Big testing questions remain as Ohio allows businesses to reopen

Gov. Mike DeWine on Friday began “reopening” the economy, or relaxing coronavirus restrictions. 

But he said Ohioans would have to wait until today, Monday, to hear how the state planned to expand testing to determine whether or how the disease might spread in response to the reopening measures. 

May 1 marked the reopening of general offices, distribution centers and construction companies. Retail stores and service businesses can reopen on May 12. Committees are meeting to plan to reopen businesses such as restaurants and hair salons sometime after that.

Under political and economic pressure, Ohio and other states are restarting economic activities while also saying they don’t have adequate testing. DeWine plans to triple testing capacity by the end of May to 22,000 a day — but that’s a level that Ohio Health Director Amy Acton on Friday said will still be inadequate.

Experts say such testing is essential to any reopening so that public officials can know whether it’s safe to continue or expand it. Georgia Gov. Brian Kemp, who allowed early, sweeping reopening measures late last month, has been harshly criticized for doing so without the ability to detect emerging COVID-19 hot spots as they occur.

On Friday, as Ohio’s coronavirus death count passed 1,000, DeWine said he was confident that Ohio would have enough of the materials needed to dramatically ramp up testing.

“As governor I feel good about it,” he said, explaining that Ohio companies are making materials such as swabs used to gather samples, and that the state is entering into long-term contracts to secure the chemical reagents used to conduct testing.

But perhaps as pressing as having enough tests is how they’re administered.

“I have a question around access to testing. Is it going to be available to everybody geographically?” asked Loren Anthes, who leads the Cleveland-based Center for Community Solutions Center for Medicaid Policy. “There’s still a lot to be figured out.”

Even without adequate testing, it’s already apparent that at least in some areas, minorities and poor communities are getting the disease at higher rates than other communities. 

And Anthes and some public health experts suspect that undiagnosed coronavirus deaths in those communities might be a factor in recent “excess mortality” — higher-than-normal death rates that haven’t been officially attributed to coronavirus. That might indicate that people are dying of the disease in communities that are hardly being tested at all.

One of the ways officials have tried to ramp up testing quickly is by opening drive-through testing centers. But because of the centers’ locations and transportation issues faced by low-income Ohioans, Anthes said he suspects that that population has been badly underrepresented in those tests.

So how best to get tests to where they’re needed?

Andy Becker is director of pharmacy operation for Fruth Pharmacy, which owns 11 stores in small Appalachian towns in Southeastern Ohio. He said in rural areas, such community pharmacies are often citizens’ first and most frequent point of contact with the medical system. So, he said, they’re natural places to test for COVID-19.

“How are you going to test all the millions of people you need to if you don’t involve the pharmacies?” he asked. “It’s just impossible.”

Acton acknowledged the importance of casting a wide net as the state ramps up its testing capabilities. But even by June, she said, that net still won’t be big enough.

“It still will not be all the testing we wish we had, so we’ll absolutely have to prioritize” at-risk communities, such as nursing homes and homeless shelters.

Such an approach might leave other at-risk communities out of the picture.

Nnodum Iheme operates Zik’s Family Pharmacy in Dayton’s Wright-Dunbar neighborhood, where most of his clientele is on Medicaid, the health program for the poor. He said two of his patients already have died of coronavirus.

“We have an elderly population,” he said. “People are very curious. We’ve had so many asking if we’re going to do testing, but the issue becomes, who’s going to pay for the test?”

The Ohio Board of Pharmacy last week issued guidance to Ohio pharmacies about how they might conduct COVID 19 testing, but it didn’t say much about how they might be paid.

“As the Board has no jurisdiction over insurance companies, it cannot offer any guidance on reimbursement for COVID-19 testing administered by pharmacy personnel,” it said. 

The issue of reimbursement is a sore one for pharmacies with high Medicaid caseloads because they say they’ve been losing money on the program for years.

The Ohio departments of Insurance and Medicaid couldn’t be reached last week for comment. Acton said that she envisioned community pharmacies being part of any testing scheme, but she’d have to look into how they might be paid for the service.