North Dakota had a problem. The state was sorely lacking a crucial testing tool for the coronavirus: long, thin collection swabs.
South Dakota had its own problem. It had run out of lab supplies needed to process tests for the virus.
Both states were waiting in vain for a resupply from the federal government. In the balance hung their ability to diagnose patients and track the spread of the virus.
That’s when the two Dakotas renewed a bond old as humanity: When the chips are down, turn to your friends and neighbors.
They arranged a no-cost swap. South Dakota sent 1,000 swabs north. North Dakota sent lab supplies for about 250 tests south.
“At the end of the day, we’re just trying to be successful, we’re all just trying to get through,” said Dr. Christie Massen, director of the North Dakota Public Health laboratory.
Old friendships between state public health staffers are fueling swaps of desperately needed supplies to test for the coronavirus while states wait, sometimes in vain, for shipments from the federal government and overwhelmed private sellers.
Quiet bonds forged early
The two states are part of a little known five-state group — the Northern Plains Consortium — set up in 2006 to forge bonds between their public health lab workers.
North Dakota and South Dakota were early consortium members, as were Montana and Wyoming. Idaho joined in 2013. The states face similar hurdles: scattered, rural populations and limited lab resources, so it made sense to join forces.
“The public health laboratory community in the United States is a tight-knit group," said Dr. Tim Southern, director of the South Dakota Public Health Laboratory. "We lean on each other every day for support."
But that support rarely involves swapping supplies. States instead provide training for each other, or process other state’s tests, for a fee. Still, the cooperation has forged "real, meaningful relationships," Massen said.
The consortium, supported by the Association of Public Health Laboratories and the Centers for Disease Control and Prevention, was a model for creating similar consortiums around the country, she said.
“Now, when things come to a head like this, you’ve got a great contact with someone to be like, ‘Oh my goodness, here’s what I’ve got going on,’ and it’s not a cold call,” she said.
Enter the coronavirus.
'A screeching halt'
The frantic need to run a flood of tests for the virus hit public health labs hard. State labs are usually equipped to run a relatively small number of tests each year to confirm cases of diseases like HIV, tuberculosis and chlamydia. They also monitor the annual influenza season.
Now they were being asked to process potentially hundreds and thousands of tests for a new disease as quickly as possible.
Testing for coronavirus is no simple process, and requires an unbroken chain of available equipment.
Special, long swabs are needed to collect specimens from those suspected of having COVID-19. Those swabs need sterile containers to transport them to testing. Labs need special substances, such as reagents and enzymes, to test specimens for the coronavirus.
“Any one of those factors can bring your testing to a screeching halt,” said Dr. Christopher Ball, chief of the Idaho Bureau of Laboratories.
In South Dakota, it did. The state lab had to stop testing for several days in mid-March when it didn’t get an expected supply shipment.
The state’s woes were mirrored elsewhere as federal disorganization and an overwhelmed private market led to a nationwide shortage for testing supplies, wrecking usual sedate supply chains.
Due to the supply shortages, a lot of public labs are now "operating day-to-day," Southern said.
“Many public health laboratories have drastically limited coronavirus testing (to) the highest priority populations like severely ill, hospitalized patients and ill healthcare workers," he said.
'Hope on a prayer'
Massen, in North Dakota, described the torturous process state lab workers take to get reagents for testing.
They file their request on a CDC-established website known as International Reagents Resource. Then they wait, hoping their request doesn't turn into a backorder, as the federal government seeks to get supplies needed to the hardest-hit states, she said.
“We put orders in, then we just sit and hope on a prayer that we’re going to get them,” she said. “It’s maddening, it’s frustrating, but it’s kind of understandable. It’s just hard. It’s hard when the supply chain gets so disrupted like this.”
Massen and Southern both say they expect ongoing cooperation between their labs in the days ahead. And the state-to-state cooperation looks to include pandemic needs beyond testing supplies.
North Dakota recently shipped 50,000 surgical masks to Montana, the result of a governor-to-governor request, said Jon Ebelt, spokesman for the Montana Department of Health.
“We certainly appreciate North Dakota’s assistance, and we look forward to returning the favor one day,” he said.
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