As Virginia slowly reopens, several key public health metrics still haven’t been met

Plenty has changed in the two weeks since Gov. Ralph Northam announced his plans to gradually reopen Virginia starting Friday.

What Northam first described as a widespread reopening with possible regional exceptions (most notably, in Northern Virginia) has become a more piecemeal approach after the governor granted last-minute exemptions to the city of Richmond and Accomack County, two localities that worried their COVID-19 caseloads were still far too high to safely loosen restrictions.

In letters to Northam, both Richmond Mayor Levar Stoney and Accomack County Administrator Michael Mason cited concerns over a lack of data to show their jurisdictions were meeting goals that the governor has cited as crucial to reopening the state.

“Currently, data is not readily available to determine Accomack County meets these metrics,” Mason wrote in a May 14 letter requesting a late reopening. “A two-week delay will allow sufficient time for data to be accumulated for this area and analyzed to determine if it is indeed ready to take further steps to reopen.”

Northam, a pediatric neurologist, has repeatedly insisted that Virginia’s reopening hinged on meeting a set of public health metrics. “We’re really emphasizing and focusing on data rather than dates,” he said Wednesday, explaining his decision to allow Northern Virginia — one of the state’s hardest-hit regions — to maintain restrictions for at least an additional two weeks.

But as the rest of Virginia enters Phase One of the reopening plan, health data shows that some of those metrics still haven’t been met. In other cases, erratic data reporting has made it all but impossible to track the state’s progress.

The Mercury broke down where the state currently stands on the health metrics and data that Northam has described as vital to a safe reopening.

An increase in testing to 10,000 a day

“A week or so ago, we were at 2,000 tests a day,” Northam said at the May 4 press briefing when he announced plans to reopen the state. “We’re now up to 6,000, plus or minus, depending on what day it is and whether it’s the weekend. And our goal is to get to 10,000 tests a day.”

It’s a metric the governor has cited repeatedly in the days leading up to Virginia’s reopening. But available data from the Virginia Department of Health suggests it’s one the state still hasn’t met, even as it’s added more than 150 community testing sites over the last three weeks, according to Northam’s latest briefing.

In the week before the start of Phase One, the number of Virginians tested for COVID-19 ranged from a high of 7,184 on Wednesday to a low of 2,035 on Thursday, according to one chart on the department’s COVID-19 surveillance dashboard.

Questionable reporting practices, coupled with repeated changes in data, also make it difficult to consistently track the number of tests performed in the state. For weeks, as The Richmond Times-Dispatch first reported, Virginia health officials blended the results of PCR (polymerase chain reaction) tests — currently the only reliable way of detecting active infections of COVID-19 — with still-dubious antibody tests. The Atlantic later described the decision as “a new low in data standards.”

Hours after The Atlantic published its report, VDH released disaggregated data with PCR tests separated from antibody tests. And despite a news release from the department insisting that antibody tests made up less than 9 percent of the overall totals, data published the next day showed that they can make up closer to 10 percent or higher. 

On Friday, there were a total of 195,636 tests reported since the start of the pandemic, both PCR and antibody. When antibody results were removed, the number plummeted by just over 19,000, for a total of 176,681.

Last week wasn’t the first time VDH changed its reporting methods. In early May, health officials abruptly announced they would switch from reporting the total number of people tested to the overall number of tests conducted in the state. Previously, one person could be tested multiple times over the course of their illness and still be counted as a single result, Health Commissioner Dr. Norman Oliver said. The new method would count each of those tests individually if they were conducted on different days — increasing the state’s overall testing numbers.

After the announcement, VDH agreed to continue reporting the total number of people tested alongside the overall number of tests, making it possible to compare new data with what had previously been published. But on Friday, that appeared to go by the wayside, at least temporarily. While the state’s reconfigured dashboard now separates PCR and antibody tests, it does not include an aggregate total of the number of people tested.

