ST. PAUL, Minn. (AP) - There are a growing number of ways Minnesotans can get screened for the coronavirus, but results can take days, even a week or longer. So if you need to know right away if you have COVID-19, you might have to pay out-of-pocket.
Ongoing worldwide constraints on testing supplies have many Minnesota providers requiring patients to be screened by a doctor or nurse before getting a coronavirus test. The state has provided free walk-in testing sites, though, in communities fighting outbreaks.
Once a patient’s sample is collected, it typically takes two to three days for larger local laboratories to return results. And if the test is processed by an out-of-state lab, it can take seven or more days.
Quick test results are key to slowing the spread of the coronavirus, so needing prior authorization for a test or waiting a long time for the results can be problematic. Delayed results also can leave patients on edge, or worse, they may disregard recommendations to isolate themselves.
Minnesota is banking on a new test that is easier, faster and could more than double capacity by October. That should help the state meet its goal of screening anyone who fears they’ve been infected.
“There’s a whole lot more people who we would like to see getting tested than have been able to so far,” said Jan Malcolm, Minnesota’s health commissioner.
That includes screening people who are not showing symptoms but may still be infected. As much as 40 percent of people with COVID-19 don’t show symptoms, but can still spread the coronavirus.
State health officials say there should be as few barriers to getting a test as possible. They encourage people who think they are sick to contact their health care provider, even if it is through an online telehealth visit.
“We don’t want people to be discouraged from testing because of the need for a video visit,” said Kris Ehresmann, director of infectious disease for the state Department of Health. “If you have concerns and have been exposed, it is worth having the conversation with a provider.”
There are other options for patients who are be willing and able to pay for a test. Testing by mail has been available for a few months, but accuracy hasn’t been consistent and results can still take a number of days.
In the Twin Cities, the small laboratory of Valley Medical and Wellness, a chronic pain management and addiction recovery clinic, has been offering tests with a 24-hour turnaround since May. The clinic is processing roughly 500 tests per day at a cost of about $120 per test, unless the patient is a member of one of the few insurers that include the clinic in their provider network.
A saliva test is the latest option on the horizon for Minnesotans.
State health officials recently announced a partnership that will bring a new lab to Oakdale that will administer and process saliva coronavirus tests. The state is using $14.7 million in federal coronavirus aid to help get the lab on its feet.
Saliva samples are easier to collect than the nasal swabs most of the existing molecular tests require. Processing the saliva samples uses some different materials than the more common existing tests, helping address ongoing supply shortages.
The new Minnesota lab to process saliva tests was an important step in diversifying how the state screens for the coronavirus, Malcolm said. It comes at a time, with schools starting to open, when increased capacity is desperately needed.
A SMALL STARTUP LAB
Dr. Ashwin George, an addiction medicine physician at Valley Medical and Wellness, said that when the coronavirus pandemic first struck with stay-at-home orders and other restrictions, his clinic had to find a way to safely continue to treat patients. It was essential that people with long-term pain and addiction issues be cared for in person.
The clinic already had a lab capable of complex testing, so the organization’s leaders quickly began working to figure out how to test their patients for the coronavirus and return the results quickly. They settled on using a testing protocol developed by the University of Minnesota.
“Our whole focus was, how do we process the test that gives results faster,” George said.
To expedite the process, George says clinic medical workers collect the samples and batches are regularly transported to their lab in Burnsville. Lab workers process samples like an assembly line to be more efficient.
Valley Medical has the capacity to process as many as 1,000 samples per day, but is currently only doing about 500, George said. That’s largely because the clinic is out-of-network for most insurers and therefore most patients.
“The major players don’t cover us,” George said. “We could be testing a lot more patients.”
Valley Medical has had other challenges.
The state Department of Health recently admonished the lab for failing to report test results to the state in a timely manner. A statement from the department said the lab had a backlog of nearly 19,000 tests that weren’t reported until state officials followed up.
“This creates multiple problems - not only does it mean the person tested is unaware of their infection and the need to self-isolate to protect family, friends and close contacts, but it also delays our case investigation work and makes it harder to slow the spread of this disease,” the department’s statement said. “We encourage all providers and laboratories across the state to be diligent and timely in their reporting.”
George says patients tested by Valley Medical receive their results in 24 hours. But he acknowledged the organization’s computer system has been unable to provide all the demographic information about the patients who were tested to the state Department of Health.
Contract tracers and other health workers need that information to interview an infected person and learn about others they may have unknowingly infected with the coronavirus.
George says his clinic recently updated its computer system and is providing the state with all the information it needs.
“This is one of the challenges of being a small lab,” George said.
WHO SHOULD GET TESTED?
There’s ongoing confusion about whether someone simply exposed to someone else with the coronavirus should get tested.
Health experts want anyone who fears they’re infected to get tested, but supply shortages have caused providers to ration tests since the pandemic began. There’s also been continued inconsistency in the messages about testing at the federal level from the Trump administration.
Just recently, Robert Redfield, director of the Centers for Disease Control and Prevention, had to clarify a recent change in federal testing guidance. Days earlier, the CDC guidelines were changed to minimize the need for a test if a patient is not showing symptoms.
“Everyone who needs a COVID-19 test, can get a test,” Redfield said in a statement. “Everyone who wants a test does not necessarily need a test; the key is to engage the needed public health community in the decision with the appropriate follow-up action.”
Federal guidelines and commitments by many Minnesota insurers also say that patients should not have to pay out of pocket for COVID-19 testing if it is done by an in-network provider.
Asked about why health care providers are requiring telehealth visits before a patient can get a coronavirus test, the Minnesota Council of Health Plans, which advocates for the state’s nonprofit insurers, defended the practice.
“Providers may require a telehealth visit in advance of ordering testing to ensure appropriate use, but the telehealth visit is usually covered at no cost to the member as long as the provider submits the visit with the appropriate COVID-19 billing codes,” the council said in a statement. The group added that the test and visit may need to be billed together so there is no cost to the patients.
MORE TESTS COMING
Minnesota health officials hope the state will be able to more than double its current testing capacity by October. A partnership with the Mayo Clinic, the University of Minnesota and other health care providers has already built state testing capacity to roughly 20,000 per day.
But the ability to test is often hampered by supply shortages. Bringing the new saliva test online through the lab in Oakdale could add 30,000 more daily tests to the state’s capacity.
Saliva tests have been in use from early on in the pandemic, but like some other tests, the initial ones had questionable accuracy. When tests were first in short supply, the Food and Drug Administration allowed for a flood of different screening options on the market.
“There are a lot of tests out there and they vary pretty widely in terms of their track record,” Health Commissioner Malcolm said.
“This one has a very high rating,” Malcolm said of the saliva test that was developed at Rutgers University and has the first emergency-use authorization from the FDA.
Once the new lab is up and running, state officials hope to create 10 “semi-permanent” testing sites across Minnesota. They also want to expand mobile testing sites so they can quickly react to virus hotspots.
Finally, the new lab should allow for more reliable in-home testing. Saliva samples are easy for patients themselves to collect and can be transported by mail.
Patients can expect to get the results of their saliva tests within 48 hours.
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