State Falls Behind In Testing

Dr. Kristina Box stands at a podium while Indiana Governor Eric Holcomb waits by her side.
Dr. Kristina Box, Indiana’s State Health Commissioner, and Governor Eric Holcomb addressed the media on March 16.
Indiana State Health Department officials are still lagging behind their goal of testing as many as 6,300 Hoosiers a day for the novel coronavirus, despite a claim by Vice President Mike Pence Sunday that the onus of expanding testing for the novel coronavirus lies on the states.

“Because we really believe that, while we’re doing 150,000 tests a day now, that if states around the country will activate all of the laboratories that are available in their states, we could more than double that overnight and literally be doing hundreds of thousands of more tests per day in a very short period of time,” Pence said on Sunday in a press briefing.

Asked whether the state could expand testing overnight, Indiana State Health Commissioner Dr. Kristina Box said Monday: “That simplifies it quite a bit, and it is not quite as simple as that. But realistically, yes, we are encouraging all of our labs to be engaged and all of our providers to engage all labs.”

Box added: “We are absolutely engaged with every lab across the state of Indiana and appreciative of all the work that they’re doing.”

That contradicts assertions by the co-owner of Aria Diagnostics, a northside lab. Zak Khan told Indianapolis Monthly last week that the state turned down supplies from him—a claim which Box has denied.

Khan had previously made a separate arrangement to send 50,000 kits from Aria to New York City. He is already providing the testing for the City of Carmel.

On Monday, however, Khan backpedaled. “[Box] said she would take the swabs and didn’t need the kits. I offered further purchase options for them which she didn’t take.”

Jennifer O’Malley, the chief communications officer at the state department of health, said the state only accepted Khan’s offer of swabs, not kits with both swabs and viral transport media (VTM), because it wanted to reserve the VTM for “those who might not have the same access.” A coronavirus test kit consists of a nasal swab used to collect the sample paired with a vial of transport media, a solution which preserves the virus in the sample for diagnosis. However, O’Malley says the state declined the VTM because “other entities have been able to produce [the VTM] in bulk for us.”

“I know there’s been a lot of talk about us turning down 50,000 lab tests from Aria, and I can tell you I have never turned down anything from Aria lab or from Zak Khan,” Box said. “There’s really no truth to that rumor and I really would like to be able to clear that up.”

What’s not in dispute is that in recent days the state has struggled to test far fewer individuals than that its stated goal of 6,300 per day. As recently as April 17, for example, the state conducted just 1,718 tests.

​The state’s goal isn’t to test everyone, ​just symptomatic individuals (except for communal living situations like nursing homes where an outbreak has occurred, where it wants to test all residents to control the spread of infection).

Mark Shrime, a doctor with a focus in public health at Harvard Medical School, told WGVU, a Michigan NPR affiliate, on April 10 that “the overwhelming consensus from experts is that testing everyone for COVID-19 is a crucial component of flattening the curve.” Widespread testing allows for selective isolation of coronavirus carriers, which Shrime and other public health experts say is key to reopening the economy.

“I know there’s been a lot of talk about us turning down 50,000 lab tests from Aria, and I can tell you I have never turned down anything from Aria lab or from Zak Khan.”

Yet the state says testing asymptomatic individuals is counterproductive. “Testing people who are not symptomatic may bring a false sense of security, because a negative test today does not mean the person won’t have a positive test in the near future from the same exposure,” says O’Malley. “It also does not remove the need for them to stay in quarantine for 14 days.”

The exception, she says, is “congregate living situations such as long-term care facilities, where testing asymptomatic individuals in a place where an outbreak has occurred can help better control the spread of infection in those settings.”

At least 120 people had died from the coronavirus at long-term care facilities in Indiana as of April 15. Eleven residents died at an Anderson nursing home the first week of April, but information about outbreaks in Indiana is limited because the state has declined to identify specific facilities where outbreaks have occurred (and nursing homes are not required by law to provide that information). Nationally, 8 out of 10 deaths reported have been in adults 65 and older, according to the CDC.

Indiana should be working towards a goal of testing more people for COVID-19, says Brian Dixon an associate professor of epidemiology at the Richard M. Fairbanks School of Public Health at Indiana University-Purdue University Indianapolis​, though allows it’s not practical to test everyone.

“However, broader testing strategies are needed to better estimate existing incidence and better project how and when the state can fully open for business,” he says. “While I understand the rationale behind the current testing protocols, I agree that more testing will provide better data and information on how to proceed with future efforts to mitigate the impact of
COVID-19 on Hoosiers.”