Records show snags in Oregon's search for COVID-19 test supplies
Update: This article has been updated with information from Legacy Health and Oregon Health & Science University.
If Oregon pandemic officials had a TV show these last two months, it could be called "In Search of Swabs" — and just about every episode would be deeply unsatisfying.
Public records show that over the last six weeks state officials have battled repeated bureaucratic obstacles in trying to obtain needed swabs and other testing supplies from the federal government and private manufacturers, contributing to Oregon's low per-capita testing rates.
Oregon's lack of success is highly significant. Gov. Kate Brown has made testing a central feature in her plans for reopening a state economy that has been battered by the pandemic.
To combat the problem, the state recently hired a new state testing director to focus on the problem. Meanwhile, Brown has asked hospitals around the state, who do the bulk of testing, to commit to contributing 18,000 tests per week to a statewide strategy to reopen the economy.
The success of those plans, Oregon Health Authority Director Pat Allen said, depend on whether the supply chain can provide the swabs other test supplies necessary to implement them. The problem is national and even global, with authorities in places like France, California and elsewhere blaming insufficient testing on the lack of swabs to collect samples, as well as other test supply shortages.
"These supply chain glitches are going to be the biggest barrier to our being able to scale testing up further than we already have," Allen told the Portland Tribune.
And Oregon, with a small population and fewer people reported killed by COVID-19 than many states, faces particular challenges.
"What we've been led to believe is that, because we just don't have very much disease in Oregon, we're very low priority for receiving any of those supplies," Allen said of the state's difficulties. He added that it "almost feels punitive. ... We think we've been doing a good job managing our resources and reactions so we don't have very much disease. And that means we can't get supplies."
Trump-hyped machines idle in Oregon
About a month ago, President Donald Trump unveiled rapid coronavirus-testing machines to great fanfare, saying the devices manufactured by Abbott Laboratories would create "a whole new ballgame" in fighting the disease.
The newly released public records show that what's happened in Oregon since is a story of frustration.
The federal government sent 15 of the Abbott machines to Oregon in early April. Today, however, the bulk of them remain effectively on the shelf — with no supplies to operate them.
When the Abbott rapid-testing machines were delivered to Oregon, they came with only 124 test kits, causing the state to distribute only three of the 15 machines. To help rural Oregon, they were sent to Curry, Lake and Morrow counties.
The machines require a special Abbott-made test-kit to operate. So, according to the emails, state officials reached out to Abbott to buy some.
Abbott, however, said Oregon could only order from the federal government.
State officials ordered 5,000 more test kits from the federal government — the International Reagent Resource office operated by the U.S. Centers for Disease Control and Prevention. Each kit contains 24 individual tests.
When the shipment arrived however, it fell short — 4,996 test kits short.
"We went through the CDC-IRR ordering process as we had been told and we were only able to get four Abbott kits out of the 5,000 that we ordered," wrote Akiko Saito, an Oregon Health Authority official, to federal officials on April 11. "Can you please assist us in figuring out how we can get closer to a requested amount? At this point we have devices but no test kits to run any tests."
Two days later, in a call with CDC, came the word: the federal government "is not accepting large orders because the tests are in short supply," wrote John Fontana, the Oregon Health Authority lab director, in an April 13 email.
Rather, he was told, states should look to Abbott for supplies, contrary to what records show Oregon was told by Abbott just a week before.
On April 16, David Csernak, an official with Health and Human Services, emailed state officials confirming that the availability of additional Abbott cartridges to boost testing would not be happening.
"At this time there is a critical shortage on the Abbott test kits and the ability to acquire more is very difficult and competitive at the moment," he wrote.
Csernak added that he would be happy to assist with a new strategy to help rural areas boost testing, "since Abbott kits don't seem to be the answer."
The federal official's pessimistic take on Abbott has proven accurate. On April 21, Shirley Smith, a contracting analyst with the state Department of Administrative Services, wrote to other state officials involved in getting test supplies saying she hadn't heard back from Abbott: "My apologies for not being able to obtain these test kits, I am trying!"
Smith sent another Abbott update the next day, saying "I have not heard from them and unlikely I will, sadly."
According to Pat Allen of the Oregon Health Authority, state officials did finally get Abbott officials on the phone, and the company said they won't fill orders directly from the state.
"This has been the maddening thing," he said. "We're getting the runaround."
Allen likened the federal government's sending of the 15 Abbott machines to "giving us a printer with no ink."
A recent study questioned the Abbott machine's accuracy, though the company has defended its product.
Trump administration spotlights Oregon problems
Two other rapid-test vendors, Cepheid and Biomerieux, similarly told Smith that they would not sell Oregon any tests. Rather, the state would have to go through the federal government, according to public records.
