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COVID surge calls for more testing, but options are now more difficult to come by in Maryland

When the COVID-19 pandemic swept into Maryland, health departments scrambled to set up testing centers where people could go to get swabbed for the viral infection. The sites often had long lines but were open most days.

After vaccines for the coronavirus became available, many of those sites transitioned into inoculation centers that also offered testing, but many of those sites scaled back or closed as more and more Marylanders got vaccinated.

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The need for testing, considered critical to managing the pandemic by public health experts, didn’t go away. As Maryland experiences the first signs of another winter surge, COVID-19 tests are now more difficult to come by. Many test sites are open only a few days at condensed hours, with few night and weekend slots available, and the test kits offered by drugstores are pricey, if they can be found on shelves at all.

The pharmacy chains also offer in-person test appointments, but scheduling one often has to be done days in advance to reserve a spot, and there can be restrictions on age and requirements to have a referral from a physician.

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Disease surveillance is a key tool for reducing the spread of the virus and helping people feel comfortable about returning to work and school, resuming pre-pandemic routines or attending social gatherings, said Elizabeth Stuart, a professor of health policy and management in the Johns Hopkins Bloomberg School of Public Health.

She said rapid tests in particular are helping catch more cases quickly. The reasons they aren’t more widely used, she said, range from supply chain issues and the government’s early misunderstanding of the need for them to the public’s lack of knowledge about them and poor messaging about how to use them.

She said she thinks the country underestimated the need for rapid tests and the current distribution isn’t easy or equitable.

“In general I think the feeling was vaccines would get us through,” Stuart said. “Vaccines are very effective. It’s not that they aren’t working; they just aren’t perfect. If there is a lot of virus around, there is a need for a layered protection strategy.”

On Monday, 1,126 people were hospitalized in Maryland with COVID-19, a patient volume not seen since late April. The spike may be attributable to Thanksgiving gatherings, more indoor socializing as the weather turns colder and the rise of more contagious variants.

The state’s testing positivity rate has been unknown since Dec. 3 in the wake of a cyberattack on the Maryland Department of Health that halted some of its COVID-19 reporting services. But the rate stood at over 5% that day, and there’s been a 44% jump in hospitalizations since then.

The World Health Organization and others use 5% as the positivity rate threshold that indicates when community transmission has become widespread.

Michael Schwartzberg, a spokesman for the University of Maryland Medical System, said the health network’s urgent care program is processing hundreds of tests per day, both rapid antigen tests — which return results in minutes — and polymerase chain reaction tests, or PCRs — which take longer but are considered more accurate.

Schwartzberg said workers have seen a rise in the positivity rate among those tests, up from about 10% in October and November to nearly 18% by early December.

The medical system provides clinical staffing support for the testing operation at State Center, which recently moved there after more than a year at the Baltimore Convention Center. The new site, one of the state’s largest, offers testing appointments Mondays, Wednesdays and Fridays, and has averaged about 320 tests per session, said Andy Owen, a spokesman for the Maryland Department of Health, which oversees it.

Testing volumes have been trending upward since Thanksgiving, Owen said.

“As needs for additional testing sites and support present themselves, we coordinate with our partners to address them through the ongoing provision of tests, staffing support, public awareness campaigns, and financial and logistical resources,” Owen said in an email.

The department also has distributed rapid tests to local health departments and partnered with BWI Marshall Airport to distribute kits to international travelers, Owen said.

Ciara Kelly and Michael Dobson have been getting tested regularly during the pandemic, mostly because they are both service workers and feel exposed even since being vaccinated. Monday they went to State Center.

The pair praised the site’s ease and convenience, though they said same-day results would be better, as would off-hour and weekend testing slots, which seem impossible to find anywhere.

“I think drugstores have them, but I’ve not seen an open appointment in months,” he said. “Last time I got one I waited 40 minutes in a line and when it was my turn they didn’t have a swab for me.”

Dobson also had trouble finding at-home tests but after visits to several stores found one with boxes on the shelves and got a small stock.

“I want everyone around me to be safe. I want to be safe. I don’t want to be a superspreader,” Kelly said. “There should be testing on every corner.”

