As the number of new cases of covid in Montana approached 1,000 every day in September, Shelly Stanley-Lehman worried about when the virus would reach her daycare in Billings.
She wanted to have covid tests on hand to help prevent an outbreak from spreading through her business, but the stores were full. She spent days making calls and searching online. When Stanley-Lehman finally got his hands on a box of tests later that month, it was too late – a family member of a child, unknowingly infected, had exposed the daycare to covid. The virus quickly spread to four other people, including children and staff.
“We had the tests just in time to close,” said Stanley-Lehman.
Rapid antigen testing for covid has become a public health tool that can help keep schools and businesses open. They are less accurate than polymerase chain reaction tests, called PCR tests, which must be sent to a lab to get the results. However, the rapid test turnaround time of just 15 minutes can detect cases early and, thanks to quarantines and isolation, prevent infected people from spreading the virus in schools, businesses and other places of life. job. But a box of two BinaxNow home tests, made by Abbott Laboratories, costs $ 24 at a retail pharmacy – and they’re often scarce.
The tests are much more accessible for those who are part of Montana’s free rapid test distribution program, which offers at least two types of BinaxNow antigen rapid tests and a third antigen-free test called Abbott ID Now from the same manufacturer. , Abbott. This fall, the state delivered up to 113,000 antigen tests to hospitals, health clinics, government offices, local health departments and others.
But communication on how to access testing has been inconsistent, as with some detention centers and childcare providers. While some prisons screen symptomatic inmates with tests from their local public health department, other law enforcement officials had not heard of the state’s availability of rapid tests at all.
Roosevelt County Sheriff’s Assistant Tina Bets His Medicine said jail workers had not received rapid state tests or had not been trained in their use. “We’re definitely interested,” she said. “It would eliminate some problems for us. Because we certainly don’t want people to be sick in our prison.
The state has communicated with schools and local health officials about the program, but it has not been more widely publicized in the past two years. Of the state’s covid-19 public service announcements, none announce an offer of quick BinaxNow tests or explain how to request a shipment.
The eligibility requirements for free tests can be complex. Some school districts order recurring mailings of tests for students and staff. But private daycares and private employers must obtain a federal waiver to administer certain types of tests. And others who qualify don’t know about the tests, don’t want it, or are too stretched to add another tedious covid task.
The result is an uneven distribution of free state testing. State officials cited several reasons for this, including federal waiver restrictions. A limited national supply chain also means that officials must prioritize recipients.
But some public health officials see gaps in test distribution as another indicator of an overwhelmed and underfunded public health system.
Drenda Niemann, head of public health for Lewis and Clark County, said many children and families in her county can get tested in school districts while other residents have few options when drugstores sell out.
“It’s really hit and miss and we’re just doing our best with the resources we have,” Niemann said. “There is no consistency.”
The Montana Department of Public Health and Human Services said it distributed nearly 550,000 BinaxNow rapid tests from October 2020 through October. DPHHS sent 45% of these to hospitals and health clinics, according to a Montana Free Press and KHN analysis of state data. An additional 13%, or approximately 73,000 tests, were performed in assisted living and long-term care facilities.
But only 5%, or 26,500 tests, went to a category called “Other,” which includes group homes, services for people with disabilities, and daycare centers. That’s just over 70 tests per day for that whole category, statewide. During the same period, less than 2% of all tests distributed, about 11,000, went to dozens of state correctional facilities and prisons.
Comparatively, other states have opened the doors to testing. Tennessee has created a program for interested companies to obtain free covid test kits, with guidelines on how to qualify. Colorado dispatches BinaxNow rapid tests directly at home for free. Libraries around the Washington, DC area offer them for free.
“In an ideal world, you would have tests readily available, just as we see in countries in Europe, where families can get 10 tests a day for their home,” said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota.
When ordering Abbott BinaxNow assays, Montana is careful not to store more than it can deliver before the assays expire after 12 months. It sent 51,200 tests to Colorado in May that were close to their expiration date. The state does not track the number of unused tests after they are distributed.
Montana Gov. spokesman Greg Gianforte Brooke Stroyke said testing is an important part of the state’s response to the pandemic and that the state is distributing testing to eligible vulnerable and underserved populations on the basis of the contribution of local health authorities.
“After all, local leaders know the needs of their communities best,” Stroyke said.
Missoula County uses Abbott ID Now rapid tests, the third type of rapid covid test the state distributes. The Abbott ID Now is not an antigen test but a molecular test similar to PCR tests. The state distributed an average of 3,120 such tests per month.
These tests may be more reliable, county officials said. Brian Chaszar, his covid-19 operations section chief, said his county had access to plenty of testing and was able to publicize what was available.
He said some businesses and groups are sure to be running out in a large county, and not all places will choose to receive testing, whether because of the workload or a potential backlash against the precautions against. covid, especially in some school districts.
“I have no desire for the principals of these schools,” Chaszar said. “Some parents really want masking and testing, other parents don’t want anything to do with it and refuse to participate.”
With the contagious delta variant on the rise this fall, the state has increased the distribution of tests to public and private K-12 schools that request them.
“We would like as many K-12 schools to tap into these resources to help schools stay open and safe,” wrote Todd Harwell, the administrator of public health and safety. from the state’s health department, in a September email to local and tribal health officials. .
But DPHHS spokesman Jon Ebelt said providing rapid tests directly to private companies is complicated by federal regulations that require every company to be given a waiver to administer them.
Ebelt said most state-distributed tests are bound by these federal rules, which he says offer “better reporting and better quality control” and are cheaper.
One of the two types of antigen testing the state receives from Abbott doesn’t need a federal waiver, but it has a much more limited amount. As of June, the state has distributed about 18,000 of these home tests. Ebelt said the state’s limited stock of less regulated home tests had been a priority for other entities, such as local health departments.
“We were very concerned that we would not be able to get enough testing from our vendor to expand distribution,” Ebelt said. Although some companies such as childcare providers may request federal waivers to access more testing, Ebelt said the DPHHS does not believe this is the best route because of the extra work for these groups. “Already understaffed”.
A former DPHHS official disagreed with the department’s interpretation of federal rules. Jim Murphy, the state’s former chief epidemiologist, said the state could find a way to distribute tests to daycares and other businesses if it provides proper training and monitoring.
Ideally, Murphy said, the public health philosophy for navigating the pandemic should be focused on solutions rather than obstacles.
“We shouldn’t find any obstacles here,” he said. “We should find ways to put these tests in good hands. “
A workaround proposed by Montana health officials was to connect daycares with a federal agency PCR test initiative operated through the US Department of Health and Human Services, the same program that Billings’ Stanley-Lehman used to order tests for his daycare. Ebelt said the ministry knew of nine Montana child care providers who had signed up to work with this program in early November. As of this year, Montana had almost 1,200 licensees nursery.
Montan’s access to tests varies by county, in part due to the number of tests requested by local authorities and the way they are used. Joe Russell, a health worker for the Flathead City-County Health Department, said he knew people were struggling to find tests, but it was not for the state to announce that tests are available.
“Sometimes that’ll be up to us, the county, and sometimes it’s the responsibility of the business, you know, to go ahead and ask,” Russell said.
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