Why Virginia Was So Slow to Ramp up Testing

Karen Remley. Photo credit: Richmond Times-Dispatch

by James A. Bacon

A record 15,000 COVID-19 test results were reported to the Virginia Department of Health yesterday, but until then the Old Dominion’s track record for testing the virus was just about the worst in the country. As contributor Jim Sherlock noted recently, even Guam performed more tests on a per-capita basis than Virginia. While a number of media outlets have noted the state’s poor performance, the Virginia Mercury is one of the few to ask why and digger deeper for answers.

While the Northam administration was complaining of how difficult it was to acquire testing materials, commercial labs were saying they had significant excess capacity. The Mercury quotes Karen Remley, a former health commissioner and co-director of Governor Ralph Northam’s testing task force, as saying that the labs did not have capacity at the time the state needed it most. “Those labs were not available to test,” she said. “Four or five weeks ago, everybody was struggling to bring up their laboratories.”

But Bill Miller, CEO of Genetworx, a diagnostic lab in Glen Allen, tells the Mercury a different story:

He approached the Virginia Department of Health in late March with the possibility of taking on some of the state’s testing. A molecular diagnostic center, Genetwork received FDA approval for its COVID-19 test on March 23 and quickly segued to testing patients at Canterbury Rehabilitation and Healthcare in Henrico, a hard-hit nursing home with one of the deadliest coronavirus outbreaks in the United States.

Over the past month, Miller said he’s taken on more cases for Hanover and Henrico counties, as well as the Virginia Department of Corrections. Genetworx has performed testing for other states, including Florida, Massachusetts, and Tennessee. But VDH didn’t take him up on the offer, Miller said.

“We’ve talked to the state,” he added. “We’ve given them our numbers. We could be running a number of tests for them, but we haven’t been assigned, ‘Here’s 10,000 samples per day.’”

In mid-March state officials did form an ad hoc group with physicians and hospitals to discuss COVID-19. While the group discussed the testing issue in phone calls and meetings multiple times a week, Michael Keatts, a regional emergency coordinator with VDH’s Office of Emergency Preparedness, said members were not working towards a specific objective. “A lot of those calls were more information sharing.”

The administration’s efforts gained more focus after April 20, when the Governor announced the formation of a testing task force headed by Remley and state epidemiologist Lilian Peake. A few days later, Northam set a concrete goal of testing 10,000 Virginians a day.

Bacon’s bottom line: As today’s data dump indicates, COVID-19 testing in Virginia has surged — or at least, the test results reported to VDH and available for guiding public policy have surged. There is little doubt now that the administration will be able to meet its goal of testing 10,000 Virginians daily.

Now we can move on to new questions. What does the hodge-podge of testing results, gathered from state labs, hospital labs, and commercial labs using different technologies and different protocols, tell us? Can we make sound judgments regarding the trajectory of the epidemic, knowing that the number of tests, though larger than in the past, still represents only a fraction of the number of people contracting the virus?

While we’re at it, we can ask where that 10,000 number comes from. A lot rides on that number. The Governor won’t relax the emergency shutdown until the testing consistently reaches that level. If his task force is still a work in progress, one can’t help but suspect that the number is totally arbitrary — a figure picked to sound substantive but lacking scientific backing.

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29 responses to “Why Virginia Was So Slow to Ramp up Testing

  1. So, the Northam Administration is just going to fall back on its favorite rhetorical strategy of lying to explain the delay in getting the testing regime to an acceptable level?

    “Over the past month, Miller said he’s taken on more cases for Hanover and Henrico counties, as well as the Virginia Department of Corrections. Genetworx has performed testing for other states, including Florida, Massachusetts, and Tennessee. But VDH didn’t take him up on the offer, Miller said.”

  2. Why does VDH report almost 1,000 more positive cases hospitalized than the VHHA? Today’s VDH dashboard eliminated several categories, including outbreaks and results by health district. No reason given for the change.

    • I think the answer to your question is this: The VDH reports total hospitalizations…. everyone who has been admitted to a hospital. The VHHA publishes CURRENT hospitalizations, adjusting for the fact that some patients have died and some have been discharged.

    • The VDH reports page opens to their dashboard. There’s a new set of boxes you have to click to get demographics, locality and outbreak details, just above the title.