It also should be free everywhere to encourage testing for those who want it and to ensure testing for those who require it, said Ella Brown, an airline worker with a medical exemption to vaccination. She tests herself regularly at multiple places but has limited herself to sites like State Center that she knows don’t have an administrative fee.

“Some places want money now,” said Brown, adding that when you need regular testing that isn’t sustainable. “That means it’s not as easy as it could be.”

Without enough testing, officials say, more people get infected and some get more severe illness and need hospitalization.

In response to what he called “an uptick in our key health metrics,” particularly the sharp rise in hospitalizations, Maryland Gov. Larry Hogan took steps last week to help hospitals with staffing and expand access to booster shots and lifesaving monoclonal antibody therapies.

But the governor’s expanded strategy did not mention testing.

An incomplete testing effort could hinder the effectiveness of monoclonal antibody therapies in particular, said Dr. Stephen Selinger, chief medical officer at Luminis Health Anne Arundel Medical Center, which runs hospitals in Annapolis and Lanham.

“For people who don’t require hospitalization, but who are at risk, one can lower the risk of hospitalization by 50% to 80%,” Selinger said. “So the advantage of knowing when you have the disease is such that there are therapies available, particularly for people who are high risk of developing severe disease.”

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Vaccinations and boosters also remain critical, Selinger said, as the majority of patients admitted to the Anne Arundel County hospitals are not immunized. But even vaccinated people, especially those with underlying health conditions, are contracting serious bouts of illness, making early detection all the more critical for all.

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The testing shortfalls may be largely out of the state’s control, said Ravi Srinivasan, associate professor at Loyola University Maryland’s Sellinger School of Business, who specializes in supply chain and operations management.

The coronavirus pandemic disrupted consumption patterns, Srinivasan said, making it difficult for producers, distributors and retailers to predict how much product volume they need. Labor shortages, physical bottlenecks and regulatory hurdles also are complicating the supply-and-demand cycle, he said.

The prioritization of at-home rapid tests is relatively new, Srinivasan added.

The BinaxNOW rapid COVID-19 antigen self-test.
The BinaxNOW rapid COVID-19 antigen self-test. (Meredith Cohn)

“There’s been a lot of focus on making sure there’s availability to get vaccines rather than test kits,” he said. “They almost have to have a dual-pronged approach, where you have two separate product lines, and both of them need to be available.”

Representatives from major retailers and pharmacies said they generally are “meeting the demand” for testing.

At CVS Pharmacy, spokeswoman Amy Thibault said the chain is offering same-day and future testing appointments and turning around results usually in one to two days. It also sells over-the-counter COVID-19 rapid antigen tests.

The U.S. Food and Drug Administration has authorized 11 such at-home tests for emergency use as well as three at-home PCR tests, according to the federal agency.

A CVS pharmacy in Hanover offers same-day and future Covid-19 testing appointments.
A CVS pharmacy in Hanover offers same-day and future Covid-19 testing appointments. (Karl Merton Ferron/Baltimore Sun)

Walgreens spokeswoman Zoe Krey said while “overall” demand is being met, the company is experiencing increased demand and acknowledged there could be “intermittent delays in supply in some locations.”

“Following Thanksgiving, we’ve seen an increase in demand for [over-the-counter] COVID-19 tests across the country and are working with our suppliers to ensure customers have access to self-test kits through the holidays,” Krey said in an email. “Some stores may experience a temporary shortage.”

To combat supply shortfalls and high price points, local health departments are distributing the kits they receive from the state to community leaders and organizations that serve under-vaccinated areas as well as families who otherwise couldn’t afford them.

The state distributed 500,000 at-home test kits for this purpose, Owen said. The Baltimore City Health Department has received about 8,000 such kits so far, assistant commissioner Dr. Adena Greenbaum said, and is prioritizing communities that have been disproportionately impacted by the pandemic and those at higher risk of contracting severe disease. The city also offers an in-person, PCR testing window on Saturdays.

Hopkins’ Stuart praised the rapid-test distribution program, which spreads the word about how to use the tests but also makes access more equitable.

She’s worried about the effects of omicron in the next few weeks and months. She suggested people keep a stack of rapid tests at home and test once before gatherings or even twice over several days if people show symptoms, recently traveled or suspect they were exposed.

“You don’t want to have to run around to stores in that situation,” Stuart said. “Get a few and have them.”

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