City and Borough of Juneau
Emergency Operations Center
155 South Seward Street
Juneau, Alaska 99801
Telephone: 586-5240  Facsimile: 586-5385

DATE:

June 8, 2020

TO:

Beth Weldon, Mayor

FROM:

Robert Barr, EOC Planning Section Chief

RE:

Local COVID-19 Testing

Background
In early May, the EOC began engaging in conversations with Bartlett Regional Hospital, DHSS laboratory
staff, and other partners from the medical, science, and business communities to determine the feasibility of
standing up local laboratory resources to test for COVID-19. Also in early May, the Assembly’s Economic
Stabilization Taskforce recommended local testing be pursued 1. A local lab would enable same-day
turnaround times for what we currently refer to as send out tests 2.
Shorter turnaround times are advantageous for a number of reasons, including:
•
•
•
•

Reduction in quarantine lengths when test-based strategies are in place (such as Health
Mandate 10)
Faster detection and isolation of asymptomatic COVID positive individuals
Contact tracing investigations begin sooner
Businesses whose critical infrastructure or COVID mitigation plans include testing can meet the
requirements of their plans faster

Short turnaround times are currently possible in Juneau with rapid tests 3; however, the supply of rapid tests
is constrained. Further, the sensitivity of rapid tests is lower than lab-processed tests and we continue to
send results from rapid tests to a lab for confirmation.
In addition to the advantage of shorter turnaround times, increased local testing capacity streamlines
workflows and eliminates dependencies that have the potential to cause roadblocks in an environment
where testing is in high demand. Examples of these workflows/dependencies include: packaging tests for
shipment, maintaining medical shipping supplies, meeting air cargo deadlines, arranging out-of-town
couriers, records management, and coordination between local and out-of-town medical providers.
Our original analysis was focused on standing up the same type of high-complexity laboratory environment
that the DHSS runs in Anchorage and Fairbanks. We were repeatedly cautioned against this approach by
1

https://beta.juneau.org/assembly/economic-stabilization, see May 11 meeting
Send out tests have also been referred to as PCR tests. This can be confused with rapid tests, which are also PCR based.
A good non-medical primer on how PCR works: https://jamanetwork.com/journals/jama/fullarticle/2764238
3
Abbott ID NOW & Cepheid Xpert Xpress are the two rapid tests available locally.
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 June 8, 2020
Assembly
Local COVID-19 Testing
medical and laboratory professionals due, primarily, to the level of personnel qualifications necessary for
such an effort.
Thanks to guidance from DHSS and BRH laboratory staff, we became aware of medium-complexity systems
that had received FDA Emergency Use Authorizations which were likely appropriate to our level of
sophistication. Bartlett laboratory staff performed a feasibility analysis that identified an appropriate
system from a large, reputable vendor.
Due to high demand, lead times on this type of equipment are long – we are currently receiving estimates of
4-6 months. We have some indication that a reduction in lead time due to our Juneau-specific circumstances
(no road system connection, regional hub) may be possible.
Two different testing systems remain under analysis. They differ from each other primarily in cost and the
number of tests that can be processed per day. The less expensive system has a capital cost of $350,000 and
can process 1300 tests per day. The more expensive system has a capital cost of $700,000 and can process
4000 tests per day. The more expensive system is twice as expensive from an operating perspective
(maintenance contract, consumables). It is also likely, due to size, that the more expensive system could not
be housed on-site at Bartlett. If housed off-campus, additional costs will be incurred in staffing inefficiencies
and space/utilities/maintenance.
For context, over the weekend at the airport, we tested 147 individuals and provided a similar number of
vouchers for a 2nd test in 7-14 days. 66 of out of state passengers arrived in Juneau with negative test results
in hand.
In a perfect world where Juneau’s COVID-19 exposure remains low, a testing level at either of these
magnitudes would not be necessary. Juxtaposed to the worst case scenario, neither of these magnitudes
would be sufficient. An additional risk is that a new testing method that is simpler, more available, and/or
less expensive may be developed in the near-term future that would obviate the need for this system. This
risk is somewhat mitigated in that either of these options can be used for other diagnostic tests at BRH;
however, in normal circumstances BRH would not acquire systems at these magnitudes.
EOC Recommendation & Assembly Action
At a glance, the less expensive option seems adequate for Juneau. At the height of its testing demand, New
York City performed 33,849 tests in a single day 4. Controlling for population, and conservatively using the
population for all of Southeast Alaska instead of Juneau alone, this translates into about 300 tests per day.
Looking at a smaller population, Iceland, at the height of its testing demand 5, was up to nearly 5 tests per
1000 people in a single day, or approximately 360 tests per day for Southeast. It is logical to procure a
system with significantly more capacity than current demand out of concern for future spike(s) or a scenario
where vaccine development takes longer than anticipated.
Looking at Juneau specifically, in a future where all out of state travelers continue to receive an average of
one local test, we can use airport and AMHS projections. BRH staff are currently working on projections for
pre-procedural testing demand. Other areas of potential high demand include JSD/UAS, fish processing
facilities, the legislature, rural southeast communities, the mines, other critical infrastructure surveillance
4
5

https://www1.nyc.gov/site/doh/covid/covid-19-data.page
https://ourworldindata.org/coronavirus/country/iceland?country=~ISL#testing-for-covid-19
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 June 8, 2020
Assembly
Local COVID-19 Testing
testing, congregate living facilities, small cruise ships (esp. those homeporting in Juneau) and anywhere an
outbreak occurs and a large contact tracing investigation ensues. Large cruise ships remain a significant
unknown at this time.
Other than testing demand and capital cost, additional factors to consider include space, lab workflows,
operating costs, and equipment lead times.
The EOC recommends that the Assembly adopt Ordinance 2019-06(AI) at its next meeting and provide any
input or direction it may have.

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