More Ohioans are getting COVID-19 tests. It’s still not enough.

The COVID-19 tests were too warm to use. Probably.  

The Ohio Department of Health attempted to send two shipments of a combined 750 COVID-19 specimen collection kits to Summit County Public Health. On April 29 and May 6, however, the Styrofoam packaging housing the swabs, the media that carries the specimens, and the ice that keeps the container cool, broke open.

“That medium they’re in has to remain at a temperature less than 40 degrees [Fahrenheit],” said SCPH Commissioner Donna Skoba.

“So if they’re out of temperature, we’re not 100% sure that media has been preserved and that the test will be accurate.”

The supplies cost a total of more than $13,000, according to Melanie Amato, an ODH spokeswoman. Around the state, five total shipments of testing supplies of the 611 ODH that have shipped since April 14, all through UPS, have arrived damaged. Total cost: $21,840.

ODH provided replacement tests to Summit County by May 11. Amato said ODH is now shipping with FedEx and has submitted a claim with UPS, who handled the two shipments in question. UPS did not answer inquiries.

Summit County has had more than1,000 COVID-19 cases as of Sunday, the eighth most of any Ohio county. Neither ODH nor SCPH publishes data on how many county residents have been tested in total.

The incidents, which happened as Ohio demonstrates one of the lowest testing per capita rates in the U.S., underscore a vexing problem: If testing capacity is as high as Gov. Mike DeWine has claimed, why are Ohio’s daily testing numbers so low?

Skoba offered two ideas: For one, available testing relies on a fragile supply chain. For two, the testing shortages themselves warrant narrow testing guidelines, which care providers follow to determine who gets tested and who does not.

The guidelines generally prioritize those at higher risk of serious complications of COVID-19, health care workers, and people in congregate settings. They do not advise testing for otherwise healthy people infected with or exposed to the coronavirus. 

At first, testing shortages stemmed from a lack of reagents for labs to run the test, according to ODH Director Dr. Amy Acton. Then it was components like swabs and media to draw samples, or multimillion-dollar machines (sold out everywhere) the labs use to process them.

“There are a lot of missing parts, and there’s no one person whose job it is to go find the missing swab in some one doctor’s cupboard, and go find the missing tube in some chem lab at OSU,” she said at an April 3 media briefing. “All the parts and pieces are in short supply.”

Insufficient testing

Ohio does not have enough tests to give health officials a clear view of the outbreak, according to statements from health officials, plus university and government research. Likewise, Ohio’s testing rate is among the lowest in the nation.

Only four U.S. states have tested fewer people per capita than Ohio, according to Worldometer, which aggregates testing data from the WHO and CDC.

Both DeWine and Acton have offered candid remarks lamenting Ohio’s testing shortages since officials first detected Ohio’s outbreak March 9. Antibody testing and contact tracing have since led officials to cases dating back to early January.

A prominent research group, Harvard’s Global Health Institute, updated its recommendations earlier this month. It estimates the U.S. needs to test more than 900,000 Americans per day to more safely phase out social distancing measures.

The researchers say Ohio needs to test about 26,000 people per day to see the full scope of the virus’ reach.

Over the last week from Sunday, about 8,400 Ohioans per day on average have been tested for COVID-19.

“Testing is critical,” said Ashish Jha, who runs the Harvard research team, to a congressional committee Thursday.

“Testing tells us who has the disease and who doesn’t. Testing is the cornerstone of controlling every single disease outbreak. It was inadequate testing that precipitated the national shutdown. We must not make the same mistakes again as we open up our nation.”

Similarly, the World Health Organization advises that if your test positivity rate is above 10%, you’re probably missing a lot of infections. Ohio’s positivity rate is about 11%; it has dropped from about 14.5% in mid-April.

DeWine has claimed Ohio currently has the “capacity” to test nearly 19,000 people per day, a figure he says will continue to rise.

Amato, in an email, explained some of the discord between the purported capacity and the raw number of people tested per day.

“To use that testing to capacity requires two things: The first is clear testing guidance about how to use those tests to control the virus even when you don’t have an unlimited number of tests. We put that guidance out a week ago Monday — aimed at use by the most ill and the most at risk (congregate settings, community outbreaks),” she said.

“We are reserving some of that capacity for expected outbreaks. The second requirement to use the capacity is an infrastructure to get the specimen kits out to collect samples and back to the labs, which requires the establishment of an entire system for testing, scheduling, billing and reporting.  We are close to completing that infrastructure.”

There are nearly 28,000 known COVID-19 cases in Ohio, according to data released Saturday. More than 1,600 have died.