The content below is a Des Moines Register analysis that includes my comments about the need for widespread, quick testing for the virus that causes COVID-19. The Register’s post, which includes live links to included graphics and social media, is here.
Register analysis: Iowa lags most states in COVID-19 tests per capita
Nick Coltrain, Des Moines Register
April 11, 2020
Iowa’s COVID-19 testing on a per-capita basis lags behind most other states, according to a Register analysis of public testing data.
As of Friday afternoon, Iowa reported 15,953 total test results for COVID-19, the respiratory disease caused by the new coronavirus. That equals about 524 tests per 100,000 Iowans — or No. 39 on the rankings of all 50 states and Washington, D.C.
Thirteen states and Washington, D.C., have reported more than double the tests per capita that Iowa has, according to the analysis. The average tests per capita across all 50 states and the capital is 832, or over 300 more people per 100,000 population higher than where Iowa was as of Friday.
The Register used census population estimates, reports from the Iowa Department of Public Health and testing totals in other states compiled by aggregator CovidTracking.com, which tracks reports of testing from state public health departments and media. It does not account for people who may have been tested multiple times. Different states also report testing in different ways and at different times.
The shortage of testing has been no secret, even as Iowa officials try to moderate expectations about what a more aggressive regime would show. There simply aren’t enough testing supplies being manufactured globally to meet the surge in demand, Amy McCoy, a policy adviser for IDPH, wrote in an email.
That leads to fluctuating numbers of available tests in the state as supplies are used and more become available. For example, on Wednesday the state hygienic lab had the testing capacity for more than 1,300 Iowans; that almost doubled on Thursday to more than 2,500.
The limited supplies prompted IDPH to issue guidance about who should be tested.
“Some of the projections (about the spread of coronavirus) will be difficult to make because we have had a limited number of tests and a limited (amount) of testing capacity,” Iowa Department of Public Health Deputy Director Sarah Reisetter said at a news conference Wednesday. “That is something that we continue to work on every single day in terms of trying to increase testing capacity in the state.”
Reisetter has also said that a positive COVID-19 test doesn’t necessarily do much in terms of determining treatment for most people who fall ill with the disease. The majority of people struck by it don’t require hospitalization. With or without a positive test for COVID-19, those exhibiting symptoms would be told to stay home and isolate for at least a week after they first fall ill and three days after their symptoms resolve.
Gov. Kim Reynolds said she has requested additional testing kits and supplies, as well as quick-testing machines, from the Federal Emergency Management Agency. The state received several of the “Abbott machines,” quick-turn, portable tests for COVID-19. Reynolds said Thursday their use will be targeted, such as for long-term care facilities that have seen outbreaks of the potentially deadly virus among some of Iowa’s most vulnerable residents.
Coronavirus tests over time
Here’s how many coronavirus test results the state has released each day since it started providing that information in late March.
(Link to interactive chart here.)
Current guidance from IDPH allows for COVID-19 testing for all hospitalized patients; adults older than 60 who show symptoms of the disease and have a chronic medical condition; people of any age with symptoms who live in congregate settings, such as long-term-care facilities and prisons; and health care workers, first responders and residential facility staff who show symptoms.
Without widespread testing, epidemiologists and doctors estimate the number of COVID-19 cases in Iowa might be up to 10 times the number of positive tests in the state — that would be 11,000 Iowans with the disease who don’t know for sure, potentially spreading the highly contagious virus.
“We recognize that testing limitations have affected some of our understanding and awareness of who has been infected with this virus, especially among those who are mildly ill,” McCoy wrote in an email.
Meanwhile, the state is pursuing more resources for testing supplies, but cautions that the science of what the test results mean needs to be better understood, including how long a person with a positive test might be immune.