State epidemiologist Dr. Lilian Peake said Friday that the number of people tested was temporarily removed while VDH’s IT and epidemiology teams reworked significant changes to the reporting dashboard, which was modified Friday to include regional testing data and case metrics in addition to the disaggregated results.

“They are working as hard as they can,” she said. “I don’t have a final date yet, but they’re trying to develop that and get it out.”

Until that data is added back to the site, it’s difficult to gauge how much testing has truly increased over time or determine how many unique Virginians have been able to access testing — an important way of determining whether rates are truly improving. Public health experts say that expanded testing, coupled with aggressive contact tracing and isolation, is the only way to stop a surge in new transmissions as social distancing restrictions relax.

At the same time, the state’s contact tracing program is still in development. VDH is in the process of hiring 1,000 tracers, a process that could extend into the summer, Health Secretary Dr. Daniel Carey said at a previous briefing. And it’s still unclear whether all contacts of infected cases will be offered testing through the state.

A downward trend in percent positivity

In his initial blueprint for reopening Virginia, Northam listed a downward trend in percent positivity — the percentage of total COVID-19 tests that return positive. Data from the Virginia Department of Health suggests that the state has met that metric, with a rate that’s steadily declined since the end of April.

But public health experts warned that an overall downward trend still doesn’t mean it’s safe to relax restrictions. With antibody testing removed, the state’s 14-day average percent positivity rate is still 15 percent. Experts from the World Health Organization have said to aim for a positivity rate of 10 percent or even lower to ensure testing is capturing most — and ideally all — COVID-19 infections in the community.

“To me, even 10 percent [positivity] indicates an ongoing epidemic,” said Dr. Hongjie Liu, chair of the department of epidemiology and biostatistics at the University of Maryland, in an interview last week. ““Meaning the epidemic is spreading relatively fast. And 10 percent is not a small number. It’s a huge number in any epidemic.”

A high positivity rate also suggests that most of an area’s testing is still being directed toward those most at-risk for the disease, including hospitalized patients and people with clinical symptoms. That can be a problem, especially in the case of COVID-19, which can be transmitted through people without symptoms.

Peake said Friday that the state still had “more testing going on in certain pockets,” including hospitals and congregate care facilities such as jails and nursing homes, which have been prioritized for wide-scale testing.

“I think we do still have a ways to go for people with milder symptoms accessing testing,” she added. “That’s something we need to continue to work on.”

Hospital capacity and a sustainable supply of PPE

A main driver of Northam’s decision to reopen has been an overall stability in hospital capacity. The administration was able to pause construction of three temporary field hospitals after avoiding an early surge in cases that could have overwhelmed the state’s medical infrastructure. Data from the Virginia Hospital and Healthcare Association suggests there are more than 4,000 available beds across the state, and nearly 3,000 total ventilators. 

There are currently no hospitals reporting difficulties obtaining or replenishing personal protective equipment — another major challenge during the first several weeks of the pandemic. On March 31, the Virginia Department of Emergency Management signed a contract with Northfield Medical Manufacturing, a Norfolk-based logistics company that began providing shipments of equipment in mid-April.

“We have a steady supply of PPE for our health workers, and we now believe that this is sustainable,” Northam said at a briefing on May 8. Part of that success, state officials have said, is thanks to McKinsey, a global consulting firm hired to boost the state’s procurement efforts.

Despite the importance of protective equipment to testing and tracing COVID-19, the Virginia Department of Emergency Management has refused to release details of the contract. The agency allowed McKinsey to redact most of the original document, and withheld approximately 120 pages of reports from the company.

And while hospitals are reporting a stable supply of gear, primary care providers across the state have struggled to source vital materials for testing, including the appropriate protective equipment. Dr. Sandy Chung, a Northern Virginia-based pediatrician and president of the Virginia chapter of the American Academy of Pediatrics, said last week that there’s been “no noticeable improvement” in the flow of supplies to smaller health care providers.

“The last places (which is where most patients are located) to be addressed are the doctors’ offices,” she wrote in an email. “We still need PPE and testing materials to do testing at the scale needed for public health.”