Oklahoma State Department of Health officials announced Friday it changed its COVID-19 testing guidelines to match those of the national Centers for Disease Control and Prevention, and acknowledged it had denied some physicians’ requests for tests due to a shortage of testing supplies.
The agency also said the state lab received 500 additional test kits, as well as key chemicals needed to run the tests, also known as reagents.
The changes and availability of additional test kits and reagents are expected to expand the number of people who can be tested for the virus, officials said.
The Frontier reported on Thursday that the health department was not following updated CDC guidelines that were aimed to get more people tested for COVID-19. The only way for a physician to test a patient suspected of having the virus was to first call a state epidemiologist for approval. Samples sent by physicians without authorization were rejected.
As of the evening of March 13, the health department reported 39 people had been tested for the virus. Another 37 tests were pending.
During an interview with the Oklahoma State Medical Association that was streamed on Facebook on Friday, State Epidemiologist Laurence Burnsed said the health department’s criteria was “very similar” to the CDC’s but that the agency modified the guidelines and sent out clarification to health care providers.
Burnsed acknowledged that a shortage of testing kits and reagents caused the health department to sometimes deny physicians’ testing requests.
“We do know that this has caused a challenge with providers and that we have had to work with providers on trying to prioritize specific individuals that have been tested,” Burnsed said.
The department asked clinicians to prioritize patients for testing who were “more severely ill,” or to consider the possibility the patient could be sick with an illness other than COVID-19, Burnsed said.
“Sometimes we have been advising that we are going to hold off on approving it at this time until we see if there’s another more likely (illness),” he said. “We know that that has caused some concern and anger with the public.”
Physicians in the state still must call an epidemiologist to send a specimen for free COVID-19 testing at the state lab, according to guidance from the state health department. However, two private labs in the state, LabCorp and RML, now have testing capabilities, health officials announced Friday.
For private lab testing, physicians do not have to get the go-ahead from an epidemiologist, but the testing is not free.
“A very important point here is to recognize that fortunately just in the last day we’ve received another shipment of reagents,” Burnsed said. “So we’re working as of today on expanding further, being less restrictive and working with providers so we can accept more specimens.”
The Tulsa Health Department held a news conference on Friday afternoon announcing the state’s policies would be aligned with the CDC’s.
“Before, all we really looked at was, were you in one of these Level 3 countries, or were you exposed to a known COVID case? That was really the main criteria,” said Bruce Dart, director of the Tulsa Health Department.
The health department’s expansion of testing will include: hospitalized patients who have signs compatible with COVID-19; symptomatic individuals such as older adults and those with chronic health conditions; anyone who within 14 days of symptom onset had close contact with a suspected or lab-confirmed COVID-19 patient; any person with recent travel history from impacted areas, including international and domestic locations within 14 days of their symptom onset.
The CDC updated its guidance on COVID-19 testing on Sunday, broadening who could be tested for the virus. The federal agency previously had a narrow criteria for who could be tested — those who showed respiratory symptoms and had recently traveled to China, or had come in close contact with a positive patient.
Asked whether the health department could still deny testing to doctors, Burnsed said yes, but noted the agency is depending on its federal partners to continue to send testing kits and reagents so the lab can work at its full capacity.
“We want to be flexible,” he said. “We’re going to try to make sure we’re adhering to the criteria and be less restrictive with providers… But the challenge that we’re still dealing with is that available capacity.
“So we will certainly stress the system more by being less restrictive by agreeing with physicians to test more individuals and expect that our federal partners are going to continue to try to work with us, and continue to supply those kits and reagents so we can continue our operation.”
‘We need tests’
The lack of testing in the state was one of the main points of discussion during a roundtable of state health care providers and public health officials on Friday morning.
“The largest obstacle is the testing. There’s just not enough of it out there,” said Phil Maytubby, director of Public Health Protection at the Oklahoma City-County Health Department
The discussion was led by Congresswoman Kendra Horn and was held at the University of Oklahoma Hudson College of Public Health in Oklahoma City.
Horn, who appeared via webcam, asked about a dozen health care professionals what their biggest hurdle was to adequately respond to COVID-19 in Oklahoma.
“To be very generic, we need tests, to start with,” said Dr. Douglas Drevets, a professor and the chief of Infectious Diseases at the University of Oklahoma Health Sciences Center.
“That’s not a surprise to anybody in this room or really anybody in the nation. So my understanding is that it’s getting ramped up. We need tests.”
Across the U.S., states have lagged to establish widespread testing.
The CDC in February rolled out faulty test kits to state and local labs that hindered states’ abilities to test for COVID-19 because the kits contained a flawed reagent. Each state now has the ability to independently test for the virus, according to the CDC, but the faulty kits delayed widespread testing across the U.S.
The Oklahoma State Department of Health gained the ability to independently test for COVID-19 on March 6. Before then, the state was sending specimens to the CDC headquarters in Atlanta for testing.
“We were one of the states that got bad reagents right off the bat,” Maytubby said. “It kind of slowed us down — our ability to respond. We have requested a lot of additional test kits.
“Our capability right now is probably not where it should be.”
President Donald Trump declared a national emergency over the COVID-19 pandemic on Friday and announced several steps the administration would take to increase the availability of tests.
As of the evening of March 13, the Oklahoma State Department of Health reported it had tested 39 people for the virus, and an additional 37 tests were pending. The state has one confirmed case of COVID-19 and two presumptive positives. A case is considered a presumptive positive when a public health laboratory identifies a positive result but is awaiting CDC’s confirmation.
Two cases, which were not connected, were confirmed in Tulsa County residents who recently traveled from Italy, health officials said. A third case was identified in Jackson County on Thursday afternoon. The Altus Air Force Base in a statement on Thursday said the patient, who is undergoing evaluation and treatment, was an active duty U.S. Air Force airman assigned to the base.
Asked during the roundtable why physicians were required to get a state epidemiologist’s permission before they could test a patient for COVID-19, Maytubby said the state lab had been short on kits.
“When we had such a shortage of test kits, we were trying to make sure that we had adequate test methodology and capacity for people who we truly needed to test at that time,” he said.
“But as these tests roll out, the physicians are going to be given the criteria on how to test their own patients and be able to submit those directly to the (private) labs. That was a timing issue.”