A woman is tested for COVID-19 in a parking lot in Richmond where the health department set up a temporary walk-up testing center. (2020 photo by Ned Oliver/Virginia Mercury)
Virginia’s COVID-19 testing numbers have reached all-time highs over the last several days as the highly transmissible omicron variant moves across the commonwealth. But even as cases reach historic levels — with more than 15,000 new infections reported on Tuesday alone, according to data from the Virginia Department of Health — experts say it’s likely an undercount given ongoing testing limitations.
Shortages in Virginia have frustrated both symptomatic patients and families seeking out testing for school, work or travel. In conversations with the Mercury, many people said they’d been unable to find appointments at urgent cares or major pharmacy chains, which are often booked out days in advance. At-home test kits are also in short supply from Northern Virginia to Hampton Roads — sparking a flurry of crowdsourcing through social media.
But state and local health agencies have also struggled to keep up with surging demand. In a news briefing on Tuesday, Dr. Laurie Forlano, VDH’s deputy commissioner for population health, said the department has faced many of the same supply challenges as private providers. While the agency began distributing antigen tests to libraries, local health departments, school divisions and other community partners, including homeless shelters and prisons, in mid-November — part of an effort to increase access to testing, according to a release at the time — supply was limited by orders that went undelivered.
“We’ve placed orders that have still not been fulfilled in total,” she said. “Some of those orders were placed weeks or months ago.” And while there’s no shortage of the supplies or lab capacity needed to process PCR tests — the kind most commonly offered through local health departments — manpower has been a struggle.
Morgan Elwell, who lives with her boyfriend in Sterling, said they decided to get tested after coming down with mild cold symptoms right before Christmas. “I wanted to be safe and protect my dad and my stepmom and my siblings,” she said. They both attended a drive-through event at Claude Moore Park held by the Loudoun County Health Department. In total, they were in line for almost six hours, with what looked like seven nurses testing thousands of people, according to Elwell.
“I honestly felt terrible for everyone,” she said. “They’ve been holding events for weeks and I’ve never seen it this bad.” On other recent occasions, cars were turned away after the health department ran out of tests.
Loudoun County isn’t the only local health department fielding massive demand. In Norfolk, hundreds of people waited hours in line for a last-minute testing event on New Year’s Eve. Another event a few days later drew just as many, with residents braving the snow and rain. Free testing events in Richmond have also seen huge crowds — including thousands of families who lined up for at-home tests before the end of winter break.
As demand continues to swell, driven by the dramatic increase in cases, the shortage of state- and locally run testing events has become a point of frustration. In late December, the Virginia College of Emergency Physicians renewed calls for Gov. Ralph Northam to declare a state of emergency in response to the surge. Testing, members said, has become a particular challenge for hospitals, where patients have been flocking in search of timely results.
“Most people who have the ability to go to a primary care office or urgent care are saying they tried and could not get in,” said president-elect Dr. Todd Parker. “Then there’s uninsured people and Medicaid patients, who have terrible access to care. That is probably one of the single most frustrating aspects of our job — every day we see those kinds of inequalities.”
The organization specifically called on the state Health Department to increase testing sites to relieve some of the pressure on hospitals. Local school boards, too, have gotten a firsthand look at the supply and demand challenges. Fairfax County, the largest division in the state, began hosting its own diagnostic testing events in late November through a third-party vendor. School Board member Melanie Meren said the decision was driven by the lack of access in the community, even among parents who could afford private testing sites and at-home kits.
“People were clamoring and angry,” she said. “Everyone wants a safe return to school. But my biggest question is, why are schools providing all this testing? Where are the other agencies when it comes to standing this stuff up?”
Over the last week, just one of the division’s sites has tested around 440 people a day, according to district spokesperson Julie Moult. On some occasions, the demand has outstripped supply, forcing the division to turn families away.
Forlano said both state and local health agencies are doing their best to meet the demand. At Tuesday’s briefing, she cited 51 community testing events scheduled across the state this week (though some were canceled due to Monday’s snowfall). After one of the state’s first orders of antigen tests were unexpectedly cancelled, VDH “ diversified its purchasing avenues,” according to a later email from an agency spokesperson, and expects supply to slowly pick up over the coming weeks.
“In addition to that, public health has really focused its testing efforts on more vulnerable settings,” Forlano said. “Nursing homes and schools and people experiencing homelessness — programs that are happening in the background to make sure we’re meeting some of the needs in settings where transmission might really take hold.”
The emphasis on underserved communities also makes it more difficult for health departments to rapidly scale up events, according to Dr. Melissa Viray, deputy director of the Richmond-Henrico Health District. As the pandemic slogs into the beginning of a third year, local health departments are working to resume the normal services they provided before COVID-19, including family planning and screening for sexually transmitted diseases. In many cases, there’s growing concern over repeatedly pulling staff members off their regular duties to handle new cases.
“As we move towards an endemic disease, we need to have surge capacity,” Viray said. “But we also need to realize that when we steal from Peter to pay Paul, there could be downstream consequences for our community.”
COVID-19 testing is also clinical work, limiting the number of employees who can run clinics, she said. While Richmond-Henrico has dedicated some of its federal funding to a dedicated surge team, the district — like other local health departments and medical providers across the state — are contending with nursing shortages and a growing number of infections among workers. Logistical hurdles, from staffing events to finding community partners to host them, have been challenging for many local health agencies, Viray said.
Still, many providers have spent months questioning why the Northam administration hasn’t re-implemented a state of emergency or previous waivers that made it easier for hospitals to add bed capacity, hire out-of-state health workers, launch drive-through testing sites and solicit federal funding assistance, along with other regulatory changes, said Parker, the president-elect of the Virginia College of Emergency Physicians.
Several health systems, including VCU and Inova, have halted elective procedures or activated emergency procedures in response to understaffing and a new wave of hospitalized COVID-19 patients. While there is some evidence that omicron causes more mild illness for some patients — particularly those who have been vaccinated and boosted — Parker emphasized that massive transmission has still led to a significant increase in severe disease, especially among patients who have’t received the shots.
The rushing of patients seeking testing in local emergency rooms is another strain on hospitals. In Maryland, Gov. Larry Hogan has already declared a state of emergency in response to the omicron surge, and signed an executive order mobilizing the National Guard to open new testing sites and boost capacity at existing events.
“Emergency departments have always been the safety net for health care in this state and in this country,” Parker said. “And this situation over the last few weeks has been one of the best examples of how emergency rooms quite frankly bail out all the inefficiencies and inequalities when it comes to access to care.”
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