A company hired to ramp up Iowa’s capacity to test for novel coronavirus has been sending messages to sick Iowans that could discourage them from seeking a COVID-19 test.

Some people who reported respiratory symptoms when completing the Test Iowa online assessment, but did not qualify for an appointment at a drive-through site, received a message warning that COVID-19 testing “is quite invasive and uncomfortable” and that tests should be reserved “for those who need it the most.”

Neither Nomi Health nor state officials have clarified whether the Iowa Department of Public Health helped write or approved the wording.

Democratic State Representative Lindsay James flagged the problematic messages on May 7, tweeting,

https://t.co/X3XQFXsHi0 and @IAGovernor is ACTIVELY DISCOURAGING TESTING!! ?

See screen shot of the email sent after screening positive for one or more COVID symptoms. pic.twitter.com/aROkHpRK3k

— Lindsay James (@Lindsay4Iowa) May 8, 2020

Bleeding Heartland independently confirmed that Nomi Health, which is handling the assessment and testing portion of the Test Iowa program under a $26 million state contract, has sent the same cautionary statement to other Iowans who feel ill but don’t meet the state’s current testing criteria. I’ve enclosed screen shots showing the whole message at the end of this post. Here is the key portion:

The video linked to illustrate the “invasive and uncomfortable” testing process is here.

Governor Kim Reynolds has frequently touted and sometimes exaggerated Iowa’s COVID-19 testing capacity, saying the online assessments completed and additional tests provided through the Test Iowa initiative will allow health officials to “really drill down and look at the virus activity” at the county or community level.

Nomi Health is under contract to conduct 3,000 COVID-19 tests daily in Iowa but has not met that benchmark. The State Hygienic Lab has not yet validated the equipment provided by the Utah-based company.

Iowa’s current policy does not call for testing everyone with symptoms suggestive of coronavirus. Those who are not hospitalized, over age 60 with underlying conditions, living in a congregate setting, or part of the essential workforce are unlikely to qualify for a test.

However, an effective containment program would involve testing a much larger number of potential carriers.

After reading the message some Iowans have received from Nomi Health, Dr. Eli Perencevich, an infectious disease specialist and epidemiologist at the University of Iowa’s Carver College of Medicine, provided this comment to Bleeding Heartland.

Any discouragement of testing or restricted access to testing will undercount infections and impede contact tracing. Without widespread access to testing and contact tracing of as many infected or exposed Iowans as possible, we won’t be able to safely contain the spread of COVID-19 as we open up the state.

I sought clarification from the governor’s office and the Iowa Department of Public Health on whether they signed off on wording that could dissuade Iowans with symptoms from pursuing a COVID-19 test through a health care provider.

Staff for Reynolds did not respond to repeated inquiries. Amy McCoy, a spokesperson for the state’s public health agency, did not directly answer the questions but said in a May 11 email, “this messaging continues to be updated to make it more user friendly, so you can continue to check back.”

Nomi Health provided this statement on the evening of May 11.

“TestIowa is part of the State’s response to COVID-19. Nomi Health’s role is to provide FDA-approved tests and accompanying supplies and hardware, a HIPAA compliant workflow technology platform, and support to the state of Iowa. Nomi Health does not provide recommendations on who should or shouldn’t be tested. The responses delivered to those who complete the online TestIowa assessment are determined by guidelines from the Department of Health. Those guidelines also prioritize who is recommended for testing based on the assessment. For any other details, please reach out to the communications office of Governor Reynolds.

I wasn’t asking about the algorithm that determined which individuals qualified for a drive-through test. It’s clear that the State Hygienic Laboratory and Iowa Department of Public Health set that policy.

I was trying to understand who wrote and who green-lighted the description of the nasal swab procedure as “quite invasive and uncomfortable” as well as the statement, “It is important that testing be used for those who need it the most.”

State Medical Director Dr. Caitlin Pedati said in March that most Iowans won’t need to be tested, since 80 percent of those who contract coronavirus will be asymptomatic or only mildly ill. But that is different from describing a test in terms that could put off someone with symptoms from seeking a diagnosis.

Staff for Nomi Health have not replied to follow-up questions. I will update this post as needed.

UPDATE: Dr. Rossana Rosa, an infectious disease specialist for UnityPoint in Des Moines, noted that federal guidance for using the type of COVID-19 tests in Iowa’s program states that the kits can be used with oropharyngeal swabs (reaching the back of the throat) as well as nasopharyngeal swabs (reaching through the nose, as depicted in the video). Rosa added, “someone [with] expertise would know these things.”
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Appendix: Screenshots of message received by an Iowan with symptoms who had completed the Test Iowa online assessment. (This person was later able to get tested for COVID-19 through another provider.)