The deliveries arrive at the lab four times a day, most in UPS trucks, some by courier, the last usually just before midnight. Each brown bag contains a sealed vial filled with saliva turned bright blue from a fluid that deactivates the coronavirus, if there is any, but preserves the nucleic acid so it can be detected. The lab is on the fourth floor of a building in what will eventually be a biotech hub. It has light sculptures in the lobby, is surrounded by farmland and construction, and is just 10 miles from downtown St. Paul, which is convenient but not nearly as important as its proximity to a United Parcel Service Inc. depot. When the lab opened in Oakdale in late October, the staff used to pile the bags onto standard rolling carts. By early November those were no longer sufficient. They began using bins, but those required them to lean in deep, again and again. By Thanksgiving, they’d switched to Gaylord boxes, with sides that easily pull down, which allowed them to more quickly unload the 900 or so samples each one holds.
That was a small adjustment among many as the velocity of the virus’s spread increased. Positivity rates, hospitalization rates, intensive care capacity, R-naught, lives lost: There are so many ways to describe the contours of the Covid-19 pandemic and measure its devastation. Every one of them was moving in the wrong direction by late autumn, first in the states around Minnesota—the Dakotas, Iowa, Wisconsin— then in Minnesota itself. That’s when the state government began an ambitious effort to encourage every resident to be tested—easily, quickly, and for free.
Minnesota isn’t the biggest state or the wealthiest. But it has a progressive governor, a budget surplus that’s allowed it to supplement federal funding and spend about $150 million on testing so far, and a well-functioning pandemic task force. It’s home to the Mayo Clinic and the University of Minnesota, one of the nation’s best public research institutions. All those advantages may explain why it’s one of the few states to implement a testing strategy that the federal government should have adopted, one that helped Hong Kong, South Korea, and Taiwan avoid the worst of the pandemic’s ruin, and that doesn’t require dramatic scientific advances or carry any potential health risks. “I love what Minnesota is doing,” says Ashish Jha, dean of the Brown University School of Public Health. “We need a lot more of that.”
Instead, every U.S. state has been on its own, says Minnesota Governor Tim Walz: “It was a catastrophic failure on the federal level.” Vaccines are coming, slowly, and limited at-home self- testing is now available. But restrictions could be lifted too soon, again, or continue to be dismissed. New, more transmissible variants of the virus will mean increased exposure and infections, and testing may have to be refined to detect these genetic changes. It’s still people vs. the virus. The virus is opportunistic—and people continue to provide it many opportunities. For much of this year, if not longer, testing will be essential. The incoming Biden administration has promised to make it a priority. And even when the pandemic subsides, the coronavirus will remain.
Not all of the tests offered in Minnesota in the last months of 2020 relied on saliva samples. But almost every one that did, no matter where in the state it was collected, arrived at this lab in Oakdale. It’s a joint venture of sorts between Minnesota and Infinity BiologiX LLC, which developed the first saliva test authorized for emergency use and runs the facility, and its partner, Vault Health Inc., which oversees the collection of the saliva.
One pallet of reagents, with 16 boxes of product—enough for 10,000 tests—seemed like a lot to Jennie Ward, the lab manager, in October. A month later, Minnesota’s positivity rate was 14% and at least 25 pallets were lined up. The lab was going through one pallet a day, then two. If it reached three it would be at its limit, which meant it would be operating every hour of every day and processing 210,000 tests weekly. Just before Thanksgiving the lab had 80 people on staff, a couple of freezers full of positive samples, and new lab coats, tags still on, hanging on a rack in a hall. By year’s end, Ward had plugged in the backup freezers, hired 20 more employees, and ordered extra lab coats. About 400,000 of the state’s 5.6 million residents had tested positive, and the Oakdale lab had processed more than 800,000 tests. “It’s worse than what I expected it to be,” Ward says of the autumn and early winter. “I expected it to be bad. But I didn’t know what bad looked like.”
Meredith Vadis had been in charge of the Twin Cities’ wastewater operations, mass transportation, and land use planning. In March she became the state’s chief operating officer for Covid testing, a role she remained in for the rest of the year. Initially, Minnesota’s focus was on testing people with symptoms of the disease and those at high risk, such as employees at food manufacturing plants with outbreaks, hospital workers, and residents and staff at long-term-care facilities. In those early times, Vadis says, the state processed fewer than 2,000 nasal swab samples a day.
On May 25, Memorial Day, a Minneapolis police officer killed George Floyd. In the weeks that followed, tens of thousands of people in Minnesota alone protested against racial injustice. The state, like others, encouraged those who’d marched and chanted to get tested. Minnesota pushed past 10,000 tests a day. But the protests didn’t accelerate the spread of the virus; the positivity rate among the demonstrators was never higher than 1.8%.
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