      There’s also a new weekly subscription for COVID-19 Data Insights.
      I commented on their UVA COVID-19 Model below. I have to figure how to change my Firefox security to get the second dashboard on COVID-19 LIKE ILLNESS.

      You can subscribe at the bottom of this page:
      https://www.vdh.virginia.gov/coronavirus/covid-19-data-insights/

  3. If the Northam Administration had done more testing, could they have used the UVA COVID-19 Model Explorer launched today? It proclaims: “The model estimates that the community mitigation strategies put in place in Virginia have prevented 94,089 confirmed cases in the Virginia so far. It estimates they will prevent 993,835 confirmed cases by June 10.”

    Wow~ nice job, except, I looked at Mathews County where we officially have 4 cases and according to the local talk, 9 or 10, and the numbers make no sense at all.
    Scenario………………..Confirmed Cases by Today
    Pause – June 10 ……….2
    Pause – April 30 ………9
    Slow – June 10 ………..41
    Slow -April 30 …………40
    Unmitigated…………..129

    The model also has columns for avoided so far, confirmed cases by Jun 14, and confirmed cases avoided by Jun 14.

    If a model can’t recognize a total of 4 cases, how is it going to forecast anything for an entire state.

    I wonder how much Virginia is “contributing” to the cost of developing this model?

    https://www.vdh.virginia.gov/coronavirus/covid-19-data-insights/?utm_source=mailpoet&utm_medium=email&utm_campaign=covid-19-data-insights-launch_4

    • Carol Buva reports that UVA now says:

      “If the Northam Administration had done more testing, could they have used the UVA COVID-19 Model Explorer launched today? It proclaims: “The model estimates that the community mitigation strategies put in place in Virginia have prevented 94,089 confirmed cases in the Virginia so far. It estimates they will prevent 993,835 confirmed cases by June 10.”

      There is no a chance in living hell that UVA’s modeling can predict the number of deaths in Virgnia saved by Northam Administration, with any accuracy, much less useful or reliable accuracy, much less project it far into future down to the last decimal point claimed. This is pure fiction disguised as science to achieve a corrupt political agenda. How much is the State, and/or any other source, paying UVa. for the this political propaganda dressed up as serous science?

  4. I still think our expectations for the reporting exceed the reality of the actual system’s abilities.

    It’s a diverse state-wide system with lots of different entities feeding data and it really should be not that much shock about inconsistencies. I also doubt seriously that the same kind of test is being used uniformly and each one of those tests has different error characteristics.

    Things that I would think that are also important would be how many asymptomatic that were tested positive AND also how many were found as a result of contact tracing…. and the average number of contacts tested and how many on average that tested positive.

    The number of contacts tested would help explain why the 10,000 number was lower (or higher) than estimated…

    Ther are LOTS of “moving parts” here… it’s just not a neat and tidy thing.

  5. Larry, I think you’re totally off base on this. Contacts were and are not tested unless they meet VDH priority criteria which essentially rules out asymptomatic individuals in the general population, unless they manage to arrange testing on their own. The deck has been stacked since day 1. VDH still says they’re not reporting all negative tests. Why? Maybe because it would change the percentage of positive results downward.

    10,000 seems to be like a lot of other state decisions–arbitrary and without meaning.

    • Carol – with 10,000 tests a day, and they’re NOT contact tracing?

      and they’re not testing asumptomatic?

      So WHO are they testing beyond the health care workers?

      Do we have any idea?

      Yes, the 10,000 is likely an arbitrary number… agree… but it’s just a placeholder as they gain experience and knowledge and figure out what that number might ought to be.

      I would not be shocked that the “arbitrary” argument could be made with regard to other states testing – as well as some of the public health experts themselves for a national level.

      There’s been a LOT of questions about how many tests… Trump himself questions 330 million but that’s a number for testing everyone once.

      Trump and Pence are tested many times… over and over… and that’s also what you might expect for most workers in a company’s workforce.

      One infected person at a Walmart – tested once initially – could then later get infected and spread it throughout that store if there is no more testing.

      • I didn’t say they’re not doing contact tracing, I said VDH doesn’t test contacts if they’re asymptomatic.

