Delaware is spending $30 million for 200,000 saliva-based test kits that will allow the state to administer upward of 80,000 tests per month – more than four times current volumes – but state business leaders are anxiously waiting to see how that will translate into restarting the economy. Although Gov. John Carney said during a Friday news conference that "widespread community testing needs to be in place before we can safely reopen our economy,” it is not yet clear how the test kits from Los Angeles-based startupCurative Inc.will be used to help Delaware businesses bring employees back to work safely – or whether businesses will have to pay for testing their employees themselves. The governor is under increasing pressure to help businesses reopen, a situation exacerbated by the fact that the state is paying out $32 million in unemployment claims per week.
[caption id="attachment_181932" align="alignleft" width="150"] Delaware Business Roundtable Executive Director Bob Perkins[/caption]
Bob Perkins, executive director of the Delaware Business Roundtable, a consortium of state business CEOs, said the business community has supported comprehensive testing from the start of the pandemic, including a recent April 24 letter to Gov. Carney signed by Rod Ward and Katie Wilkinson, who chair the business roundtable and Delaware State Chamber of Commerce, respectively. “At Friday’s press conference when the governor announced expanded testing, he indicated that [the Delaware Division of Public Health] would be issuing guidance for companies that want to test their employees,” Perkins said. “Consumer confidence will play a big role in reigniting the economy. We plan to work collaboratively with the Carney administration as they work to determine the best way to make such testing a reality. While the acquisition of an additional 200,000 tests is a great start, there is a potentially long runway until a vaccine or proven treatments are available, so Delaware will need to quickly build on this effort.” Delaware State Chamber of Commerce President Mike Quaranta agreed that expanded testing is a “good and important tactical step. However, missing from the announcement Friday were details about a broader strategy that could include contact tracing, procurement of personal protective equipment (PPE), and more. There are about 57,000 licensed businesses in Delaware, and it is in everyone's best interest to help them do this right." State officials were introduced just a few weeks ago to Curative by New Castle County Executive Matt Meyer, who first advocated for statewide testing in March. The state will do a “soft” launch of the Curative test at community testing sites over the next two weeks – one in Sussex County and one in New Castle County, said A.J. Schall, director of the Delaware Emergency Management Agency, which will work with Delaware’s hospital systems and other health care partners to operationalize the testing framework and stabilize the supply chain. Curative’s price tag of $150 per kit could be lower given that the federal government pays $100 for a test for Medicare patients, many of whom are on the state’s target list of vulnerable populations. The state will use community testing by hospitals, primary care physicians, federally qualified health centers and community organizations to target symptomatic individuals, anyone who has tested positive for the COVID-19 virus; low-income individuals; and front-line essential workers like nurses and first responders.
Who is Curative?
Curative was formed in January by Fred Turner, a 24-year-old scientist and entrepreneur, with a mission of creating a test for sepsis. Less than two months later, it had pivoted to focus on COVID-19. The nascent startup is booming with interest, performing most of the public testing across Los Angeles County, the country’s most populous county with more than 10 million residents; recently signing a $13 million deal with the U.S. Air Force; and providing tests for Florida and Alaska. That growth has been attributed to a unique approach that enables patients to self-administer the tests by swabbing their own mouths after coughing. It’s painless and requires less protective gear. The company is one of dozens that fast-tracked its own test and one of a few that has obtained emergency use authorization from the U.S. Food and Drug Administration (FDA) – a type of approval that provides additional credibility to organizations that receive it. To date, Curative has processed more than 174,000 tests. Los Angeles officials have said they felt comfortable using Curative’s oral swab test – which some critics have said is less reliable and accurate than nasal swabs or blood tests – because of a shortage of equipment and professionals to administer other tests. On the other hand, the Curative test does not run into the problem that other tests have due to shortages in the supply chain for critical components, enabling it to scale quickly. “Conducting mass testing using nasal swabs was not possible for the city,” Chief Advisor on Emergency Medicine Marc Eckstein told the Los Angeles Times in late April. “We made an informed decision to conduct testing based on the oral-swab method, rather than doing no testing at all.” In terms of effectiveness, clinical trials have demonstrated Curative's oral swab test (89.7%) to have a higher rate of accuracy than nasopharyngeal tests (79.3%), said Curative spokesman Ian Martorana, adding thata third-party research team at Yalehas supported the comparative efficacy of this methodology, which tests for the presence of virus in both the respiratory tract and the oral cavity.
