This story was updated on November 5, 2020 to include comment from Dr. Jonathan Heidt.
When MU Health Care closed one of its two drive-thru coronavirus testing sites in mid-September, it pointed to a drop in the number of people getting tested. At that point, drive thru testing appointments had fallen by more than 1,000 from the peak of nearly 3,200 at the end of August. Since then, appointments have fallen further, dropping to just 1,500 the week of October 19.
Dr. Jonathan Heidt is the vice chair of operations for emergency medicine at MU Health Care and oversees the system's coronavirus testing. He says demand has fluctuated, increasing in the summer, and spiked at the end of August, as university students returned for classes. Since then demand has tailed off, and Heidt says that's worrying, especially with the positivity rate increasing. "We really should be doing more testing to find those cases and intervene on them," Heidt said.
Scott Clardy is the assistant director of the Columbia/Boone County Public Health and Human Services department and he's been watching the decline in testing with concern. “I think more people need to be tested in order for us to get a real accurate idea of what’s going on," Clardy said. "From what I can tell the issue is a lack of demand for testing not a lack of availability.”
Data from the county’s dashboard show a steady decrease in weekly tests from just over 2800 the week of September 20 to less than 1700 a month later. Clardy says the department isn’t sure what’s driving the decline in demand, even as cases are on the rise, but he’s heard speculation.
"“Some people don’t want to get tested because they can’t afford to stay home from work, which is certainly a terrible situation to be in," Clardy said. "We’ve been hearing stories about those kinds of things occurring.”
Clardy also points to COVID fatigue as another potential cause of the drop – he says 8 months into the pandemic, people are just tired of taking precautions or thinking about the virus.
Nevertheless, Clardy says whether we want them or not, tests are available for everybody - the department has received CARES Act funding to provide coronavirus tests to uninsured county residents, who can call the department to get tested through the Family Health Center in Columbia.
And the Missouri governor’s office has pushed expanded testing as a priority. The Department of Health and Senior Services has held free community testing events for months, where people can get a test without a health provider’s order. But participation in those events has also flagged.
At a recent press briefing, state health director Randall Williams encouraged Missourians to take advantage of the free testing, even if they don’t didn’t have symptoms. Not just for themselves – but also for their loved ones.
“To anyone out there who goes, ‘well I’m asymptomatic, I’d just rather not know if I have it.’ I’d really try to dissuade you from that because you might be asymptomatic, but your loved ones may not be,” Williams said.
The state’s online dashboard shows a decline in new coronavirus tests over the past month, dropping from a 7-day average of 19,000 on October 6 to just 16,000 on October 24. The most recent community testing event in Boone County drew 296 people – that’s the fewest the county has ever seen.
This decreasing number of tests also impacts the state’s positivity rate, which is one of a handful of COVID-19 measures that has been on the rise. The positivity rate is typically calculated by dividing the number of positive coronavirus tests by the total number of tests done. That means a high positivity rate can represent a high prevalence of the virus, a low number of tests, or both.
In May, the World Health Organization set a positivity rate of five percent or lower for at least two weeks as the benchmark for lifting COVID-19 restrictions. Missouri’s most recent in-house positivity rate was more than four times higher than that, at 22 percent.
Missouri governor Mike Parson last week said Missouri calculates its positivity rate differently, and he discouraged comparisons with other states.
“Most people is going to use the CDC, state dashboard or Johns Hopkins, and what you’ll see a lot of the time in the media will be the worst case scenario,” Parson said.
The Centers for Disease Control calculates its positivity rate using all tests done in the state. DHSS Missouri divides the number of people receiving their first positive test by the total number of people being tested for the first time to account for people getting multiple tests.
Regardless of how the positivity rate is calculated, with the number of new cases increasing, a continuing decline in tests will make it harder for public health officials to get a clear picture of the outbreak.
This story was updated on November 5, 2020 to include comment from Dr. Jonathan Heidt.
