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Coronavirus testing in Texas and Florida has taken a nosedive since the middle of July. Epidemiologists worry that this shift means the states are flying in the dark just as their surveillance systems are urgently needed to detect any uptick in COVID-19 cases caused by school reopenings.
“I think we should be very concerned,” Angela Clendenin, an epidemiologist at Texas A&M University in College Station, told BuzzFeed News.
Ashish Jha, director of the Harvard Global Health Institute, tweeted his alarm about the situation in Texas: “Why is testing falling off a cliff? … Texas is in trouble and has to turn things around.”
Both Texas and Florida saw big surges in COVID-19 cases in June, a couple of weeks after the states reopened businesses, including bars and restaurants, and people gathered to celebrate Memorial Day weekend. After their governors reversed reopening plans, the surges peaked in each state around the middle of July.
The new problem worrying epidemiologists is that coronavirus testing has declined sharply since then. Although state-supported testing sites in Florida were closed for a few days from July 30 as Tropical Storm Isaias moved up the state’s Atlantic Coast, the main problem isn’t a lack of availability of testing sites and appointments. Rather, it seems largely to be driven by people choosing not to get tested.
The reasons for the falloff in demand are still unclear. “I don’t think anybody knows what’s going on in Texas,” Saskia Popescu, an epidemiologist at the University of Arizona, and a member of the Federation of American Scientists’ Coronavirus Task Force, told BuzzFeed News. “Which is even more concerning.”
Clendenin suspects that a number of factors are involved, including a shortage of certified lab technicians that is causing a backlog in processing, which means that results can take a week to appear.
“People are like, ‘So why am I doing this?’” Clendenin said. “There’s also a real concern that if people get tested and they’re positive, they can’t work for 10 days.”
In Texas, there is also confusion about tests labeled as “pending assignment,” which means they haven’t yet been assigned to a county. According to a report in the Austin American-Statesman on Aug. 11, more than half a million test results fell into this category at that time.
These probably represent people who found it easier to drive to another county to get tested, Clendenin said. Bureaucratic delays in assigning the test results to people’s county of residence add to the difficulty in understanding the true rate of infection in the state.
In Texas, the percentage of test results returning positive has also spiked, surging past 20% in recent days. This doesn’t necessarily mean that the number of new infections is rising — instead, it probably means that the people who are choosing to get tested are more likely to have symptoms and therefore actually be infected.
But the numbers show how far Texas and Florida are from conducting enough tests to have a good handle on the true rate of infection, and to have a reasonable chance of isolating people who are infected and stopping viral transmission. In May, the WHO recommended a 5% or lower positivity rate for two weeks before governments decide to reopen.
The fact that both states are so far from meeting this benchmark is worrying, given that schools in the states are making plans to reopen — likely creating new opportunities for viral spread. And although new cases have been trending down for a couple of weeks, they are still running at high levels, which means that spread could easily take off once more.
“If we’re having challenges adequately testing people right now, before school starts and we need to really be able to ramp up, that is a huge red flag to me,” said Popescu. Testing in her state, Arizona, has also declined — although not to the extent that it has in Texas and Florida.
“I think we’re all very much in the dark and quite confused about where the testing challenges are coming from and where the information gaps are coming from,” Popescu said. “From a hospital response level, knowing what’s going on in the community is incredibly important for us. It’s definitely dropped to a number that’s been quite concerning.”
Decisions on reopening lie with individual school districts, taking advice from health authorities. But in both Texas and Florida, there is political pressure on officials to get children back into classrooms. In Texas, Gov. Greg Abbott announced on July 31 that local health authorities “do not have the power to issue preemptive, blanket closures of schools.”
Meanwhile, Florida Gov. Ron DeSantis’s administration has rejected a plan from Hillsborough County, home to the state’s third-largest district, to hold online-only classes for its students for the first four weeks of its fall semester, Politico reported on Aug. 10.
As schools reopen, epidemiologists are concerned that the declines in testing will deprive health officials of any early warning of spikes in cases. “We’re all just kind of watching and waiting,” Popescu said. “There is a lot of concern that it will result in cases.”