Testing needed to reopen economy, but Michigan trails other states

Craig Mauger
The Detroit News

Lansing — Michigan falls far behind other states in testing for COVID-19, a distinction that health experts say could complicate efforts to reopen the state's economy.

A sign at a drive-thru COVID-19 testing location in Lansing tells drivers to "proceed ahead." No testing appeared to be occurring at the site on Tuesday morning, April 14, 2020.

While Michigan has the fourth most coronavirus cases in the nation, it ranks last among the 10 states with the most cases for the amount of testing tracked, according to a Detroit News analysis. As of Thursday, the Michigan Department of Health and Human Services reported 97,093 tests — 25,000 fewer than any other state among the top 10 for confirmed cases.

Michigan's health officials have said they're looking into why the state's tracking indicates fewer tests than those in other states. But they've primarily mentioned three potential reasons: a shortage of testing supplies, tight restrictions on who has been able to get a test and potential shortcomings in the state's tracking.

Michigan is also missing negative testing results from "a couple labs," said Lynn Sutfin, spokeswoman for the state Department of Health and Human Services. Likewise, it's possible some labs might have prioritized submitting positive results over negative results, speculated Ruthanne Sudderth, spokeswoman for the Michigan Health and Hospital Association.

"We’re trying to learn more about some of the lab/testing numbers as well," Sudderth said.

Michigan and other states experienced delays in obtaining testing supplies from vendors, Sutfin said. The delays affected testing capacity at Michigan's Bureau of Laboratories but also at clinical labs at several hospitals, she said.

Tracking the testing numbers and expanding testing will be crucial as the state tries to figure out who has the virus and how to roll back social distancing measures that have shuttered businesses and kept most Michiganians inside their homes for weeks.

Gov. Gretchen Whitmer and six other Midwest governors said Thursday they would work "in close coordination" in deciding how to reopen the region's economy in consultation with experts. The governors of Illinois, Indiana, Ohio, Kentucky, Wisconsin, Minnesota and Michigan said they would consider the rate of new infections and hospitalizations and the ability to test and trace cases, among other indications, in deciding when to slowly resume certain activities.

They cautioned the regional economy would not "reopen all at once" or all the states "will take the same steps at the same time."

"When we do have these emergency situations, we need to have the people and systems in place," said Jeremy Youde, an expert on global health politics and a professor at the University of Minnesota Duluth. "Trying to do it on the fly like we’re seeing in a bunch of states is a recipe for disaster."

The availability of testing has been "wildly uneven" across the country, Youde said.

Jeremy Youde

Public laboratories that process the COVID-19 tests in some states are facing capacity issues, Youde said. And some states don't have substantial access to commercial laboratories, he said to explain differences in testing numbers.

Regardless, Youde said, having an abundance of testing will be key to giving government officials the "broad-based understanding" of what's happening with the virus they need to decide how to eventually lift social distancing restrictions.

Asked if a governor could make the right decisions without widespread testing, Youde responded, "It would be difficult."

'Laser focused' on testing

Dr. Joneigh Khaldun, Michigan's chief medical executive, said Wednesday that the state needs to "significantly expand testing" to know "how comfortable we are with lifting any social distancing recommendations."

But she also acknowledged the number of tests happening in Michigan has declined in recent days. The state is "laser focused" on addressing the fall-off, she said.

Thirteen drive-thru testing sites have been opened across the state, and Michigan has rolled back restrictions on who can get a COVID-19 test, Khaldun said.

Previously, the state prioritized testing for hospitalized patients and health care workers, leaving some people who wanted tests without one. Now, the state is allowing individuals with mild symptoms to get tests.

Dr. Joneigh Khaldun, the state's chief medical executive, and Gov. Gretchen Whitmer speak during a press conference on Thursday, March 26, 2020, in Lansing. The two state officials were updating the public on the Michigan's response to COVID-19.

“We want anyone who needs a test to be able to get it done," Khaldun said Wednesday.

