosened criteria to do just that.
A 36-year-old teacher who lives in Northeast Portland is among those left dismayed by Oregon’s mixed messaging on testing.
The teacher developed a dry cough in the center of his chest April 6. Over the Easter weekend, his fever reached the low 100s and he felt fatigued. He wondered if it could be coronavirus but doubted whether he could get tested.
An online assessment through Kaiser Permanente told him that, despite his symptoms, he was at low risk for coronavirus. He called a nurse, pre-emptively hoping to get his name on a list in case his symptoms worsened.
“The big message was, you don’t qualify for testing, don’t come in,” he said.
A spokesman for Kaiser said people with coronavirus symptoms are screened for testing under nine defined criteria, none of which included non-essential workers or those without underlying health conditions.
The teacher asked for anonymity to shield his family from possible social reprisal. Given the uncertainty of his illness, his wife has still been leaving the house for work or to pick up groceries for the couple and their two kids.
He eventually found a different provider who tested him Thursday and is awaiting results.
“If you don’t know, you don’t know what to do,” he said. “It’s really hard to be in the gray area.”
Oregon Gov. Kate Brown announced Tuesday that schools will remain closed for the rest of the academic year. April 8, 2020 Beth Nakamura/Staff
‘NOT RECOMMENDED FOR TESTING’
Coronavirus testing has expanded immensely since Oregon became one of the first states in the country to identify its first infection.
When a Lake Oswego elementary school janitor tested positive for the virus Feb. 28, his test went to the state health lab – the only place in Oregon