Georgia’s evolving testing machinery will be tested as state reopens

A National Guard soldier from the 170th Military Police Battalion checks a person into the Cobb County CO-VID 19 testing site at Jim R. Miller Park in Marietta, Georgia, on Friday, April 17, 2020. Christina Matacotta / for the AJC
A National Guard soldier from the 170th Military Police Battalion checks a person into the Cobb County CO-VID 19 testing site at Jim R. Miller Park in Marietta, Georgia, on Friday, April 17, 2020. Christina Matacotta / for the AJC

The success of Gov. Brian Kemp's hotly-debated decision to begin reopening Georgia's economy rests on whether the state can detect novel coronavirus hotspots before they flare out of control, and reliably demonstrate that it's safe to move about.

The state Department of Public Health is rapidly increasing the number of testing sites and deploying the Georgia National Guard to help build up the state’s testing system. But whether enough tests, supplies and sites are available statewide to ease restrictions for the state’s 10.6 million residents — without a spike in new COVID-19 cases — depends on a testing infrastructure that is still a work in progress.

» COMPLETE COVERAGE: Coronavirus in Georgia

Public health experts estimate conservatively that Georgia needs to double or even quadruple the 4,000 or so diagnostic tests by public and private labs that the state has reported daily in the past five days. Preliminary information on the current locations and capacities of state-operated testing sites show that steep challenges lie ahead before everyone who needs testing can get it, an Atlanta Journal-Constitution analysis shows.

These challenges face rural and urban areas alike, and are complicated by a stressed testing supply chain where the availability of manpower, swabs, masks and other equipment is constantly shifting. The number of tests local health departments receive from the state can change from delivery to delivery, local health agency officials said, and it is still unclear how many private practices, urgent care facilities and others are available to help them in the effort.

DeKalb County’s health department has two sites that can test a total of 120 people daily out of its 760,000 residents.

Any state that opens up without getting a handle on these complications runs the risk of ending up back where it started and getting more people sick, cautioned Dr. Thomas Tsai at the Department of Health Policy and Management at Harvard T.H. Chan School of Public Health.

“You’re liable to open the system before you are ready, and stress the system again,” Tsai said.

Based on successful efforts to contain the spread of COVID-19 in South Korea and Germany, Tsai and other members of his research team estimated that conservatively, the U.S. needs to test 152 people per 100,000 each day.

That’s more than 16,000 tests per day in Georgia.

Figuring out if the state meets President Trump's coronavirus guidelines to reopen is difficult because of the way the state reports its data, an AJC analysis found. Trump suggested that states could consider easing shut-downs if, among other criteria, a state could demonstrate a 14-day downward trajectory of confirmed cases, or positive cases as a percentage of total tests.

Because the state reports accumulated totals of cases, deaths, tests and positive test results on its COVID-19 Daily Status Report, it is impossible to reconstruct actual daily counts from those reports because there may be a lag in when confirmed cases from a particular day are added to the total. Updated case numbers could include figures from multiple days, not just one.

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Another of the task force’s guidelines suggests states consider a 14-day downward trajectory of flu-like symptoms. The Centers for Disease Control and Prevention tracks this data.

Between March 15 and April 5, the most recent time period available, hospital and clinic visits by Georgians reporting flu-like symptoms declined from 9% to 4%. Total flu-like cases declined over that period from 5,800 to 1,700. That period, however, also coincided with stay-at-home orders.

‘Very concerning’

The challenges differ between rural and urban areas.

People who live in certain rural areas of northeast, southwest and south Georgia are 40 or more miles from a publicly-run testing site, according to an AJC analysis of the state’s testing locations. Such long drives are a challenge for those who are too sick to drive, lack access to a car, or can’t afford gas amid skyrocketing unemployment.

State Department of Public Health tests remain in limited supply across Atlanta’s core counties, although officials are planning to boost their availability.

“We can’t schedule and test if we don’t have the kits,” said Eric Nickens, a spokesman for the public health district that covers DeKalb.

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Fulton County’s site can test about 70 people daily, although a pilot project with CVS Health at Georgia Tech is testing about 700 and could do up to 1,000, said Fulton County manager Dick Anderson. The county plans to double capacity by next week and add four new sites.

Still, locals struggle to figure out where to go to find tests, said Fulton County Commissioner Marvin Arrington Jr., who continues to receive calls from confused residents.

“No one knows,” Arrington said. “There has not been any advertising on any center.”

Arrington pushed for sites to open in north and south Fulton so residents who rely on public transportation could access them more easily.

"We can't schedule and test if we don't have the kits." —Eric Nickens, a spokesman for the public health district that covers DeKalb

Dr. Harry J. Heiman, with the Georgia State University School of Public Health, was doubtful the state has built sufficient infrastructure to prepare for a possible spike in cases as Georgia loosens shelter-in-place restrictions. Even Georgia National Guard’s commander, Adjutant General Tom Carden, acknowledged the state’s ability to test is limited by factors outside its control — including lab processing capacity and supplies of test kits and other equipment, he noted.

“What you’re telling me is we’re opening things up in a few days and we have these plans and all the critical pieces are all in process and unconfirmed,” said Heiman. “That to me is very concerning.”

New cases multiply test needs

Through Sunday, Georgia ranked 42nd in the nation in tests per capita, according to an AJC analysis of testing figures. This is an improvement from recent weeks.

“We are testing a lot of people (nationally). The scale-up has really happened,” Dr. Carlos Del Rio, an Emory University infectious disease expert told CNN on Monday. “But we’re not quite where we need to be. I’d say we’re about halfway where we need to be.”

Such progress could be fragile. Should Kemp’s decision to reopen result in more COVID-19 cases, Georgia’s need to test may increase even more, said Tsai, the Harvard public health expert.

Consider the case of a man who goes out to a restaurant or bar with a friend who unknowingly has the disease and only tests positive days later, Tsai said. The man would need to be tested, as would his server or bartender, the patrons he sat with, family members or roommates he lives with, and people he stopped to chat with on the street.

The numbers of tests needed to test a single case can grow large quickly, along with the personnel needed to find his contacts and test them.

“All of us hope that we will return to life as normal as soon as possible, but the operative word there is ‘possible’,” Tsai said. “In order to make things possible, you need a testing infrastructure in place that can do this.”

Staff writers Emily Merwin DiRico, Jennifer Peebles, and John Perry contributed to this report.

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