Draft for discussion purposes only --- Preliminary and Pre-decisional
Testing & Contact Tracing Expansion and Scale Up Brief
Testing Surge Task Force
4-23-20
Testing Expansion and Scale Up
Issues: In order to move to the next phase of our response to the pandemic and begin to lift our
community restrictions, increased access to testing is an important capability.
Goals of testing
1. Inform clinical care
2. Inform public health containment strategies of isolation, contact tracing, and quarantine
3. Be one element of population-based surveillance strategies
Increasing capacity for testing is a function of three things:
1. Number of tests that can be processed by labs (state lab, health system labs, commercial labs,
point of care machines)
2. Number specimens that can be collected at a testing site. Rate limiting factors include supplies
(swabs, reagent, transport media, saliva tubes, PPE), staff, and traffic of patients to be tested to
sites
3. Number of test collection sites
Suggested Prioritization of testing:

1. CDC guidance as a start
2. Augment with State Lab of Public Health criteria: Those are person with symptoms compatible
with COVID-191 who are in one of the following five categories:
a. Hospitalized patients;
b. Healthcare workers or first responders (e.g. EMS, law enforcement, fire department,
military);
c. Patients who live in or have regular contact with a high-risk setting (e.g. long-term care
facility, homeless shelter, correctional facility, migrant farmworker camp)2;
d. Persons who are at higher risk of severe illness and for whom a clinician has determined
that results would inform clinical management;
3. Could add symptomatic and asymptomatic in the setting of an outbreak in a confined congregate
setting.
4. With additional emphasis on equity and ensuring communities of color have access to testing
Opportunity:

1. Estimates of the desired proportion of the population to be tested varies
(https://www.kff.org/coronavirus-policy-watch/what-testing-capacity-do-we-need),
2. Based on ranges, we estimated a goal of 1.2% of population tested per week which translates to
17,480 tests per day. This is our moonshot or audacious goal. (See excel spread sheet)
3. Currently, there is an estimated lab processing capacity available in the state close to 17,000
diagnostic tests when combining commercial, state lab, and health system lab processing
capacity (See excel spread sheet). It is anticipated that this lab processing capacity will continue
to grow.
4. North Carolina average number of COVID-19 Diagnostic Tests per day has been around 2500 per
day, with some recent increases. (Figure 1)

 5. On a weekly basis to set pace to match the rate of lab processing capacity in NC, ambitious
weekly targets would need to be met. If we assume a weekly doubling capacity, the weekly
targets for the entire state of NC could be as follows.
a. Week 1: 3,919 per day*
b. Week 2: 5,879 per day*
c. Week 3: 8,818 per day*
d. Week 4: 13,228 per day*
6. To understand the rate limiting step to unlock the full capacity, there is a need for granular data
from lab processing and specimen collection sites that can be collected by this survey tool

https://forms.office.com/Pages/ResponsePage.aspx?
id=sudUhWjmHEyNJzsS9cczrOIEDYKYDBNDpIvuMd5dZndUOTk4VFk1VUVVN0
ZQTDREUDlXOTgwWFpVVy4u
7. To increase the access to testing for North Carolinians across the state, we need to unlock the
capacity for sample collections across our counties and have target sample collection goals by
county (See Excel spread sheet). Based on the population of the county, this target translates to
the high end of 1,853 tests per day in one county vs. 7 tests per day on the low end.
8. To reach this capacity for testing, we will need to increase the number of specimen collection
sites.
9. If we assume a model of centralized high-volume collection sites that are able to test ~200 people
per day, the goal at 30 days would be 87 collection sites throughout the state. This ranges from
9 testing sites in the most populous counties, and 1 testing site in the least populous.
10. A visual review of “date of collection” data suggests that an area of opportunity is weekend
collections.
a. Weekend collections represent an opportunity of over 25% of the week
b. Optimizing weekend collection will bring up weekly averages
c. Weekend collection may require different strategies (e.g., collectors may be less
available)
d. Weekend collection may represent different opportunities (e.g., targeted community
events for essential workers)
Approach:
1. Establish the 100 County Plan - Directors of local health departments to lead county-level plan
to reach target tests per day goal. Local health department leaders are well versed in the needs
of the community and have close relationships with key stakeholders in the county.
a. Delegate weekly survey to collection and lab processing sites that captures granular
details to assess rate limiting steps in daily lab throughput. The survey can be accessed
here: https://forms.office.com/Pages/ResponsePage.aspx?

id=sudUhWjmHEyNJzsS9cczrOIEDYKYDBNDpIvuMd5dZndUOTk4VFk1VU
VVN0ZQTDREUDlXOTgwWFpVVy4u
b. Expand capacity for testing at health department sites
c. Engage health system executive leadership, federally qualified health centers, and other
health care providers across the state to partner with health department directors to be
part of the solution for reaching target numbers by county per day.
d. For both health department and health care partners, work on ways to immediately
expand existing capacity through additional testing site (urgent care, ambulatory sites),
additional access (after hours, weekends).
e. Engage new entrants (e.g., mobile/pop-up, retail, home deliver, pharmacy-based testing,
community and faith-based organizations) to provide additional test collection capability.
Deploy new entrants in areas where specimen collection options are limited and need
rapid ramp up.
f. Commit to development of a testing and contact tracing ecosystem which includes
collaboration, coordination, recruitment, and communication strategies that

 2. Use data from surveys to monitor and address bottlenecks and coordinate movement of lab
capacity (specifically commercial lab capacity) and other supplies throughout the network to
optimize throughput. Provide central place for all collection and lab processing sites to view
these data.
3. Launch and engage a scientific council to support rigorous review of novel tests and/or
innovations in specimen collection. This may include running validation studies of tests to assess
performance and providing guidance on appropriate use.
4. Consider reserving some testing capacity for State or DHHS directed work (10%) to be utilized for
outbreak identification, mitigation or containment efforts
5. Develop testing surge dashboard of key metrics that demonstrate we are on the right path & can
forecast future testing capabilities
a. Sites opened v. Goal for sites open
b. Utilized capacity as a percent of potential capacity
c. # of individuals tested by county
d. Demographic data of individuals tested
Current short-term strategies (Draft for Discussion and Refinement):
Engage Testing Surge Task Force and their networks to immediately work on ways to expand
existing capacity
1. Continue to identify all potential lab processing and specimen collection sites and their capacities
a. Get data from the labs not accounted for today
b. Requesting survey completion to account for volumes and opportunities for optimization
of supply chain to unlock more tests.
2. Increase community-based sample collections sites and access
a. Develop collection sites rollout plan for rolling two weeks
b. Set goal to ensure community sites with access to communities of color
3. Utilizing lab capacity in outbreaks
4. Rebalance capacity if there is excess in some areas and limited in others
5. Enable new entrants into ecosystem e.g.,
a. Walmart
b. Walgreens
c. LabCorp for in home nasal swabs
6. Promote community-based education and messaging

 Figure 1: New tests per day 7 day rolling average (source; DHHS)

New tests per day with 7 day rolling average
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