        Guidelines are the same as when posted 4-17:
        1. Healthcare worker or first responder with COVID-19 symptoms*
        2. Person hospitalized with COVID-19 symptoms*
        3. Person with COVID-19 symptoms* AND who resides or works or is about to be admitted into a congregate setting (e.g., homeless shelter, assisted living facility, group home, prison, detention center, jail, or nursing home).
        4. Person with COVID-19 symptoms* AND underlying condition that increases the risk of severe COVID-19 (e.g., aged 65 years or older, person with chronic heart or lung disorder, diabetes, or on dialysis, etc.). Until more information is available, VDH is including pregnant women in this category.
        5. Un- or underinsured person with COVID-19 symptoms*
        6. Newborn of mother diagnosed with COVID-19 at time of delivery
        7. Potential cluster of unknown respiratory illness, with priority for healthcare facility outbreaks.**
        All suspected clusters or outbreaks should be reported to the local health department immediately.

        CDC Priority 1:
        Hospitalized patients
        Symptomatic healthcare workers
        Priority 2:
        Patients in long-term care facilities with symptoms
        Patients 65 years of age and older with symptoms
        Patients with underlying conditions with symptoms
        First responders with symptoms
        PRIORITY 3: As resources allow, test individuals in the surrounding community of rapidly increasing hospital cases to decrease community spread, and ensure health of essential workers

        Critical infrastructure workers with symptoms
        Individuals who do not meet any of the above categories with symptoms
        Health care workers and first responders
        Individuals with mild symptoms in communities experiencing high COVID-19 hospitalizations

        NON-PRIORITY: Individuals without symptoms.

    • If VDH is not reporting all negative results, that makes the Governor’s criteria of a 14-day increase in positive results meaningless. I would say that using only the official criteria also makes it meaningless. To be credible, the testing should be random.

    • I tend to think the testing issue is more in the weeds stuff for a lot of people. They hear the words “testing” and “need to do a lot of it”… and even “contact tracing” but beyond that most don’t even consider a regime or a criteria to who would get tested or why beyond those who have symptoms.

      Even Trump who apparently gets tested fairly frequently espresses skepticism that we’d test all 330 people – much less multiple times.

      I’m not advocating testing all 330 but as pointed out in this thread,one guy gets tested 4 times… and it’s ought not be so surprising that health care workers, first responders, nursing homes, even folks who work at things like meat packing plants and restaurants might need to have regular testing to insure that that people in congregated settings have not had someone in their group get infected and not be detected until they have infected many others.

      The testing thing is such a conundrum that some folks consider it not achievable and just default to a ” the healthy will get infected and survive and the elderly and folks with health conditions go hide under the bed”.

      In Virginia, once again, compare and contrast what Virginia is doing compared to most other states rather than looking at Virginia in isolation and judging it based on individual opinions or with respect to partisan folks and groups who really are not interested in testing just things to blame on government and institutions they have been opposed to all along.

      That’s part of the problem – How do we fairly assign criticism and blame objectively versus the “anti” boo-bird types that have been with us before the pandemic and now just see the pandemic as more opportunity to continue their partisan and ideological attacks.

      In my mind, the folks who have credibility are NOT the ones who have been attacking all along and just adjust tactics to coincide with the current circumstances.

      Finally, anyone who is expecting perfection or flawless performance from the govt is living in La La land from the get go – Government is people and people vary in their abilities – even heads of agencies and elected leaders. One of the legitimate hits on Northam and administration and agencies is that they do not have PR savvy… They have no clue how to present their efforts to the general public in a simple and understandable way so they do come across as bumbling sometimes.

      The fact that they have now started contact tracing is a good example. Just how many states out of 50 have started contact tracing? My bet is not more than a handful… and Virginia has now joined that group – but that don’t stop the critics…nope.

  6. Virginia’s health commissioner just explained all in the Guv’s briefing. Before, if Joe went to his doc for a test, and it was positive, then went to the hospital for another test, which was positive, then was tested before discharge and found to be negative, then moved to a nursing home and tested again and was found negative – under the old rules Joe was counted as one test. Now that is counted as four tests.

    The implication was THIS is why Virginia had fewer tests, it wasn’t counting all three or four of Joe’s tests. Well, that makes me feel better….

    Not making it up, you can find it later on the recording….

    • ehh…. if four different labs did those four tests…..on different days?

      and is this is how other states are or are not counting “tests”?

