Some Mainers are waiting for days to get COVID-19 testing appointments, as infections continue to surge and more people seek a clean bill of health before holiday travels.

Those with symptoms of COVID-19 generally face little to no delay obtaining tests, but the situation is different for some asymptomatic Mainers hoping to take advantage of free testing at the state-affiliated “swab-and-send” sites.

Testing locations in Portland, Bangor and elsewhere were booking appointments for next week – or later – as of Wednesday, and even some private testing providers were reporting peak demand this week. Meanwhile, clinic staff members are also seeing higher numbers of potentially exposed people seeking tests, as COVID-19 infection rates, hospitalizations and deaths hit record highs in Maine and across the country.

“We’re swamped,” said Martin Sabol, director of health services at Nasson Health Care at York County Community Action Corp., which conducted 47 tests during the last week of October but 179 tests last week. “After a relatively slow late summer or early fall, demand for the service has really increased in the past two or three weeks.”

The Sanford clinic was “booked solid” on Tuesday and Wednesday of this week as well as next Monday but, Sabol added, “We are trying to keep up with demand.”

There was a similar situation at Portland International Jetport, where staff members have been averaging 220 to 230 appointments daily and, by Tuesday afternoon, were already having to schedule appointments for next week. A similar “swab-and-send” clinic, also run by Promerica Health under a state contract, at the Auburn Transportation Center is averaging 175 appointments daily.

“We’ve really been fully booked since we started, in particular because we are offering rapid testing in addition to the ‘swab and send,'” said Kevin Joyce, executive vice president and general manager of Promerica Health. The Falmouth-based company is offering free standard, molecular-based testing to both passengers and the general public at the jetport and in Auburn as well as rapid-result tests for $25 at the airport.

“People are wary of increased incidence rates, and there is an increased appetite for testing in general,” Joyce said. “The holidays are upon us. … We are probably at peak demand right now and I would expect that we see something similar before Christmas and New Year’s.”

The Maine Department of Health and Human Services began rolling out swab-and-send sites with provider partners over the summer as the state testing laboratory ramped up capacity and as more out-of-state tourists began arriving in Maine. Funded with federal coronavirus relief dollars, the sites offer free testing to individuals regardless of whether they are symptomatic.

DHHS officials are aware of the testing crunch, particularly for asymptomatic individuals. But they said the state lab in Augusta, which actually runs the tests from swab-and-send sites, has been able to keep pace with the flow and turn around results typically within 24 or 48 hours of receiving samples.

“We do recognize that in the last week there really has been a challenge,” DHHS Commissioner Jeanne Lambrew said Wednesday. “We have a lot of people seeking testing around colleges adjourning for the semester, people potentially traveling for the holidays, even though we continue to advise people not to travel. So we have reached out to all of our sites asking them what will it take to expand hours and increase staff and to try to ensure that we open up access.”

Lambrew said some locations could begin expanding hours or operations as early as next week. And in recognition of the ongoing crisis, DHHS plans to continue providing the financial support needed to keep the swab-and-send locations into next year.

“Our swab-and-sends have been great partners, so we are both going to potentially increase support for increased hours and access as well as extend the time period for those sites,” Lambrew said.

Potentially adding to the backlog, some of the swab-and-send clinics operating around the state were closed for Thanksgiving and will be on Friday, which is a state holiday. The Maine Center for Disease Control and Prevention’s lab in Augusta, which processes all of the samples collected at the swab-and-send sites, will be closed Thursday but will resume running tests early Friday morning.

Dr. Nirav Shah, director of the Maine CDC, noted that the state lab has been operating nonstop, without a single day off, since early-March, so staff “are going to be taking a well-deserved day on Thanksgiving to re-connect and re-energize.”

“My view is the staff at the Maine CDC laboratory have been working 18- to 20-hour days since before we even had our first case,” Shah said during Wednesday’s briefing. “Anyone who doesn’t think that they will be doing a better job after having a couple of hours off with their family, well, I’m going to be straight: You haven’t run a lab before.”

State and private labs in Maine have expanded their testing capacity exponentially since the spring.

Since March, the Maine CDC has reported more than 830,000 molecular-based or PCR tests – considered the gold standard – along with more than 17,000 antibody or antigen tests. Testing volumes have risen from less than 2,000 per day in June to consistently between 8,000 and 12,000 per day this month.

As of Tuesday, Maine’s testing rate was 727 tests per 100,000 residents, well above the national, seven-day average of 548 tests per 100,000. And while Maine’s daily case numbers are climbing – topping 200 new cases during nine of the past 17 days and hitting a record 255 cases on Tuesday – the state has the second-lowest infection rate in the country after Vermont, according to tracking by The New York Times.

