It’s clear that testing for COVID-19 in eastern Idaho has improved.
Tests have become more available, and they’re processed much quicker than they were at the start of the pandemic.
But what’s not clear is how widespread the coronavirus is locally.
Eastern Idaho health professionals said, this week, that they don’t have a full picture of the virus’s prevalence because it's still mostly symptomatic people who get tested, testing data is limited, and tests still take days to be processed and reported to public health officials.
That means, in part, that more testing isn’t the sole reason Idaho — which is in the fourth and final stage of Gov. Brad Little's four-stage reopening — is seeing its COVID-19 caseload spike more rapidly than ever.
“Certainly as testing has increased, more individuals who may not have been tested before … now are able to test because of our slight increase in testing ability,” said James Corbett, an administrator for Eastern Idaho Public Health. “To say that the increased (cases) are due to increased testing would be misleading.”
Locally, it’s difficult to find out how many tests are being administered. Corbett said Eastern Idaho Public Health only receives updates on positive tests, not on negative tests, so he said the district can’t say what percentage of tests performed in the district returned positive. Nationally, there has not only been a rise in cases but in the percentage of tests that come back with positive results, indicating that the spread of the virus is accelerating.
In each of the past two weeks, Idaho has reported roughly 11,000 tests were completed. On Idaho’s coronavirus tracking website, the state updates daily how many total tests are administered, but it takes days and sometimes weeks for it to update how many tests were administered in each health district.
Niki Forbing-Orr, spokesperson for the Idaho Department of Health and Welfare, said in an email to the Post Register that processing test results is a tedious task.
For instance, she said the state must verify each person they receive a positive test for is a current resident of Idaho because the state tracks cases by where people live, not where they get tested. And though many testing labs send the state results of both negative and positive tests, some only provide the positive results, Forbing-Orr said. She said the state excludes results from labs that don't provide full test results because that would skew the data and make it impossible to accurately calculate the percent of cases that prove positive.
"The volume of results and inconsistencies in data quality means it takes a lot of time to verify the data and accurately report the metrics," Forbing-Orr said.
The World Health Organization says positive percentage rates for COVID-19 tests are key to understanding if a state is testing enough people. It says states with more than a 5% test positivity rate aren’t testing enough. Johns Hopkins University on Thursday reported that Idaho’s positivity rate was among the highest in the U.S. — at 12.99%.
Benjamin Ridenhour, a University of Idaho professor who developed the COVID-19 model that the state uses, said Wednesday he waited “a long time” for the state to report positive test rates, locally and statewide, for the week of June 14 to June 20. On Thursday, the state added test results for the week of June 21 to June 27. (Forbing-Orr said the testing data "are based on the date the (test) specimen was collected.")
“These are frustratingly slow to update,” Ridenhour said in an email to the Post Register.
The state doesn’t readily report local positive testing rate in each health district, either. Dr. Kenneth Krell, who leads Eastern Idaho Regional Medical Center’s COVID-19 response team, said the gaps in testing data hampers public understanding of how widespread the disease is.
“Who knows who gets tested? We don’t know,” he said. “There’s nothing systematic about the way that we’re testing.”
In eastern Idaho, Corbett said the health district “recommends that only symptomatic” people get tested. And he said before people pursue a COVID-19 test, they should — but aren’t required to — be evaluated by a doctor.
Forbing-Orr said state guidance for who should get tested includes symptomatic and asymptomatic people in certain situations.
"We don't have enough testing capacity to test all asymptomatic people, and health care providers are making testing decisions on a case-by-case basis," she said.
Ridenhour said that even if the state more consistently updated total test numbers, the positive test rate would be difficult to interpret because there’s a lot of variance in who gets tested.
“The problem is that testing is conditional on the doctor you went to see,” Ridenhour said. “Some doctors will be more prone to test patients than others. What we would really like is random testing of the population to get an idea of (the) amount of coronavirus circulating in the population at large.”
Positive test rates that are high, according to Johns Hopkins, "may indicate that the state is only testing the sickest patients who seek medical attention."
Another weakness in local testing is how fast samples are processed. Corbett said the health district typically gets test results back in three to five days. It’s better than the 10 to 12 days that it sometimes took during early stages of the pandemic, Corbett said, but it still makes contact tracing more difficult. Statewide, the average recent turnaround for test results is 2.5 days, according to Forbing-Orr.
“That can be a long wait to then be told that you’re negative and that the symptoms were allergies or some other disease,” Corbett said. And he said delayed test results mean people who were exposed to someone with COVID-19 won’t know for days.
Krell said he’s seen that in the hospital, even among the more than 20 COVID-19 patients that have been hospitalized in ERIMC since the start of the pandemic.
“We (EIRMC) are testing patients that come into the ER with appropriate symptoms, but again, if they’re sick enough to be hospitalized, then we’re gonna have to isolate them for a few days until we can get the test back,” Krell said.
Despite struggles in testing locally, health officials say cases in eastern Idaho likely will soon follow suit with case spikes in surrounding areas, including in neighboring states and in Ada County, which recently moved back to Stage 3 of Idaho's reopening.
At a meeting Monday where eastern Idaho health officials said they are considering mandating mask-wearing in public, a measure that a growing number of Idaho cities are eyeing, Eastern Idaho Public Health Director Geri Rackow warned that the region is likely to see a surge in COVID-19 cases. Krell agrees, and said that Idaho still doesn’t know how bad things are.
“We aren’t in good shape in testing,” he said. “We are still just fumbling in the dark here.”