      I’m sure different folks will put different spins on this depending on their agenda – but I think this demonstrates how easy it is for someone to look at data and assume some things – that are not necessarily the facts.

      I still do not see any testing of asymptomatic nor contact tracing – which ought to be part and parcel of any efforts to reduce restrictions.

      Without doing that, we have no idea of what he impacts will be of reducing restrictions until days/weeks after we’ve done that and then
      what we’d do if it turned out we loosened restrictions more than we had capacity to handle?

      People can have this idea of “opening up” but what does it really mean when you get down to the nitty gritty on a business by business basis?

      If a restaurant starts seating people – without testing – it can easily become another vector for infecting both staff and customers.

      And if we’re not testing – we don’t know until dozens, hundreds became infected…

      The idea that we’re going to open up K-12 schools, higher Ed, spectator sports, DMVs, is a pipe dream and it’s not the govt that is going to be the holdup – hardly anyone in their right mind is going to go to something like a spectator sport stadium anytime soon.

      There is no “back to normal” – it’s a mirage for those who won’t face the realities.

    • So, we run 2,000 tests. 20% test positive. That’s still 2,000 tests. 150 are admitted to the hospital. 150 are discharged from the hospital. 50 go to nursing homes. That’s 2,350 tests counting each test individually. The inflator is 17.5%.

      First you’d have to believe that Virginia was sophisticated enough to not count the admission test because it was already counted wherever the first test was run. Then, not count the discharge test. Then, not count the nursing home test. As opposed to tallying the number of test results received from labs.

      So, suspending your disbelief by believing Virginia has sophisticated case management technique you would inflate the testing numbers by 10% – 20% given the low percentage of positives and the low rate of hospital admissions. Unfortunately, Rhode Island was testing at 500% of our per capita rate not 10 – 20% more.

      Even if you accept that we were counting incorrectly that might lead you to think we sucked somewhat less than previously thought but still sucked.

      And, even if you do accept the multi-test excuse it took 7 weeks to figure that out?

    • Geeze.. given what Carol “found” by actually going to the video – looks
      like big changes are happening with regard to testing and contact tracing.

      I know I was too lazy to go looking… so give Carol credit… and unless there was some way to cut/paste all those testing criteria…she must have hand-copied them!

      It’s a bit odd for that stuff to be buried like that when Northam and VDH have been taking so much heat over their “lack” of testing. Instead of shouting from the mountaintop – they’re, not exactly doing that. Or perhaps there really was not much heat except for folks who didn’t like Northam and VDH to start with and were just flinging whatever criticism that might stick.

      So, now they have made stealth-like changes that has even tripped them up on their FAQs… DJ would characterize it as more “bumbling”.

      Also interesting – Cuomo says they will need a veritable “army” to do contact-tracing…. I realize that NYC is as big as Virginia population-wise so where is our contact-tracing “army”?

      Heckfire, we got all these people that are unemployed including medical, you’d think this could be a win-win.

    • Why should Mr. Oliver not be removed from office immediately? Did the citizens of Virginia have no remedy at all to enforce his removal? See comments below:

      “However, Health Commissioner Oliver seems to have missed that we’re in Phase 2. He said at 12:31 on the same YouTube video, “As you’re well aware, one of the metrics that we’re looking at to judge when we’re ready to move into Phase 1 of Forward Virginia is the percent of positive tests to total tests. We were previously counting people who were tested, and not tests which makes it not possible to really calculate that well in terms of proportion of tests. So that’s what that represents.”

      This makes no sense to me when VDH has said all along and still says “all negative results may not be represented due to the large number of fax reports from new labs testing for COVID-19.” And we’re supposed to believe they actually tracked multiple tests back to one person? So what test did they count?

      It feels a bit like listening to Abbott and Costello.

      Why Virginia Was So Slow to Ramp up Testing
      View Post
      2525 approved comments11 pending comment

      2020/05/01 at 7:27 pm
      Steve Haner
      Virginia’s health commissioner just explained all in the Guv’s briefing. Before, if Joe went to his doc for a test, and it was positive, then went to the hospital for another test, which was positive, then was tested before discharge and found to be negative, then moved to a nursing home and tested again and was found negative – under the old rules Joe was counted as one test. Now that is counted as four tests.

      The implication was THIS is why Virginia had fewer tests, it wasn’t counting all three or four of Joe’s tests. Well, that makes me feel better….