The state directed health care facilities last week to avoid sending tests to state laboratories as more private labs could perform the task. 

The state has been "diligently working to expand testing capacity" since Feb. 29, when the Department of Health and Human Services Bureau of Laboratories was the only lab in the state providing COVID-19 testing, said Sutfin, the department spokeswoman. Testing has since expanded to more than 15 hospital systems and counting as well as several commercial labs, she said.

Joan Sanders of Berkley is among the Michigan residents who've wanted a test in recent weeks as the number of confirmed COVID-19 cases here climbed to more than 29,260 on Thursday.

Sanders, a mother of four, last week lost her senses of smell and taste. She went to a Beaumont hospital to try to get a test but was turned away. She was told, at that time, the hospital was only testing people with symptoms "strong enough to be checked into the hospital."

She eventually worked with her doctor to get a prescription for a test at the temporary testing facility at the former Michigan State Fairgrounds. When Sanders went there on Saturday, she noted how few people were in line to get a test.

Medical tents are prepared for the first day of testing at the new regional COVID-19 testing facility at the former Michigan State Fairgrounds site in Detroit on Friday.

Workers stuck a swab in her nose that "hurt like hell" and told her it would be four to seven days before finding out her results, Sanders said. As of early this week, Sanders hadn't found out if she's positive for the virus. But she said she is concerned that others who need a test may not jump through the hoops to get tested.

“Anybody who doesn’t have a doctor, are they really going to go the further steps to get tested?" she asked.

Since Sanders' experience, the state has loosened the requirements in hopes that more testing will happen.

According to Michigan's data, 25,092 tests occurred in the seven days from April 7 through April 13. That's a 32% drop from the previous seven days when 36,571 tests occurred.

The prior stringent restrictions on who could get a test likely influenced the drop in testing, said Brittany Bogan, senior vice president of safety and quality at the Michigan Health and Hospital Association.

"I don’t think the demand has gone down," Bogan said. "I think word has probably gotten out on the criteria you must meet to have a test ordered for you."

The prior tight restrictions were prompted by a national supply shortage of the materials used to conduct the tests, including the swabs and products needed to transport the sample, she said.

"There’s a worldwide shortage of these materials," Bogan said. "It’s not that we can’t get them in Michigan and we are unique in that. There’s just far too great of a demand. The backlog at some of these international manufacturers is immense."

Federal vs. state

Whitmer called Wednesday for "some assistance" from the federal government to get testing supplies during an appearance on "The Third Hour of Today." 

"Robust testing" is needed to make sure there's reliable data available to make decisions on reopening the economy, said Michigan's governor, who issued a stay-at-home order that required most businesses to cease their operations on March 23.

President Donald Trump said this week the federal government would be working with governors on testing.

"The states are much better equipped to do it," Trump said.

During an appearance on CNN this week, New York Gov. Andrew Cuomo said Trump doesn't want to go near testing because testing is a "quagmire." To ramp testing up where it needs to be is an "impossibility," Cuomo said.

New York has done five times the number of tests Michigan has done, according to the two states' data.

While Michigan reported 97,093 tests through Tuesday, New York has reported more than 500,000 tests, and California and Florida have each reported more than 200,000 tests.

Illinois, a Midwest state with a similar number of cases, reported 122,589 tests performed there, according to data released Thursday. Pennsylvania, another state with a similar number of cases, reported 141,470 tests.

Asked if the responsibility for increasing testing falls on the federal or state levels, health expert Youde said it's the "$64,000 question."

Testing happens on the state and local level, and that's where the expertise is, Youde said. But the president has the power to ramp up production and prevent states from bidding against one another for scarce supplies, he said.

"It’s more about what sorts of comparative strengths you have," Youde said.

Testing, he added, will continue to be important because the countries that have lifted social distancing requirements have had broad testing processes.

"The virus ultimately doesn’t care about timelines,” Youde said.