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Coronavirus testing is down in Florida. What does it mean for the state?

Testing is down across the nation, and Florida wasn't spared. Public health experts worry about the falling numbers

After a summer surge in which coronavirus infections skyrocketed, reports from state agencies in recent weeks show signs that the virus’ spread could be waning.

As new infections reported each day continue to slow this month, so do the average number of coronavirus tests being done across the state.

Public health experts can’t pinpoint exactly why this decline is happening. But they warn that limited testing goes against some of the strongest tactics used for identifying and curbing the spread of the coronavirus, along with contact tracing and quarantining.

Testing is essential as Florida students return to school and businesses continue to reopen, said Dr. Marissa Levine, a professor of public health and family medicine at the University of South Florida. Knowing where the virus is and preventing clusters of disease spread is vital, she said.

A test is administered at the drive-thru COVID-19 testing site on Wednesday, Aug. 26, 2020, at the Ruth Eckerd Hall parking lot in Clearwater. The site location, which has been open for a couple weeks, was chosen to provide closer access to residents living and working in northern and central Pinellas County, according to county leaders.
The site is supervised through a partnership between BayCare, Pinellas County, the City of Clearwater, the Florida Department of Health Pinellas County (FDOH), and Ruth Eckerd Hall.
A test is administered at the drive-thru COVID-19 testing site on Wednesday, Aug. 26, 2020, at the Ruth Eckerd Hall parking lot in Clearwater. The site location, which has been open for a couple weeks, was chosen to provide closer access to residents living and working in northern and central Pinellas County, according to county leaders. The site is supervised through a partnership between BayCare, Pinellas County, the City of Clearwater, the Florida Department of Health Pinellas County (FDOH), and Ruth Eckerd Hall. [ DOUGLAS R. CLIFFORD | Times ]

“Those to me are the critical infrastructures for managing COVID-19 in communities, and that’s where we should be putting all of our effort,” Levine said. “I’m sorry to say here we are in August of this pandemic and we’re still as a country really not where we need to be with testing.”

Testing in Florida hit a peak in mid-July when the state had a weekly average of about 100,000 tests processed a day. Now, just over a month later, that average has declined to fewer than 70,000 tests a day, a more than 30 percent dip from the peak.

Calls and emails to officials at the Florida Department of Health were not returned this week.

Florida isn’t an outlier. There has been a decline in testing this summer across the nation, according to the New York Times. It’s been especially pronounced in states that led the summer surge of coronavirus cases, including Texas and Florida, said Josh Michaud, the associate director global health policy at the Kaiser Family Foundation.

Michaud said understanding why testing has declined requires a bit of speculation. One theory is that demand from the public for testing has dropped because people were discouraged by long wait times, he said.

In June and July, Floridians reported waiting hours for swabs at drive-thru testing sites. Some waited nearly two weeks to get results back.

“In states where there’s been a large surge is where we’ve seen testing result delay and testing capacity constraint,” Michaud said.

The number of people tested at Raymond James Stadium, one of the largest state-run facilities in the Tampa Bay area, ballooned in late June with more than 1,000 tests collected a day, according to the Florida Department of Health in Hillsborough County. But in August, fewer than 400 tests were collected on some days.

A shortage in testing supplies is another barrier that many states still face, Michaud said.

A worker removes a sign for the drive-thru COVID-19 testing site at the conclusion of testing on Wednesday, Aug. 26, 2020, at the Ruth Eckerd Hall parking lot in Clearwater.
A worker removes a sign for the drive-thru COVID-19 testing site at the conclusion of testing on Wednesday, Aug. 26, 2020, at the Ruth Eckerd Hall parking lot in Clearwater. [ DOUGLAS R. CLIFFORD | Times ]

While testing materials are much easier to come by now than they were in the spring at the start of the pandemic, facilities still struggle to secure enough staff, personal protective equipment and laboratory availability to process COVID-19 tests, Michaud said.

“Given the amount of transmission that we have in this country, we need to be doing millions of tests a day in order to really get a sense of where we are,” he said. “Capacity constraints still prevent us from getting there.”

Shelter-in-place mandates from March and April were meant to curb the spread of the coronavirus while states built up their capacity to be able to test and snuff out outbreaks, he said. But in many cases, states opened too soon.

“At the national and state level, in most cases, we are definitely still hampered,” Michaud said.

The positivity rate, or the percentage of positive results among all tests processed, can be a useful indicator for understanding if there’s enough testing going on in a community, said Dr. Thomas Tsai, an assistant professor in health policy and management at the Harvard T.H. Chan School of Public Health.

The Harvard Global Health Institute initially suggested communities have a positivity rate of about 10 percent for slowing of the virus, and have a rate of 3 percent or lower for eradicating it.

But Tsai said positivity can be confusing to understand, even for experts. More types of COVID-19 tests are constantly being approved and each state tracks and compiles data differently.

“The test was never a goal in itself,” Tsai said. “You don’t get a gold star for testing a lot. You get a gold star for suppressing a number of cases.”

The strategy of how to best test continues to evolve the more experts learn about the virus, Tsai said. There has been a lot of emphasis on the sensitivity of tests, but to conduct widespread testing, it may be better to rely on less sensitive, cheaper rapid tests that return results quicker and can be used more frequently, he said. Some areas of the country still aren’t using those kinds of tests.

There also needs to be a better availability of test supplies for hot spot areas with higher demand, Tsai said.

In late August, the Centers for Disease Control and Prevention modified their coronavirus testing guidelines to say people without symptoms for the coronavirus don’t need testing, even if they’ve been exposed to a known case, according to the New York Times. Experts warned that limiting testing like this, to cut out potential asymptomatic cases, could make things worse and increase spread.

Though testing has declined, Tsai said he believes that disease transmission is in fact slowing down, and it’s not just because of fewer tests being done.

Other ways to control the spread of the pandemic without widespread testing are dramatic, and would require strict lockdown periods as seen in cities like Melbourne, Australia, and Auckland, New Zealand, the latter shut down completely after detecting just 29 coronavirus cases.

But in the U.S., the hope was always to layer testing with contact tracing and quarantine practices to control disease spread.

“That was always the goal, to get control of the wildfire so they’re not just individual fires. They’re embers which can be very quickly spotted and put out,” Tsai said. “The good and bad news is we can control this.”

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