State Still Tracking COVID-19, Despite Reduced Testing

On June 2, Gov. Jim Justice announced that West Virginia would significantly scale back COVID-19 community testing programs. This led to concerns both in the general public and in the medical community that the next wave of COVID-19 cases would catch the state by surprise. But even with the rise of the highly infectious BA.5 variant, that hasn’t been the case.

The start of the COVID-19 pandemic in March of 2020 was a hectic time.

“It was just baptism by fire,” said Regional Epidemiologist for Northeast West Virginia Dr. Lucas Moore.

“And at that point there, we didn’t have the vaccines and it was really scary,” he said. “It was all hands on deck. It didn’t matter what your role was at the health department. We had a job to do.”

Moore is based out of the Monongalia County Health Department offices in Morgantown. He said that at its peak, the county’s program would test 1,000 people on a single day.

“Lot of people came in and they wanted to know, ‘I’m going to be around family,’ or just for personal awareness if they were positive or not,” Moore said. “But there were a lot of people that were visibly ill and to be put in that situation.”

Data from the West Virginia Department of Health and Human Resources COVID-19 dashboard shows that more than 25,000 individual tests were administered across the state on single days during the pandemic’s peaks in January 2021 and again in January 2022.

At $25 per testing kit and at least another $70 for lab processing, that single day would have cost close to $2.4 million, before factoring in the labor cost. As Moore said, it was an all hands on deck situation, and health departments still had to complete their other, regular duties.

Since then, things have changed significantly. Vaccines are readily available, and other mitigation processes like quarantining and mask-wearing have become ubiquitous. The biggest change, however, is the availability of at-home testing. All of this drove a steep drop in engagement with community testing events.

Moore said he and other public health officials always understood community testing had to end at some point, but Justice’s announcement at the start of June still came as a surprise.

Moore said calculating daily rates gave him and his community a clear path forward. Now, he’s left with some doubts. First, at-home tests are antigen tests, which, while quick, are not as accurate as the PCR tests administered by health departments and doctors.

Second, unless someone chooses to call into their local health department to report a positive test, which some do, there is no way for that data to reach epidemiologists.

“My concern, I think it’s a shared concern at our health department, is we, with at-home tests so prevalent, that we’re under-reporting what our true infection rate is, our true how many cases per day,” Moore said.

To be clear, PCR testing in West Virginia has not ended completely. Tests are still available at more select locations like pharmacies and other healthcare providers.

Dr. Abir Rahman is the director of Epidemiology at the Huntington Health Department. He and his team secured grant funding to continue PCR testing, but he is realistic about diminishing data.

“We knew that we are not getting the whole scenario,” Rahman said. “But we knew that regardless, the numbers we’re getting, it was somewhat proportional to the actual number.”

Even with reduced testing, Rahman said other tracking tools like wastewater management have allowed public health to keep track of COVID-19. He also points to the use of existing data from across the country and even the world that is used to extrapolate local levels.

Almost exactly a month after the end of community testing in West Virginia, the opportunity to put these new tracking methods to a true test came in the form of the latest variant: BA.5.

Despite reduced testing, Rahman said in an email that, “from the very beginning we have been monitoring the spread of BA.5 and other variants/subvariants through CDC Nowcast. Doing so allowed us to stay informed and communicate with our partners early to take preventive measures. Also, it helped us be prepared for the increase in case numbers and outbreaks.”

As the pandemic has evolved, the goals of public health have evolved as well.

“These few things, in addition to some other things, obviously change the whole environment,” Rahman said. “Initially, of course, the numbers are really important, and it still is now. But right now, the main focus is more towards preventing severe disease and preventing healthcare strain.”

Ultimately, community testing at the scale West Virginia was conducting was no longer an efficient way to address the virus.

“When you go from events that have hundreds of people showing up, down to less than 10, or, in some cases, nobody showed, they became less of an efficient and effective way for us to get data that we need,” said retired Maj. Gen. James Hoyer.

He is the director of the governor’s Joint Interagency Task Force. He coordinates the response to COVID-19 between the federal and state government, as well as hospitals, universities, and other private entities.

Hoyer said the end of community testing signals a new phase in the pandemic, but is quick to clarify that we are very much still in it.

“I wish I could say that we were at the endemic phase right now,” he said. “But I think Dr. Marsh and the rest of the team would say, we’re not sure we’re quite there yet.”

Using all the tools available to them, Hoyer is confident the state can move forward without the large amounts of information (data) community testing provided. But, he said, the most important tool of them all is one many West Virginians still haven’t used: the COVID-19 vaccine.

With a new type of vaccine approved by the Centers for Disease Control and Prevention this week, Hoyer and others are hopeful to see the state’s vaccine uptake increase.

Unlike existing vaccines from Pfizer or Moderna that use mRNA technology to immunize against COVID-19, the Novavax vaccine uses more traditional protein-based technology.

“Folks need to remember where we’re at now, with variants changing, the vaccine is not about keeping you from getting COVID,” Hoyer said. “The vaccine is about lessening your possibility of getting seriously ill or dying from COVID.”

Moore, Rahman and Hoyer all agree that the pandemic is still not over, but the resources available have made it manageable.

“COVID, you think about the past two plus years, has taken a lot of things from people,” Moore said. “Live your life. Take appropriate precautions. You’re going to have to roll with the punches. Public Health, we’re going to do our very best to keep the community safe, wherever that might be.”