Even as the number of confirmed COVID-19 cases in Minnesota continues to soar, the push to dramatically expand testing is coming up short because not enough people with symptoms are seeking tests.
The puzzling twist comes as the state Saturday recorded its fourth consecutive day of more than 700 new confirmed COVID-19 cases. It also reported 24 more deaths. The case count continues its steady climb even as officials admit that testing remains unable to capture the full extent of the virus' spread.
In April, Gov. Tim Walz unveiled a "moon shot" testing program for COVID-19 with the Mayo Clinic, the University of Minnesota and HealthPartners with a goal of gathering up to 20,000 samples per day. Yet Walz said during a call with reporters Friday that the number of completed tests in recent days doesn't reflect even half of the state's current capacity, which he described as "over 10,000."
"The providers are telling us: People aren't coming in, either because they had gotten the message previously that testing wasn't available or for whatever reason," said Jan Malcolm, the state's health commissioner. "People aren't availing themselves of the testing capacity that's there. We need to do better."
The Minnesota Department of Health is calling for patients with symptoms to get tested. Testing is key to understanding not only the disease, but also when states can begin to safely reopen businesses and activities that remain shut down by stay-at-home orders.
"The problem with this virus is that it does spread really easily," said Dr. Mark McClellan, a health policy expert at Duke University.
"The more we can get testing capacity up and in place … the safer it will be to reopen," said McClellan, who was a top health official in the administration of President George W. Bush. "We need to go slowly because we don't know how much the steps we're taking now are really accelerating case growth. We also should be cautious because testing is not ideally where we'd like it to be."
As of Saturday, COVID-19 has claimed 558 lives in Minnesota, according to the Health Department. Sixteen of the deaths reported Saturday were residents of long-term care facilities, and the other eight were over age 65 or had underlying health problems.
Long-term care residents and those 65 and over are at greater risk from COVID-19. That's also true for people with a variety of medical conditions ranging from lung disease, serious heart conditions and cancer to severe obesity, diabetes and kidney patients who need dialysis.
During the first nine days of May, the number of confirmed COVID-19 cases has more than doubled to 10,790, in part due to increased testing.
From March 6, when the first case was reported, to April 30, only 5,136 COVID-19 cases had been confirmed.
Three Minnesota counties — Cook, Hubbard and Lake of the Woods — still have no confirmed cases, though health officials believe the virus is circulating throughout the state.
The gap in recent days between the supply of tests available and the number of people seeking them likely reflects a delay in patients getting the message to be tested if they have symptoms, said Dr. Tim Schacker, vice dean for research at the University of Minnesota Medical School.
Those symptoms range from cough, fever and shortness of breath to muscle pain, sore throat and loss of taste or smell. Late last month, the state launched an online tool so those with symptoms could find testing centers.
When there were only limited testing supplies available in March, Minnesota put the priority on testing health care providers, patients already in the hospital and people living in long-term care centers. The state in late April expanded the criteria for who can get tested, but not everyone is aware of the change.
"Many hospitals and clinics around the state have been operating under the premise of test scarcity and have developed guidelines with the idea that tests are a limited resource," Matthew Binnicker, director of the clinical virology lab at Mayo Clinic in Rochester, said via e-mail. "It will be essential to communicate this increased capacity."
"It is all about message," Schacker said. "It is all about getting the word out."
Another factor is that testing capacity varies at health care centers across the state, said Daniel Huff, an assistant commissioner at the Health Department. About a week ago, the state created a testing command center that works "like air traffic control, to move samples to the people who have lab capacity," Huff said.
The Health Department also is informing doctors about the new availability of testing, since some patients with symptoms will contact their regular physicians. Testing centers listed on the state's website are an alternative, Huff said, similar to the way people can obtain some vaccinations at pharmacies or clinics.
"We know that some people have tried to get tested in the past and were turned away," he said. "So, we want people to know … we have the capacity now."
Huff said the extra testing supply is part of why state officials Thursday announced a new "battle plan" for addressing COVID-19 in long-term care facilities.
The extra capacity alone does not suggest the state could move more aggressively to open up schools, businesses and gathering places, Huff said.
Walz has said a necessary first step toward reopening is hitting a goal of 20,000 tests per day — the "moon shot" target that Huff said the state is on track to hit. The plan also requires enough public health workers who can reach out to close contacts of those who are newly infected so they isolate themselves to prevent spread of the disease.
It takes a lot of testing capacity to make that work, and most states aren't there yet, McClellan said.
"Without very strong and rapid testing in place and even with it — because some cases are going to spread without symptoms — it takes a week or two to know the consequences of what you're doing now," McClellan said. "There's a big lag there."