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As the pandemic weeks turn into pandemic months, many questions remain about how we know what we know about COVID-19. One of the major limiting factors in testing for the virus is the availability of supplies for test kits.

As Michigan slowly moves to re-open its economy—and resume something like “normal” life—what is the state of testing in the state right now?

What’s in a test kit?

COVID-19 test kits are actually remarkably simple. They consist of three things: a nasal swab to take a viral sample; a clean, uncontaminated tube to store the swab in; and oftentimes, a liquid solution to put the swab in as it’s taken to a lab. Importantly, that must be a sterile solution, without any chemicals that interfere with the polymerase chain reaction (PCR) testing that’s used to actually process COVID-19 test samples.

Sounds pretty simple, right? But there have been huge supply chain problems, leaving the entities that conduct tests—mostly hospitals, and state and local governments—constantly scrambling for the supplies.

The obstacles

Detroit Mayor Mike Duggan has declared himself “obsessed” with COVID-19 testing. He’s been clear about his intention to test as many Detroiters as possible for the disease caused by the coronavirus. And his administration has pretty successful at actually getting testing supplies.

But they’ve also run into some significant, sometimes mind-boggling obstacles, which Duggan illuminated at a press conference earlier in May.

"We found a supplier in China who delivered us the first 5,000 [tests], and the FDA [U.S. Food and Drug Administration] embargoed it when it came into the warehouse,” Duggan said. “And I talked to Dr. [Stephen] Hahn, the head of the FDA, and they cleared it. They got the 5,000 released.

“So we ordered another 20,000. They got embargoed by the U.S. Department of Agriculture at a Romulus warehouse. But Senator Debbie Stabenow stepped in and with the federal government's help, they released the 20,000 kits. I won't tell you this is easy.”

Duggan said his procurement people are constantly “scouring the country” for more testing supplies. But Duggan has also looked for supplies closer to home.

Duggan, the former CEO of the Detroit Medical Center, is well-connected within the health care industry. So when he needed 6,000 test kits to launch drive-thru testing at the former Michigan State Fairgrounds, he turned to Dr. Roberto Romero.

Romero heads the National Institutes of Health Program for Perinatal Research and Obstetrics, which is housed in Detroit. So he does a lot of research and testing on high-risk pregnancies.

“One day I got a phone call from [Duggan], and he asked me if the perinatal research branch could help the city by providing swabs in a format that would allow collection of the samples, storage and shipment to the laboratory,” Romero said. “And what we did is pretty straightforward: repurpose Dacron swabs that I use in our prenatal clinic, and in labor and delivery, to collect samples from patients suspected to have COVID-19.”

Romero also had the tubes and sterile solution needed to transport the swabs. “In essence, we provided approximately 14,000 swabs with tubes of media, and they were prepared by volunteers working in our branch,” he said.

Romero has continued to provide some test kits for the city on an as-needed basis, but Duggan says the city looks for supplies everywhere.

“We recognized early on that the federal government was not going to take the lead in doing this,” Duggan said. “And rather than complain about it, we just went to work.”

“You have states and counties out on the open market competing against each other for these supplies.”

Oakland County Executive Dave Coulter echoes Duggan’s thoughts on the federal government’s failure to leverage its buying power, and create a pipeline to filter testing supplies down to states and local governments.

“If you looked at the pandemic playbook, it would have said that the state or the federal government would be supplying these things,” Coulter said. “But this is such a massive undertaking, and that just wasn't happening. And so we really have learned to, you know, be creative on our own and scramble on our own.”

Coulter said the scramble for testing supplies takes up a lot of time and bandwidth at Oakland County’s Emergency Operations Center, which is already going full-speed during the pandemic. And it creates a perverse type of market for the supplies.

“I think one of the sad realizations in this pandemic is that you have states and counties out on the open market competing against each other for these supplies,” Coulter said. “And then think about it, because this is a global pandemic, we’re not only just competing against Ohio and California, but we're competing against other nations. And so the supply chain issues have been very, very challenging.”

Coulter said things have been getting “incrementally better” when it comes to testing, especially as more labs to process the tests have come online. But when it comes to test kits, “We are out on the market purchasing our own supplies as we can get them.”

At the beginning, states and local governments hoped the federal government’s stockpile was going to provide them with sufficient supplies, at least for awhile.

But that hope turned out to be misplaced. And even when the federal government has stepped in with supplies, they’re sometimes not really what the state or local governments need.

For example: the state of Michigan recently received a large shipment of swabs from the federal government. But they were 100% foam swabs. And that turned out to be a problem, according to Governor Gretchen Whitmer.

“Each of these tests depend on a specific type of swab,” Whitmer said. “And so when our shipment from the federal government comes in, and it is 100% foam swabs, it means we can't execute those for all of these other tests that we have.”

So where do things stand now?

If you’re a person who wants to get tested for COVID-19 in Michigan, your chances of actually getting a test have improved a lot. Whereas in the past, tests were restricted to the highest-risk and most seriously symptomatic people, more places will now test you regardless of symptoms. In the past seven days, the state has tested an average of nearly 18,000 people per day. That’s a marked improvement since the start of the month. And fewer people are testing positive.

But that’s still far short of the 30,000 tests per day the state has set as a goal. And even that goal is short of the level of testing some public health experts say is needed to truly re-open Michigan's economy—more like 58,000 per day, according to one model.

So things are getting incrementally better. But we’re not where we need to be to start returning to anything like the pre-pandemic “normal.”