Texas is spending $45 million on 300,000 new coronavirus tests to largely be used in the infected state prison system, according to a Texas Department of Emergency Management purchase order.
Unlike the often-painful nasal swabs most commonly associated with testing for the new coronavirus, the prison tests, bought from a months-old company in California, are oral swabs that patients administer themselves. But like every other test for the pandemic-causing virus, it isn’t perfect.
The new test by Curative, a startup in the Los Angeles metro area, has a 10% rate of producing false negatives, CEO and founder Fred Turner said in an email to The Texas Tribune on Wednesday. But all tests for the coronavirus and COVID-19, the disease caused by the virus, have false-negative rates, he told dot.LA earlier this month.
“In our studies, we demonstrated that the sensitivity is at least as good if not better than the nasal pharyngeal swab tests,” which he calls “brain swabs,” Turner said in the dot.LA interview.
Still, the U.S. Food and Drug Administration said with its emergency authorization of the Curative test that if people are symptomatic but have a negative result, there should be follow-up testing. A spokesperson for the Texas Department of Criminal Justice said medical testing, which has been much slower comparatively, will still continue along with the new testing.
As of Wednesday, nearly 1,800 inmates and 700 employees in Texas’ 104 state-run prisons and jails had tested positive for the coronavirus, according to agency reports. More than 72% of inmates tested were confirmed to have the virus. But with nearly 140,000 inmates in TDCJ, less than 2% of the prison population had been tested.
Epidemiologists and prisoner rights advocates have called for mass testing in the prison system to be able to see how pervasive the spread is behind bars and separate infected and exposed inmates from healthy ones. They have stressed that because disease tends to explode throughout cramped, often unsanitary prisons and jails, the virus endangers inmates, staff and the local communities.
On Tuesday, TDCJ announced it would begin new widespread testing with Curative tests, crediting Gov. Greg Abbott and the emergency management department. TDCJ spokesperson Jeremy Desel said Wednesday that in the first day of implementation, 1,919 inmates and 920 employees were tested for the virus, and he expects that number to grow exponentially. Without Curative tests, about 2,450 inmates have been tested since March, according to prison data.
Some advocates applauded the expanded testing by TDCJ. Prisons and jails across the country are hot spots for the coronavirus, but testing is not often done on a large scale.
Turner said in the email that Curative began rolling out its testing in Los Angeles in late March. The FDA authorized the tests in April for emergency use. Aside from Texas, Curative is also now working with several states, cities and the U.S. Air Force.
“We’re constantly in conversations with state and city governments, along with federal agencies, because there is a huge need for testing across the country,” Turner said. “We are fortunate that we are able to scale quickly and meet a large need thanks to the types of materials we use, and the noninvasive nature of an oral swab test.”
In Texas, Seth Christensen with the Department of Emergency Management said the Curative tests are only being used in prisons, but he didn’t knock the possibility that the program could expand. By Wednesday, he said the prison system had received 80,000 of the 300,000 tests ordered by the state. Though no other use outside of state prisons has been determined for the rest of the purchased tests — which are sitting in a state warehouse — he said more could go to TDCJ or could be used in other places with high infection rates, like county jails.
He said the price, at $150 a test, is reasonable since it includes collection kits and lab testing, and it eliminates the need for medical staff and protective gear since the tests are self-administered.
A Curative video explains that to take the test, at least 20 minutes after eating or drinking, a patient should cough deeply three to five times. Then, the person should swab both cheeks, gums, tongue and the roof of the mouth before putting the cotton swab in a plastic tube. Desel said all TDCJ inmates have been shown an agency-created instructional video on how to use the oral swabs.
As Turner has suggested, Desel said inmates and staff using the swabs are monitored to ensure tests are being done properly. The department has trained 120 staff volunteers to go to prisons in groups of 10 to ensure the testing is done correctly and deliver the kits to the Curative labs. Results are expected to be returned within 24 to 48 hours of testing, Turner said.
Desel said staff members are required to take the tests, and, though inmates have a right to refuse, nobody seems to be doing so. He expects the system will have enough tests for everyone who needs one.
“For now, we are only doing this testing at units where there is a positive case,” he said. “We’re prioritizing by need.”
On Tuesday, Desel said the 12 teams coordinating the testing were at 12 prisons: Clements, Ellis, LeBlanc, Lopez, Michael, Middleton, Murray, Pack, Sanchez, Telford, Terrell and Wynne.
Many of those prisons have reported outbreaks, but the Beto Unit, which has had more than 200 inmates test positive, was not on the list.
Doctors have warned against taking negative coronavirus test results as gospel. A Yale professor of medicine said in a New York Times opinion piece last month that false negatives seem to be “uncomfortably common,” but there is little public data to give a better sense. A Mayo Clinic brief said with a 10% false negative rate, like Curative reports, a lot of people who are infected would think they weren’t.
“Even with sensitivity values as high as 90%, the magnitude of risk from false-negative test results will be substantial as testing becomes more widespread and the prevalence of COVID-19 infection rises,” the article said. “Negative test results should be viewed cautiously, especially for individuals in higher-risk groups.”
But Turner has said self-administered oral swab testing is the way to get as much testing as the country needs, countering limitations on protective gear and health care workers.
“Ultimately, the goal is to do as many tests as we need to reopen the country,” he told dot.LA.