Federal officials have stressed to Oregon and other states that they have to "triage" requests for help based on certain criteria, including need. Supplies, including for testing, are allocated based on state population size as well as the severity of the COVID-19 outbreak there.
Nevertheless, Oregon was one of three states to be mentioned in an April 17 White House press briefing about lack of testing and touting the Trump administration's efforts to help states. A prominent adviser to Donald Trump, Deborah Birx, suggested it was the states' fault and said the administration was "working on building capacity" in Oregon, Montana and Maine.
Allen said of Birx's comment, "it was really annoying to have the White House call us out … for low testing capacity, in the face of them making decisions that don't get us the supplies that would let us have more testing capacity."
The statement by Birx appeared to reinforce the scrutiny that Oregon officials have received for limiting the amount of testing done, in order to conserve supplies.
The emails, however, show the federal government has encouraged Oregon to take that approach.
Two days before Birx made her comment, a federal official assigned to the Oregon State Emergency Coordination Center told state officials in an email that in light of the national testing supply shortage, the federal government wanted states to prioritize their testing location needs and limit the state's urgent requests to the federal government for more supplies.
The official explicitly acknowledged that the federal guidance "may reduce overall capacity" for testing in Oregon.
"There is a nationwide shortage on all testing supplies," wrote Csernak of Health and Human Services. "In order to avoid reaching a point where supplies are depleted and testing has to shut down, it is critical that each state strategically prioritize their labs and testing locations. While this may reduce overall capacity in the short term, it will allow vital resources to be concentrated at key locations and maintain testing capability."
Some tests arrive
The next day, the state was informed that 10,000 testing kits had been approved for Oregon by the federal government — a more general-use kind, not the kind that can only be used in Abbott machines.
But Oregon was forced to wait before ordering any more of the kits. Under federal government rules, it cannot order additional kits until the previous shipment arrives, according to the emails.
Allen said the bulk of the 10,000 kits were shipped out to county public health agencies. And despite the latest shipment, the state's testing problem doesn't look to be solved anytime soon.
That's because Oregon officials hope to ramp up the overall statewide testing rate to 15,000 to 25,000 tests a week.
"Do the math on that: 10,000 collection kits is not much," Allen said.
In March and April, The Oregonian revealed that an earlier claim by Gov. Kate Brown that the state had contracted with Quest Diagnostics for 20,000 new test kits was false and overstated, and that in reality the state had contracted with the lab company to process 10,000 tests, not provide the supplies needed to collect samples, such as swabs.
Allen said that contract is not the answer. In addition to the lack of collection supplies, the speed of the Quest testing turnaround is not as good as what Oregon hospitals have developed since the contract was inked.
Currently most of the testing happening in Oregon is processed by hospitals and private labs, some of whom have established relationships with their own suppliers.
In contrast, the testing overseen by the state public health lab is reserved for people who are significant risk to others, such as health care providers.
Health systems report a range of experiences seeking out supplies. Legacy Health, which can do about 750 tests a day, said its testing has not been limited by lack of supply.
A spokesperson for Oregon Health & Science University, which can do about 400 tests a day, said in an email that the institution has seen significant challenges similar to what the state has experienced. She credited creative and tenacious work by staff to find new supply sources and identify alternative ways to collect samples.
"While the situation has improved, it is far from where we would like it to be," she said, adding that the improvement did not happen "through traditional supply channels."
After weeks of difficulties in securing supplies, the state appears ready to increase its reliance on hospitals to take on the job.
Hospitals key to next phase
The state's new strategy is to rely on the state's hospital system to support Brown's plans to reopen the state, including rapid testing to identify and isolate health care workers who contract the disease.
A draft April 22 strategy document crafted to share with hospital systems relayed Brown's request — dubbed a "Governor's Ask" —that hospital labs commit to a state strategy "to maximize use of tests to address high-priority needs and support contact tracing, quarantine and isolation." Each hospital system would provide a certain number of tests each week to the state-overseen system.
The draft notes the national supply chain problem, saying "Smaller hospitals and clinics are only now beginning to have orders filled for supplies."
The document also sheds light on how state officials plan to reopen the economy. It notes that the state has so far limited testing by adopting criteria focusing it particular categories of people with symptoms, such as front-line workers who are a high risk to other people, such as those employed in grocery stores, health care and nursing homes. But, according to the document, "This guidance will soon be expanded further to cover everyone with symptoms."
Testing also will be expanded to people with no symptoms at all, but who work in health care, child care, jails, prisons and schools. Also, health care providers will be asked to test patients as they come in.
There have increasingly been signs that the supply situation is improving. Walgreens, for instance, recently opened up a drive-through testing site in Hillsboro.
"We are moving into a second phase where we need even more testing to be able to move forward," Allen said. "And the nature of the testing needs to change: it needs to be faster testing. ... Right now it's the supply that's the limiting factor."
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