During the last two weeks, Johnson County, Kansas, has limited COVID-19 testing to a sliver of patients and at-risk people. That’s left health experts without much solid information about how the disease is spreading.
Now, the county has the money and a plan for advanced community testing and tracking which would include seemingly healthy people, like countries such as Iceland have done. But there’s one thing holding it back: lack of swabs.
“It really comes down to the swabs. That’s the biggest piece,” says Sanmi Areola, director of Johnson County’s department of health and environment.
As in the rest of the country, testing in Johnson County has been limited due to faulty test kits, shortages of testing chemicals, high demand for tests and limitations on who is authorized to conduct testing.
Many of those issues have been resolved in recent weeks. The problem with the specialized swabs, however, is that many of them are manufactured in northern Italy, and manufacturing there has been slowed due to the catastrophic COVID-19 epidemic there.
Areola took over as the head of Johnson County’s health department three weeks ago, just days before state health officials said community spreading of COVID-19 had been identified there. In an effort to conserve resources, testing in Kansas’s most populous county was restricted essentially to only people who were sick enough to go to hospitals.
Areola says this left the county playing catch up in its efforts to address COVID-19.
“Think about this as you’ve got a water leak,” Areola says. “Because of limited resources, we are really at the end, mopping the water, when the reality is what we should be doing is trying to stop the leak.”
The number of positive cases in Johnson County had grown to 213 as of Monday morning, but that number almost certainly represents a fraction of the total cases in the county, many of which aren’t being identified due to limited testing.
The Johnson County Commission recently approved a $400,000 plan to test around 4,000 additional people.
On Monday, Areola announced that the county had obtained a total of 700 additional swabs, which would mostly be used to test at-risk residents, such as people living in nursing homes.
But ultimately, county leaders want to expand testing to include people who seem healthy but may have asymptomatic cases of the disease. This, they believe, will help determine the extent of the virus’s spread.
“You’re going to make decisions based on what the virus is telling you,” Areola says. “You’ve got to be careful about making those decision (unless) you are convinced you’ve got the right data, adequate data. And that’s what we want to make sure we are in a good place here in the county to be able to do.”
Areola says representative samples of 400 people would be randomly tested during four rounds over time. Other tests would be used on medical care providers, first responders and vulnerable populations, including people in nursing homes and long-term care facilities.
Widespread testing has not been available in most parts of the world, but epidemiologist Melissa Nolan of University of South Carolina says that the few countries where it has been available, including Iceland, South Korea and Germany, have been far ahead of the game when it comes to curbing spread, especially transmission that occurs from people who don’t show symptoms.
“It’s really important for us to understand the numbers and the rate of asymptomatic transmission,” Nolan says. “That means presumptively healthy people could be walking around, transmitting virus and not know it, and we don’t really know the extent of that.”
Public health experts believe that community transmission is likely taking place even in parts of the U.S. that have relatively low positive test numbers.
But Nolan says community testing also plays a key role in helping public health officials determine how to strategize and eventually scale back stay-at-home policies and social distancing after community spreading has peaked.
“Community testing is going to be really important for us to know when it’s safe for people to go back to the normal operating conditions,” Nolan says. “And I think it’s really a big goal of state governments and local government to identify what the risk is within their population so that they can ease these measures and help us get back to normal life.”
Areola says he’s pleased with the aggressive stay-at-home orders and social distancing measures implementing in Johnson County and neighboring communities so far, and he believes that the timing of these measures helped slow the transmission of the disease.
But he warns that, without more testing information, local leaders who are making decisions about next steps could risk backsliding on COVID-19.
“The consequences of relaxing the measures before we are sure that we have this thing under control is not good,” Areola says. “We’ve seen what’s happening in Italy. We’ve seen what’s happening in New York and other places. We can see the consequences.”
Alex Smith is a health care reporter for KCUR 89.3 FM. You can reach him at alexs@kcur.org.
