Minnesota health officials say COVID saliva testing paid off
A popular at-home program has ended, but saliva tests are still widely used.
ST. PAUL — Minnesota health officials say they are committed to providing residents with a variety of COVID-19 testing options even as less reliable at-home tests become more common and have upended the way the pandemic is tracked.
The promise comes after the state discontinued its popular mail-order saliva testing program in March because of declining demand. Instead, Minnesotans can now order up to four free rapid tests, similar to those federal officials offered earlier this year.
Minnesota has committed more than $111 million to saliva testing and still uses it at community sites across the state. Early in the pandemic, it helped grow the state’s capacity and gave it one of the best testing rates in the Midwest.
“We have always tried to meet the moment,” said Daniel Huff, assistant health commissioner, who notes that while other options remain, rapid tests are quickly becoming the standard. “We want to meet Minnesotans where they are and the disease where it is so we can control it.”
Further upending the testing landscape, a recent change in federal rules means most schools, nursing homes, jails and other facilities that frequently screen for the coronavirus no longer are required to report negative results to the state. The change, coupled with the growing use of rapid tests that also are not reported, led the Minnesota Department of Health to stop reporting test-positivity rates altogether.
Since the pandemic began, test-positivity rates were an important and reliable metric of the size of the state’s outbreak.
Huff said the Minnesota Department of Health remains confident it can understand and track the future ebb and flow of coronavirus cases without test-positivity data. Other measures — such as the prevalence of virus genetic material in wastewater, hospital capacity, data modeling and syndromic surveillance — give a better picture of the state’s outbreak, he said.
“All scientists love data. However, in public health we want the data to be meaningful,” Huff said. “At the beginning of COVID, (test-positivity) was really important because we didn’t have other tracking mechanisms. Now we have a robust system. I would say our surveillance is better than it was in the past even with less complete testing data — because back then, we only had testing data.”
Coronavirus testing options were much different in the summer of 2020 when the state announced its initial $15 million partnership with Vault Health and Infinity BiologiX to bring the first, emergency-authorized COVID-19 saliva test to Minnesotans.
Before the saliva test, which was developed at Rutgers University, nasal swabs done by medical professionals were the norm and antigen tests were not widely available. The state used federal coronavirus aid to help with lab startup costs to process the tests locally.
By the fall of 2020, when the state-partnered saliva test processing lab opened in Oakdale, cases were on the rise and tests were increasingly difficult to find. With its partnership, Minnesota offered residents tests delivered to their front door, conducted in their homes, processed by mail and results via email within a few days.
The program proved popular, with more than 811,000 test kits ordered since it began in 2020. That’s nearly 30 percent of the more than 2.8 million COVID-19 tests performed through state-sponsored initiatives like community testing sites.
Since the pandemic began, more than 22 million COVID-19 tests have been conducted in Minnesota, the vast majority of those done by health care and other providers.
State health officials estimate the at-home saliva testing program alone cost the state about $32 million. It has officially ended, but residents who have unused, unexpired test kits can still use them.
Furthermore, Minnesota’s commitment to saliva testing goes beyond the at-home program. The state also has used the tests in schools and at community testing sites.
Over the pandemic, contracts with Vault Health and Infinity BiologiX for saliva testing grew from the initial $15 million investment to its current agreement that cannot exceed $111 million total.
Health officials are in the process of negotiating another extension to the contract first approved under the coronavirus state of emergency that would run through the end of May. Another longer agreement, done through competitive bidding, is also in the works.
Huff says the partnership has been a success, and it’s money well spent.
“I think the numbers speak for themselves,” he said. “We have the lowest death rate of any Upper Midwest state and a lot of that was the work we did before vaccines were available. Testing was a cornerstone of that strategy.”
Past questions about cost
Sorting out who would pay for coronavirus testing has been a bit of a labyrinth throughout the pandemic. Federal legislation initially required health insurers to cover the costs — up to a point — and state and federal dollars often covered the rest.
Minnesota’s contracts with Vault and Infinity BiologiX stipulate the cost of saliva testing varies from $87 to $120 per test depending on how the sample is collected. Often the testing companies billed insurance for the tests and the rest was covered by the state.
Minnesota health officials say on average, the state paid about $40 per test after insurance.
Last year, after some lawmakers and insurers questioned whether the cost per test was too high, the Office of the Legislative Auditor, a government watchdog, examined the pricing.
While the inquiry found questions from some insurers and managed care providers for how testing services were classified in bills, it concluded that no overpayments were made.
“Managed care organizations — acting on behalf of the state — scrutinized the claims submitted by Vault and (Infinity BiologiX) and paid a fraction of the amounts billed by the companies,” the legislative auditor’s report summary said.
The pandemic, now in its third year, continues to confound health officials in a lot of ways. While they know more about the virus, it still behaves in unexpected ways.
Currently, the subvariant omicron BA.2, a relative of the strain that drove cases to record levels in January, is driving up cases in Minnesota. Other variants continue to be identified.
That means testing will need to be widely available and accessible well into the future. Minnesota plans to continue to offer a variety of options for residents at community sites and at home.
“It’s not an either/or; it’s a both/and strategy,” Huff said, noting the importance of options and the roughly two dozen community sites still in operation. “We will continue those at a level that we feel is appropriate to meet the demand and the need. We don’t want to dismantle prematurely and then have another surge.”
Yet as Minnesota learns to live with the pandemic, health officials say rapid at-home tests will be increasingly useful for residents to know if they are infected so they can react and help slow the spread.
“With everything, there’s trade-offs,” Huff said. “I think at this point in the pandemic, the costs are a lot cheaper with antigen tests; they’re a lot more likely to be used because I just have it in my medicine chest and I can just grab it when I need it and there’s a greater availability throughout the state.”