Supplementing the state’s testing strategy
State officials and a Curative spokesman said it was premature to discuss how many Delawareans will be tested or the frequency that individuals will be tested. The state is expected to provide additional details on the rollout and on plans for contact tracing to understand who might have been exposed in advance of the possible start of Phase 1 of reopening the economy, currently targeted for June 1. The state explored many tests and strategies, and felt the saliva test offered “excellent performance and turnaround characteristics,” said Jen Brestel, spokesperson for the Delaware Department of Health and Social Services. "The saliva-based tests will supplement the state’s testing strategy,” she explained. “We will continue to work with our partners to maximize testing capacity with all available resources (saliva test, nasopharyngeal/oropharyngeal swab polymerase chain reaction (PCR) tests, etc.). We will also continue to evaluate new technologies to compose the best combination of testing for Delawareans. All tests will complement each other to provide access to as many Delawareans seeking testing as possible.” Through May 9, the state had tested 31,039 Delawareans, with 6,447 positive cases. In recent weeks, testing in Sussex County has intensified given skyrocketing positive results – even though hospitalizations have decreased. Delaware’s long-term care facilities have been hit hardest during the COVID-19 pandemic, accounting for 124 deaths, or nearly two-thirds of the state's 193 deaths as of May 6. On May 5, the state alsolaunched a universal COVID-19 testing programfor staff and residents in long-term care facilities statewide. Public health experts at DPH will develop a list of front-line workers who will receive prioritized testing and will work with employers to develop employee testing programs.
[caption id="attachment_188122" align="alignleft" width="237"] DSCC President Mike Quaranta[/caption]
"The Delaware State Chamber of Commerce is encouraged to see the state take steps to begin widespread COVID-19 testing," said Quaranta, president of the DSCC. "The chamber and its members believe more testing and tracing, in conjunction with reorganized workplace footprints, best practices like frequent cleaning protocols, face masks and more, will restore confidence in employees and consumers as we move about more freely." Delaware’s new testing strategy will be implemented alongside a robust contact tracing program to isolate infected individuals and their close contacts, DPH’s Brestal said. Details of Delaware’s contact training program will be released this week and will include details on hiring a dedicated workforce to help Delawareans who have contracted the virus to safely self-isolate. Perkins, of the Delaware Business Roundtable, said that it is not clear who will pay for testing of Delaware businesses and “that will have to be worked out.” “There have been a number of meetings but it is clear there needs to be many more discussions and a great deal more input from the business community to ensure we develop an effective, comprehensive testing program,” he added. Carney said during his Friday press conference that he has not been tested, although at least one member of his governor’s office staff reportedly tested positive in early April. Among the companies that have tried to connect with state officials with testing options isLabWare, which is developing a field-testing laboratory that can securely share results nationwide, working with federally supported Tangen Biosciences, whose CEO is Delawarean Rick Birkmeyer. Meanwhile, a different consortium of Delaware companies called Scan Delaware Health and led by Victor Cushmanhas a scalable package of PCR and rapid teststhat would cost about $45,000 per month for a combination of 4,000 tests.“Our state should be progressive in testing all Delawareans through a collaboration that leverages the strength of businesses, medical professionals, and nonprofit organizations that can contribute to the fight and is not a further tax on businesses or disadvantages our state to do business in comparison to our neighbor states,” Cushman said. “We hope that, as the state continues to develop a layered testing approach that is cost-effective, complete, and uses testing in combination with technology, the state will decide to respond to our inquiries so that we can discuss how we can help. The people we’re talking about are our greatest heroes and deserve the support of frequent testing by the nature of their public-facing positions and greatest risk of exposure. Testing cannot ramp quickly enough.” By Peter Osborne firstname.lastname@example.org