But demand for testing is rising among individuals exhibiting symptoms of COVID-19 as well as among people either worried they were exposed to the virus or who want a test before traveling, returning to work or coming home from college.

Northern Light Health, which operates nine of the roughly 30 swab-and-send locations affiliated with Maine DHHS, had no appointments available before Sunday or Monday for non-symptomatic individuals at its locations in Bangor, Ellsworth, Waterville and Portland as of Wednesday afternoon.

As with some other health care networks, Northern Light offers both free swab-and-send testing through the Maine CDC lab as well as private-pay testing through its own lab. Dr. James Jarvis, who is helping to lead Northern Light’s COVID-19 response, said the company has significantly expanded its internal capacity throughout the pandemic but continues to deal with limited testing supplies.

Jarvis said Northern Light can quickly schedule and run results internally when there is a “clinical need,” such as a person exhibiting symptoms or in distress. But he urged people to plan ahead if they are seeking a test for other purposes.

“If you’re traveling, I strongly encourage you to go to the (Northern Light) website before you travel so that you can schedule your test for when you arrive back home,” Jarvis said. “That’s a really important thing to do because the volume is increasing. But we continue to look at how we can improve our staffing and lengthen our hours to meet the needs of the entire state.”

Not all swab-and-send facilities are fully booked with appointments this week. For example, as of Wednesday afternoon, MaineGeneral Health’s swab-and-send clinic in Augusta still had openings for asymptomatic appointments on Friday. But the pace of testing at the clinic is rising rapidly, from an average of 83 tests in September to 157 during the first week of November, 252 tests during the second week and 260 tests last week.

Private labs, pharmacies and health care networks also continue to offer testing, albeit sometimes with co-pays or up-front costs.

Earlier this month, DHHS announced a partnership with Walgreens to offer free, rapid-result antigen testing at 65 drive-thru locations of the pharmacy chain in Maine. Appointments are required for the testing, however, and a representative from Walgreens’ corporate office in Chicago did not reply to a question about demand for the service so far.

The CVS Health pharmacy chain has also been offering free testing to prescreened individuals at nine drive-thru locations in Maine.

“We are seeing peak demand for COVID-19 testing at our more than 4,000 test sites around the country, including the 9 drive-thru locations in Maine,” said Joe Goode, spokesman for the Rhode Island-based chain. “On average, test results are typically available in 3-4 days, but may take longer due to the current surge in COVID-19 cases and increased testing demand during the holiday season.”

Some private labs have additional testing capacity.

NorDx Laboratories, the lab affiliated with the MaineHealth network, has been processing about 3,000 samples per day, roughly half of which are for asymptomatic patients who require a precautionary test prior to receiving non-COVID care. Another 800 to 1,000 samples are from people exhibiting symptoms of the virus.

But NorDx recently began offering asymptomatic screening tests to community members for $105, with results usually available within 12 to 16 hours, lab president Stan Schofield said this week. MaineHealth also operates several of the state-affiliated swab-and-send sites, although those samples are shipped to the Maine CDC lab in Augusta for analysis.

Schofield said the NorDx lab could process another 200 to 300 samples daily and that “wouldn’t break the bank” and theoretically could handle up to 1,000 more tests per day. But logistically, such a large expansion would requiring hiring more of the highly skilled individuals needed to process the samples as well as acquiring more chemical reagents and other supplies that are in high demand nationwide.

“Every day is a scavenger hunt,” Schofield said. “We’ve secured pretty good streams of reagent and plastics and then, the next day, we find out the shipment we ordered doesn’t show up.”

Health officials nationwide urged Americans not to travel or gather with anyone outside of their immediate household this Thanksgiving in order to avoid worsening the current surge in infections, hospitalizations and deaths. While holiday travel is expected to be down in Maine this year, AAA estimated that 2.2 million New England residents are still likely to travel.

During Wednesday’s briefing, Maine CDC’s director cautioned Mainers not to allow a negative test result to provide them with a false sense of security that leads to riskier behavior. Shah said a negative result, while encouraging, should be viewed as “a snapshot” that does not offer an “ironclad guarantee” of health.

“The test tells you what was happening at the moment the sample was taken,” Shah said. “You could have been exposed the morning that you got your test or you could be exposed the day after you got your test done. All the more reason why we can’t let down our guard with the basics. Face coverings, physical distancing, avoiding crowds are just as important today as they were back in March.”

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