Coronavirus testing ramps up in Texas, but more is needed

Medical professionals wearing protective clothing and masks administer COVID-19 tests to patients at the Baylor Scott & White Health facility in Round Rock. (Jordan Vonderhaar for The Texas Tribune)

The availability of numbers alone tells the story of how testing for the new coronavirus has significantly ramped up in Texas in the last few days.

A week ago, a spokesman for the Texas Department of State Health Services didn’t have an answer to the question of how many people had been tested at public health labs in Texas. Now that tally — plus the number of people tested in some private labs — is updated daily. The state’s running count showed more than 1,000 tests between 8 p.m. Tuesday and 8 p.m. Wednesday.

The steady rise in the number of tests administered — at least 2,335 at the state’s last count Wednesday night — and the number of positive cases of COVID-19, the disease caused by the new coronavirus, have come as the state has built out its testing capacity in the last week, with drive-through testing cropping up in various regions. But Texas still appears to be far off from the 15,000 to 20,000 tests a week Gov. Greg Abbott has set as a marker for the state’s testing trajectory. Limited medical equipment and resources have kept regional testing efforts down. And the lag in data has forced local leaders to grapple with a growing outbreak without knowing exactly how widespread the infection really is.

“The numbers are always five to seven days behind,” Dallas County Judge Clay Jenkins said in a Wednesday radio interview with Texas Standard. “We have more testing capacity here than any other metro area, but even so, we’re testing hundreds a day, not thousands a day at this point. And so the numbers are behind what is actually the situation on the ground.”

The number of known cases of COVID-19 in Texas had surpassed 160 as of Wednesday night, including 18 at a federal quarantine area at Lackland Air Force Base; the count in Dallas County alone rose to 55 on Thursday after 20 new cases were announced.

Those numbers are expected to continue to rise as testing expands and more results come back from public and private labs. But while health experts said Thursday that the state’s testing capability was improving markedly, it wasn’t where it needed to be to measure how effective efforts to contain the virus have been or to make informed assessments of where the outbreak is on its trajectory toward peaking.

Although the state has seen “a tremendous number of infections” detected in the last few days, it’s nearly impossible to determine how much is new testing or new cases,” said Catherine Troisi, an epidemiologist with the University of Texas Health Science Center at Houston School of Public Health. “Once we’re testing everybody who needs to be tested, we’ll know.

"We need to have that to know what’s happening in the community, to know if our mitigation efforts are working,” Troisi said.

The state’s limited testing network came under intense scrutiny last week when Texas health officials identified the first instances of community spread in the state’s biggest metropolitan areas at the same time that state officials were unable to provide exact figures for how many people had been tested so far under the state’s strict criteria.

On a call with lawmakers last Thursday, Abbott said 104 people were being tested or monitored for the virus. The state health department couldn’t confirm that number at the time, though a spokesman estimated that figure was in the “dozens.” Unless a patient was sick enough to be hospitalized, meeting the state’s criteria for who could be tested was difficult at that point.

By Monday, state officials released figures that put the number of people tested by public and federal labs at 439 and said “hundreds” more tests had been conducted by private labs. The jump in confirmed testing came this week as the state reported figures for private testing.

Of the 2,335 tests that had been counted as of Wednesday night, 872 were administered in public labs and 1,463 in private labs. (The figures for private testing are incomplete because the state’s tally doesn’t include all private labs.) Nearly three-fourths had been administered in the previous 48 hours.

The increases have come, in part, as drive-through testing has been set up and expanded in several cities. The first site for drive-through testing went up in San Antonio but was limited to health workers and first responders. On Wednesday night, San Antonio Mayor Ron Nirenberg announced the city had opened another facility at Freeman Coliseum and opened testing to people without a travel history or contact with a known COVID-19 patient — as long as a doctor had pre-approved them for testing.

In Central Texas, Baylor Scott & White Health has set up drive-through testing for individuals who are prescreened through an online questionnaire. The city of Austin announced Wednesday it had received 1,000 additional test kits from the federal government and that the availability of testing was set to increase in the area. But officials noted tests would still be doled out by priority because of the “significant gap between the number of tests available and the number of people seeking a test.”

“Testing remains limited and even with more tests available, we must continue to prioritize testing for the immediate future such as healthcare workers, hospital patients, and individuals who live in nursing homes and those at high risk of complications,” Dr. Mark Escott, Austin-Travis County interim health authority, said in a statement.

On Thursday, Houston saw the opening of its first drive-through site at United Memorial Medical Center’s Tidwell site, where individuals with symptoms related to COVID-19 can be tested regardless of whether they’re insured. Once the samples are sent to the lab, results will be available within 24 hours.

But the unmet demand for equipment needed for implementing mass testing has left a stubborn gap between where the state’s testing infrastructure is and where local leaders are hoping to be to mitigate the spread of COVID-19.

Limited resources, including insufficient personal protection equipment and specialized swabs, will keep Harris County from opening all four of the sites it has been approved to set up, Houston Mayor Sylvester Turner said at the launch of the hospital’s drive-through.

“The good news is that here they are starting up, and as the county and the city put online its testing sites, hopefully that will supplement,” Turner said.

One of those sites will go up on a “limited basis” and will primarily focus on first responders and health care providers, Turner said, but testing “will ramp up” as additional resources come in.

The repeated warnings from the governor about the spike in cases the state is expecting in the next week have served to underscore how far behind the state’s testing capacity has been.

At a virtual town hall Thursday night, Abbott said Texans should expect that thousands of people will have tested positive by next week.

In two weeks, Abbott said, the number of positive tests will likely be in the tens of thousands.

Disclosure: Baylor Scott & White Health and the University of Texas have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.