As the coronavirus marches from America’s coastal cities to its heartland, testing gaps in the South and Midwest are crippling efforts to contain emerging hot spots in smaller cities and rural areas.
Georgia, Michigan and Oklahoma are among the states where coronavirus outbreaks are intensifying — and where per capita testing rates are some of the lowest in the nation. While hard-hit New York was testing more than 950 for every 100,000 people as of Monday, Georgia was testing only 127 and Oklahoma 43. That raises the likelihood that these states are severely underestimating the size of their outbreaks.
The testing blindspots not only make it harder to slow the spread of disease, health officials say, but to know when it’s safe to ease social distancing measures.
The gaps have persisted even as the United States has made huge leaps overall in testing capacity, after a series of early failures. The country’s labs have analyzed more than 1 million tests and are now processing at least 100,000 samples each day. The Food and Drug Administration recently authorized the first high-volume tests and the first rapid tests, which deliver results in minutes instead of hours.
But those advances haven’t trickled down to Oklahoma, where a lack of basic testing supplies has hampered the coronavirus response, says Shelly Zumwalt, chief innovation officer for the state’s Office of Management and Enterprise Services.
After struggling to obtain critical testing materials from the federal government, Oklahoma recently bought supplies to test 10,000 people on the private market. State officials are worried that without adequate testing, the disease will spread stealthily into rural areas and overwhelm communities with a shortage of doctors and access to care.
There are already signs of rapidly expanding outbreaks in some parts of the state, which reported its first case of coronavirus in early March. Over the past five days, the number of confirmed infections more than doubled to 565 on Tuesday.
“Hopefully this week and into early next week, we will have a much better idea of what the population looks like as far as where the hot spots are,” Zumwalt told POLITICO. Oklahoma State University’s lab — which can process about 2,300 tests a day — will soon start testing patient samples from across the state.
Michigan, which opened its first drive-through testing site this week in the emerging hot spot of Detroit, saw its confirmed case count jump by 1,000 on Monday, and then again on Tuesday. The state ranks third nationally in deaths, with 259, but its per capita testing rate is less than one-third that of New York’s.
Former acting CMS chief Andy Slavitt worries that undercounting coronavirus cases is lulling some states into a false sense of security that is enabling the virus to spread farther and faster.
“There’s a perfect storm I worry about in certain states where their commonality is that they have low testing and low social distancing guidelines,” Slavitt told POLITICO. Oklahoma, for example, has put in place limited “stay at home” guidelines that apply to the elderly and those with underlying medical conditions, not to the general public.
Individual states’ testing struggles also mask the actual size of the national coronavirus outbreak, says Mike Carome, director of the health research group at the advocacy organization Public Citizen. “The failure to do testing in some states is giving us an underrepresentation of the scope of the pandemic,” he said.
Texas, which has a per capita testing rate of just 124 people for every 100,000, ran out of coronavirus tests Tuesday after processing its last 40 tests at state public health labs. Any further testing of Texas residents must be done by commercial firms unless public labs get more testing materials, said Tom Banning, CEO at the Texas Academy of Family Physicians.
“Honestly, I think we need a point-of-care test that we can stand up at health clinics or retail establishments like drug stores,” Banning said.
The FDA recently authorized the use of rapid coronavirus tests from Cepheid, Abbott and other diagnostic manufacturers, but it will take time to roll them out, said Jeff Engel, former executive director of the Council of State and Territorial Epidemiologists.
The rapid tests can be administered in doctors’ offices, with results delivered before a patient goes home — much like more familiar tests for flu or strep throat. But that convenience comes with its own trade-offs.
“Physicians are really notoriously very poor reporters” of test results, Engel said. Point-of-care tests “are good for the clinical side, but they are going to displace laboratory based tests and public health surveillance is likely going to lag.”
In the meantime, the commercial labs that are conducting the bulk of U.S. coronavirus tests also need more supplies — including swabs, protective equipment and the diagnostic machines required to conduct high-volume testing — according to the American Clinical Laboratory Association.
The demand for testing will only grow as the pandemic proceeds, according to an analysis released this week by the American Enterprise Institute. Once the number of cases in the United States begin to fall, health officials will need to conduct at least 750,000 tests per week to understand when and how they can safely relax social distancing measures, finds the AEI white paper, authored by former FDA Commissioners Scott Gottlieb and Mark McClellan and other health researchers.
With point-of-care tests now coming on to the market, the country appears on track to hit that 750,000-test goal, Gottlieb told POLITICO. But he warned that it is too soon to back away from social distancing measures.
“The virus will be a national epidemic,” Gottlieb tweeted Monday. “While we hope some communities will be spared, we should expect urban centers to all be engulfed. Because the virus hasn't reached every city yet; every urban center should prepare as if it will. Many still aren't.”
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