City officials explain coronavirus pool testing pilot

By , Daily Memphian Updated: August 13, 2020 8:41 PM CT | Published: August 13, 2020 12:41 PM CT
<strong>Poplar Healthcare technician Lakshmi Nellore logs tested COVID-19 samples on Monday, July 6, 2020. The City of Memphis is working with Poplar Healthcare on the city&rsquo;s pool testing pilot. Pooling allows a lab to group test samples together and save money. Instead of running each sample separately, they are grouped in small numbers depending on how much disease is thought to be in the group. If one group tests positive, the lab will rerun the sample to find out who tested positive.</strong> (Mark Weber/Daily Memphian)

Poplar Healthcare technician Lakshmi Nellore logs tested COVID-19 samples on Monday, July 6, 2020. The City of Memphis is working with Poplar Healthcare on the city’s pool testing pilot. Pooling allows a lab to group test samples together and save money. Instead of running each sample separately, they are grouped in small numbers depending on how much disease is thought to be in the group. If one group tests positive, the lab will rerun the sample to find out who tested positive. (Mark Weber/Daily Memphian)

Back in the spring, $2 million of the $12 million the city received in CARES Act funding for testing was set aside to develop pool testing.

The architect of the program was Dr. Manoj Jain, who one day told Mayor Jim Strickland that the two asymptomatic members of President Donald Trump’s staff who tested positive last spring would likely never have been found if they were not employed by the White House and being tested every day.


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“They could have spread that virus to others in the White House,” Strickland said Thursday. “The importance of testing rang true to me, and I started reading more about colleges — Notre Dame, the University of Southern California — they all talked about when they entered school in the fall, they would do targeted mass testing of students and teachers.”

By early June, the city was rolling out its own version of a mass test pilot, starting with volunteers on the city staff.

Within weeks, the testing had expanded to youth in summer programs, with parental approval, and other city workers.

The question, Strickland said, was how to build a mass program, from the ground up that was sound scientifically and logistically.

For every test given, there has to be a way to quickly courier it to a lab, there has to be an affordable and reliable way to process the test and then there has to be an IT interface so the patient can get the results, which are also reported to the state and local health departments.

“Scientifically, we were faced with great tests that were really accurate, but they cost a lot of money, well over $100,” Strickland said.


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In mid-June, Memphis was one of the first cities in the nation to apply to the U.S. Food and Drug Administration for pool testing approval.

Pooling is in no way new. It was used a half century ago to detect syphilis. When the pandemic hit, the FDA gave emergency-use authorization for COVID.

This is how it works. Labs like American Esoteric and Poplar Healthcare here, hold back some of each specimen they receive. Then, they combine 7-10 specimens and test them as one sample.

Because large populations of people with no symptoms have a very low positivity rate, almost all the combined samples come back negative.

If they register positive, the lab can take the samples it set aside and retest that batch only, saving untold time and cutting the cost of test significantly.

By July, Poplar Healthcare and AEL labs here both had FDA approval, thanks to the advocacy of the Tennessee congressional delegation, Strickland said, which went to bat with the FDA for Shelby County.

Today, the city’s mass testing program is being offered on site in two charter schools with capacity to test 4,000 people a day.

“Others are looking at it very closely and looking to come on as well,” Jain said. “We have a pretty good sense that there is interest.

“It has to do with changing our culture. People have to see this as the new culture of routine testing, just like we have the culture of masking,” he said.

The test is a shallow nasal swab, about a half-inch into the nostril. It can be self-administered, even by children.

“People are going to think about swabbing their noses, a student going into school, a nurse going into a hospital, a cashier going to a grocery store to work,” Jain said.


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“With our ability to test, we are going to bring a level of safety and sense of security to people’s lives. ‘Yes, I tested earlier this week, and I was negative.’”

But, he quickly adds, no one should take off their mask.

With pool testing, the price has dropped to $30 per test.

“And we are going to work on lowering the cost further,” Jain said.

The test likely will be given every 8-10 days but frequency will depend on positivity rates.

Employers who want to join would cover the cost themselves. The city is paying for the charter school testing because they are public schools in its jurisdiction.

What happens when the CARES Act money terminates December 31 is an unknown now.

“Frankly, we don’t have any concrete financial plan right now to carry forward with this program,” Strickland said, noting that the stimulus package Congress is reviewing may include additional money for cities and “some flexibility on how to use the money that we’ve already received.”

He also wants it clear that the testing program should not be interpreted as a city government imprimatur on in-person school.

“But we are saying, if a school goes in-person, we are offering them another tool, like masking social distancing and good hygiene. This is just another tool, if a school decides to do in-person lecturing,” Strickland said.

“If you have symptoms, you don’t need to be going to school, which is where we are giving the tests,” Strickland said. 

The tests are given in the schools by a third-party medical provider, said Tiffany Collins, deputy director of general services for the City of Memphis.


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“We have tested children as young as two,” she said. “Children are very comfortable taking the test. We have not had any push-back from parents.”

Poplar Healthcare CEO Jim Sweeney said the lab has applied for FDA approval to run the tests on a second machine, expanding the capacity.

Poplar is also researching how it could process saliva tests here.

“We’ll be reporting with the task force in the next couple of days on some of those findings,” he said.

Saliva tests are as accurate as the deep-nasal swab. Currently, they are being sent to Rutgers University in New Jersey for analysis; Rutgers sends notification to the patient and the health department.

The number of people getting tested in the county is down. Wednesday, 1,081 tests were performed, a low last recorded in June.

The county has capacity to test 8,000 people. Every community site this week has unused slots.

That has led people to wonder if lack of testing could be the reason the number of new cases is down.

 Thursday, the health department reported 171 new cases; the average is 256.

In late July, daily numbers surpassed 300 three days straight.

“We actually are one of the most heavily tested counties in the United States,” said county epidemiologist David Sweat.

“In fact, if Shelby County were a state, we would still be in the top 10 nationally in terms of the proportion of our population that has been tested for COVID-19,” he said, noting that 24% of people in the county have been tested at least once since early March.

But as positivity rates fluctuate, so too does the availability for asymptomatic people to get tested

This week, Sweat said, people without symptoms would likely not have difficulty making a testing appointment at a community testing site.

Dr. Bruce Randolph, health department medical director, continues to be emphatic about the department’s position on contact sports.


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“Now, I want to just make it very clear to you. The Shelby County Health Department, our position is that we, at the moment, do not feel that contact sports are safe.”

Gov. Bill Lee’s health directive said contact sports were permitted for schools, college and professional teams but it did not cover contact sports in non-school sponsored events.

That ruling was clarified August 6, by a state panel, to say that those events were permitted.

“We are not recommending contact sports,” Randolph said. “We will be happy to look over plans and provide some technical assistance, but you do not have to have our approval.

 “We anticipate there could be cases due to contact sports. We will have to wait and see. We consider contact sports to be a high-risk activity.”

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Topics

coronavirus pool testing Shelby County Health Department Memphis Mayor Jim Strickland David Sweat
Jane Roberts

Jane Roberts

Longtime journalist Jane Roberts is a Minnesotan by birth and a Memphian by choice. She's lived and reported in the city more than two decades. She covers healthcare and higher education for The Daily Memphian.


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