      Not making it up, you can find it later on the recording….

  7. Virginia slow? I thought the two words were synonymous.

    I developed my calm demeanor because of years of driving in Virginia. If you’re tooling along and run up on someone going slow, don’t get worked up. Relax, and in a couple of seconds, they’ll move to the left lane.

    • That is a highly informative article indeed, especially as to how it displays the competence of state governance in Germany. What took my be total surprise was the relative youth of German patience, far different from what I have read as to patients in this country. What possible could account for this, other than the relative health of the two populations, given vastly different lifestyles among groups of citizens.

      • Editing and typo corrections:

        This is a highly informative article, especially as to how it displays the competence of state governance in Germany. What took me by total surprise was the relative youth of German patients, far different from what I have read as to patients in this country. What possibly could account for this difference, other than the relative health of the various groups within populations, given vastly different life styles in America as opposed to Germany.

    • “Emily Haber, the German ambassador to the United States, waved away any notion of German exceptionalism amid the pandemic. “We can’t state there is a specific German template,” she said during an online briefing call last week with reporters organized by the Meridian International Center in Washington.

      Haber pointed to a number of key factors that gave Germany an advantage in its preparations: the widespread mass testing program; a relatively young population that made up the initial bulk of covid-19 cases and mostly survived; and the benefit of time to expand intensive care facilities and build up stockpiles of medical equipment.

      “We were able to prepare because we were not the first country in Europe affected, and we saw and could analyze developments elsewhere,” Haber said, adding that the “well-oiled machinery” of the country’s universal health-care system and effective coordination between the federal government and local and state agencies helped.”

  8. Testing is the opiate of the masses.

  9. no contact tracing? what then?

  10. Steve Haner, thanks for the comment. I had to go listen. So sharing what I heard:
    During today’s press conference, Dr. Karen Remley, the former State Health Commissioner picked to lead the COVID-19 working group last week, reviewed the CDC priorities and showed a slide which shows some changes from those previously posted by VDH:
    HIGH PRIORITY
    Hospitalized patients.
    Workers in healthcare facilities and congregate settings and first responders WITH symptoms.
    Residents in long term care facilities or other congregate living settings WITH symptoms.
    People identified through public health cluster and contact investigations.

    PRIORITY
    Persons WITH symptoms of potential COVID-19 infection as defined by CDC.
    Persons WITHOUT symptoms who are prioritized by health departments or clinicians.

    She said, “We’re encouraging our clinicians across the state to test anybody who’s symptomatic or if a healthcare provider deems it appropriate to test someone who might be prioritized as asymptomatic that you could imagine to be a close contact of someone who is, or who is very high risk and undergoing a procedure.”

    But the VDH FAQ on “Can I get tested for COVID-19?” still refers to the 4/17 guidelines that does not include asymptomatic contacts. “Should I get tested for COVID-19?” says, “Your healthcare provider will determine if you need to be tested for COVID-19 and might consult with your local health department if needed.” https://www.vdh.virginia.gov/coronavirus/frequently-asked-questions/testing-for-covid-19/

    Under healthcare providers, the Testing for COVID-19 Guidance is still the 4/17 information.

    Regarding Phase 1 and 2 in the press conference:
    Dr. Remley showed a slide of the Timeline and said at 2:32 of the YouTube video, https://www.youtube.com/watch?v=jWNzXogbibM: “As we remember, this is the timeline we talked about when we first started talking about testing, we are in, as you can see, Phase 2, and we’re very quickly moving to the point where we’ll be in other phases. I would tell you that a lot of states talk about Phase 2, we’re already there.”

    However, Health Commissioner Oliver seems to have missed that we’re in Phase 2. He said at 12:31 on the same YouTube video, “As you’re well aware, one of the metrics that we’re looking at to judge when we’re ready to move into Phase 1 of Forward Virginia is the percent of positive tests to total tests. We were previously counting people who were tested, and not tests which makes it not possible to really calculate that well in terms of proportion of tests. So that’s what that represents.”

    This makes no sense to me when VDH has said all along and still says “all negative results may not be represented due to the large number of fax reports from new labs testing for COVID-19.” And we’re supposed to believe they actually tracked multiple tests back to one person? So what test did they count?

    It feels a bit like listening to Abbott and Costello.

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