State: Coronavirus testing expands as 4 private labs offering services

At least four private labs have started offering coronavirus testing in Michigan and the state has expanded its testing capacity by about 1,000 people in recent days, state health officials said Thursday. 

The state has approved testing for 120 individuals so far and has enough testing materials to do 1,300 tests thanks to recent deliveries. Gov. Gretchen Whitmer announced late Tuesday that two individuals had tested positive for COVID-19 and the results were sent to the Centers for Disease Control and Prevention for verification.

CDC's laboratory test kit for the new coronavirus.

Because LabCorp, Quest Diagnostics, Mayo and ARUP facilities are now offering testing, it is possible the state testing numbers are not a true reflection of how much testing is being done or the total number of people who have tested negative or positive, state Chief Medical Executive Joneigh Khaldun told state lawmakers Thursday. 

A patient sample was submitted Thursday to Quest Diagnostics for COVID-19 testing, said Dr. Nik Hemady, chief medical officer for Pontiac-based Honor Community Health, a federally qualified health center with 16 Oakland County locations. The company already has laboratories embedded in the health center's clinics.

Honor has been getting so many calls from patients about the novel coronavirus, it set up a hotline this week. Many calls come from seniors or family members of people who are at greatest risk from the disease because they are elderly, or have suppressed immune systems or chronic health conditions like chronic obstructive pulmonary disease. 

"We’ve developed a call triage system to see if we can actually see this patient in our health center," Hemady said. "We’ve got a separate entrance for them, and a separate room, and medical personnel in protective equipment.

"If we feel they need testing, we’re going to perform the test as long as the local health department is agreeable."  

Until now, all testing for the novel coronavirus, which causes the COVID-19 disease, is done at the Michigan Department of Health and Human Services Bureau of Laboratories in Lansing.

Doctors who suspect a case of COVID-19 contact their county health department to determine if the patient meets the CDC's protocols for testing. If so, a throat swab from the patient is delivered to the county health department for transport to the state laboratory in Lansing.

If the sample tests positive at the state's lab, it's called a "presumptive positive" until results are confirmed by further testing at the CDC's laboratory in Atlanta. 

The state will not release the hometowns of individuals to protect their privacy, said Lynn Sutfin a state health department spokeswoman.

"Local health departments have been working diligently to identify anyone who has come in close contact with these cases, assess them for symptoms and monitor appropriately, as well as provide other public health recommendations as needed," she said.

The state is working to obtain data through the private health care providers who refer patients for the testing.

Opening testing to commercial laboratories will benefit the state, said Duane Newton, director of the clinical microbiology laboratory in the Department of Pathology at Michigan Medicine, the University of Michigan health system.  But communication between the companies and public health officials will be essential to contain the epidemic, he said.

"At some point the burden within the state of Michigan is going to be so high that (Michigan state laboratories) are not going to be able to have tests available," Newton said. "But it does produce challenges if a commercial lab is doing the testing." 

Since all orders for tests previously have come through county health departments and been processed by the state health department, public health officials in Michigan have known about every suspected case. It has allowed local and state epidemiologists to track the movements and contacts of suspected cases, and to take preventive measures like having people quarantine themselves.

While Michigan hospitals and doctors have streamlined methods for reporting communicable diseases to county and state health departments, this could be more difficult for commercial laboratories, Newton said.  

"(Commercial laboratories) try to create mechanisms to communicate information to public health entities, but imagine the difficulty of that scenario with a national reference lab getting specimens from 50 states and around the world," Newton said. "It's hard to know how it's going to effect reporting." 

Calls to LabCorp and Quest were not returned.

“We have asked all of our providers to make sure if they believe someone needs to be tested and they’re sending it to a private entity, that they let the local health department know so that we have at least some information about that individual so the public health response can be swift,” Khaldun told reporters.

The state lab has no backlog of tests, she told lawmakers. Samples are being turned around the day they are received, she said. 

“Anyone who thinks that they may have COVID-19 or they think they may have been exposed to someone with COVID-19, they should be reaching out to their provider,” Khaldun said. “And that provider has the discretion to determine whether or not that person needs to be tested based on their clinical symptoms and based on what other tests they’ve run.”

The state is running testing at the state lab seven days a week, sometimes multiple times a day, Khaldun said.

“If we are testing two specimens per person within an eight-hour period, we estimate we can test 86 people in a day," Sutfin told The Detroit News last week. "If we mobilize more staff and stagger shifts, we can increase that number if needed.”

In the event that a “positive spike” is identified, Khaldun and the local health systems involved are notified. 

“I’ve asked my team to not wait obviously until you get low on testing kits but to order, order, order because I expect more to be coming in,” Khaldun told lawmakers.

Nationally, the number of cases has risen to more than 1,215 in 42 states with 36 deaths through Thursday, according to the CDC website. 

In Michigan, 12 individuals in Oakland, Wayne, Ingham, Kent, Montcalm, St. Clair and Washtenaw counties have tested positive. Ninety-three individuals had tested negative for COVID-19 and 28 test results were pending as of Wednesday night. 

Michigan public health officials since Jan. 31 have asked a total of 520 people to self-quarantine for 14 days due to travel to areas with a high risk of exposure to the coronavirus, according to the state's data. 

Dr. Joneigh Khaldun, the Michigan Department of Health and Human Services' chief medical executive, answers a reporter's questions after a Nov. 14, 2019, press conference to announce new steps to combat the opioid epidemic.

There are 150 people in isolation under active monitoring by county health departments in Michigan. The remainder were released after completing their 14 days of quarantine without showing symptoms.

Khaldun told lawmakers she was concerned about resources and staffing at local health departments, especially when it comes to the manpower need to trace contacts a COVID-19 patient had with others.