Dr. Daniel Diekema, director of the division of infectious diseases at the University of Iowa, said the state’s testing capabilities have improved weekly, even if they’re not ideal. In situations like the current shortages, his view largely matches that of the IDPH: Prioritize testing for individuals where test results will have the greatest effect on either the patient’s care or the greater public health, and if someone is sick but without the need for hospitalization, “let’s assume you have COVID and you behave accordingly.”
“When you have a large group of people that are likely infected, and you’re not identifying them with a test, and when you add to that individuals can transmit COVID when they have very few symptoms or no symptoms, then the best approach is to say we have to behave as if every person in our state could be at risk for transmitting COVID to every other person,” Diekema said. “And that means pretty extreme approaches to social distancing” and other mitigation strategies.
However, that situation also presents a Catch-22 of sorts, Diekema said: If the state is not testing as many people as others, then it’s also not reporting as many cases. And there’s the rub: If Iowa is not reporting as many cases of COVID-19, then the federal government is less likely to allocate tests to the state in the short term because it can’t demonstrate the need.
Iowa was No. 35 in reported cases per capita on Friday afternoon, with 45.55 positive tests per 100,000 Iowans. Minnesota had the fewest, with 23.42 per 100,000, even as it reported over 150 more tests per 100,000 residents.
Diekema said the key time for widespread testing would have been in late January or early February, soon after COVID-19 was found in the United States. He pointed to South Korea’s aggressive, widespread testing and mitigation measures as a model response. Early detection and containment — not just for the individual, but also for people who came into contact with the individual in the days leading up to their showing COVID-19 symptoms — is key to preventing widespread infection, he said.
Widespread testing at this point in the pandemic “isn’t a panacea; it wouldn’t keep us from having to take the measures we’re taking now,” Diekema said, but it also isn’t too little, too late. It could still shed light on statewide or regional mitigation efforts, and on individual treatment.
“That confirmation that the test is positive is a little bit more enforceable to the patient,” Diekema said. “There’s no uncertainty, you have it, and so they’re more likely then to adhere to the public health recommendation.”
Early in the spread of the pandemic into the country’s heartland, Dr. David Carlyle, a family physician in Ames, circumvented guidelines for testing at the state laboratory and sent samples to a national lab. The patient didn’t meet the criteria from IDPH, but Carlyle felt compelled to know for sure if COVID-19 had made its way to Story County. The test was positive.
Armed with that knowledge, he could tell the patient to call everyone the person had associated within the three days before reporting symptoms and tell them to self-quarantine — and, he hoped, stifle the spread there.
“That’s what the testing does — it tells you who to quarantine,” Carlyle said. “I really believe in contact tracing.”
Confirmed cases of coronavirus in Iowa
The size of the dot represents the number of confirmed cases.
(Link to interactive chart here.)
Asked about contact tracing in Iowa and specifically how it pertains to people who likely have the coronavirus but are untested, Reisetter said Iowans should assume the virus is spreading in their communities. People should leave their homes only for essential trips, such as to get groceries or go to the pharmacy, she said. If someone feels ill, regardless of testing, they should self-isolate themselves and other members of their household.
McCoy said state guidance on contact tracing is typically centered on health care environments, family spread and workforce exposure.
The limited tests and strict guidelines at the state level have affected the national labs that Carlyle turned to initially. They’re being flooded with requests, he said. Another patient of his waited 12-plus days for a result. When Carlyle called to complain about the delay, the lab told him it could be up to two weeks for a sample to be tested — or roughly the period when someone could show symptoms after being exposed, according to the U.S. Centers for Disease Control and Prevention.
“To do the test and not get the results, it’s a question of: What good is it what it tells you when you get it back so late?” Carlyle said.
He added that everyone in the field is “working their tails off,” and that there aren’t enough supplies to go around, such as reagents necessary for the tests. Told that Iowa’s rank in national tests was in the bottom half, Carlyle was disappointed.
“It indicates you’re below the mean,” he said. “If you can be the mean, that’s one thing. But more testing is better. That’s what I believe.”
Nick Coltrain is a politics and data reporter for the Register.