- Some counties say they can make their own tests or use other testing supplies while others wait for kits
- COVID-19 cases reported by state may not be the actual number of infected people in the state
- Private labs, hospitals starting to conduct their own testing
As testing for the novel coronavirus increases across North Carolina, it remains unclear how many tests are available, where testing is being conducted and how accessible tests are in each county.
In an effort to get answers to those questions and others, journalists from six newsrooms across North Carolina have collaborated to track COVID-19 testing in the state.
Reporters from WBTV, WRAL, Carolina Public Press, WECT, the Charlotte Observer and the Raleigh News and Observer sent an identical list of questions to the directors of all county health departments and multi-county health agencies on Monday.
What has become clear is that state-issued testing kits for COVID-19 are still in short supply in some counties.
All local agencies that answered the question indicated the North Carolina Department of Health and Human Services has made three test kits available to each county. Many agencies said they had received additional kits after using their initial supply but it was not immediately clear how quickly the additional kits were arriving nor was it clear whether agencies had to use all three kits before getting three more from the state.
On March 18, DHHS officials said the state had stopped limiting the number of new kits they would send at a time to three.
On Wednesday, NC DHHS announced 1,850 people had been tested for the virus in the state. Of that number, DHHS said, the state lab had processed 430 tests.
Some agencies responded with detailed answers, including the number of people tested, the number of tests on hand and the number of people, if any, who have tested positive in their county.
Other agencies - including large agencies like those in Guilford County and the seven-county Albemarle Regional Health Services agency, which is responsible for public health in the northeast corner of the state - refused to provide any information.
In Alamance County, health department spokeswoman Arlinda Ellison initially said in an email on March 18 that her agency was instructed by the N.C. Department of Health and Human Services to forward all requests about testing to the state's Joint Information Center.
An email to the JIC seeking comment March 18, had not yet been returned at press time.
The U.S. Centers for Disease Control did not respond prior to publication to a series of questions about testing that the collaboration sent March 17.
Nearly half of the state’s 85 local health agencies did not respond at all.
Reporters collaborating on this project will continue asking questions of public health officials through the duration of the pandemic and will provide updates and additional reporting as more information becomes available.
Agencies seek other options as state tests still limited
Some local agencies that did respond to questions from reporters indicated that state-issued testing kits for COVID-19 were still in short supply as of March 18.
In Richmond County, the health department has requested as many test kits as the state will send, according to Health and Human Services Director Tommy Jarrell. On March 16, the agency had none of the test kits on hand after collecting samples from three patients.
Mecklenburg County Health Director Gibbie Harris told reporters over the weekend that the shortage of testing supplies from the state was impacting her agency’s ability to do surveillance monitoring.
“We have not been able to do sufficient testing to do active surveillance which is what we typically do with a communicable disease,” Harris said.
The reason stems from the fact that they need significantly more tests.
“We were sent three tests and what we were told is after you use those we’ll send you three more," she said at the time.
By Tuesday, March 17, Harris told reporters her agency was able to secure additional tests from a private lab and was no longer relying on the three-tests-at-a-time being sent by the state.
But other counties told reporters they were able to use their own supplies to gather testing samples.
“We don’t use the test kits and as of right now, we have enough supply to complete the tests,” Burke County Health Department spokeswoman Lisa Moore said. “If you have the viral medium and the correct swabs then you have all the testing supplies needed.”
In Craven County, Health Department Director Scott Harrelson said his agency had requested 200 kits from the state but were so far getting them two to four at a time.
If necessary, Harrelson said, his county could also put sampling kits together using the same materials used to test for viral flu. The county had 18 of those on hand as of March 18, he said.
"They aren't the COVID-19 kits, but they are basically the same viral media," Harrelson said in a 10 a.m. email on March 18. "So in a pinch we could just use that, box it up with ice packs and send it through the same channels."
It is not clear why some counties have been able to use their own supplies while other counties have insisted on waiting for kits supplied by the state or a lab.
A spokeswoman for the Wake County Health Department—which has seen the largest number of COVID-19 patients so far in the state—said the agency currently had about 200 test kits in supply and was receiving between 50 to 100 at a time.
Spokeswoman Kelly Owens said those kits were a mix of state lab tests and kits provided by LabCorp.
Number of patients tested, being monitored, positive not clear
Of counties that did respond to the collaboration’s questions, several declined to share how many total samples they had collected for COVID-19 testing or would not say how many people were in isolation or being monitored by health officials pending a positive test.
“Only positive case numbers are released, not the number of patients tested,” said Kelly Nettnin, a spokeswoman with Dare County’s Department of Health and Human Services.
County health departments are required to report only positive tests to the state health department, not total tests administered, Nettnin said. That is true for a number of diseases. Those that must be reported immediately to the state include positive tests for anthrax, hemorrhagic fever like Ebola or Marburg virus, smallpox or a novel coronavirus.
The director of the Albemarle Regional Health Services agency said his office was also only tracking positive test results.
"An accurate number of tests will be impossible to quantify, as private labs will only be reporting positive results," agency director R. Battle Betts said via email.
By contrast, at least one agency in southeastern North Carolina has been able to track the number of tests conducted.
Brunswick County, which has begun providing updates on the number of tests conducted as part of its daily briefing, indicated it was aware of 76 samples collected in the county as of 4 p.m. Tuesday. Of those, 69 were pending at the close of business, and six had come back negative.
In Mecklenburg County, Harris, the health director, told reporters Tuesday night her agency was getting information on roughly 90 percent of tests being conducted.
“We know that we’re getting all of the testing information from the hospital systems,” she said. “Some of the providers are providing that to us and we’re asking as that testing expands that we continue to get that information because it does help us with our surveillance.”
Even for the number of people who tested positive, tracking the numbers can be complicated. The state tallies its positive cases by residency, and this survey found examples where the numbers don’t reflect cases in the community.
One patient who tested positive for COVID-19 in Buncombe county and remains in isolation in Macon County isn’t counted because he or she is a resident of New York state.
A Durham resident who tested positive for the virus out of state and who has remained out of state to recuperate, meanwhile, is counted as a positive case from Durham County.
“Reportable diseases are reported by residence, yes,” said DHHS spokeswoman Kelly Haight Connor via email Tuesday. “This is not an NCDHHS-specific policy, but how diseases are reported everywhere, I believe.”
The Centers for Disease Control counts cases by state or nation of residence, she said later in response to a list of detailed questions. There is currently one case of someone testing positive in North Carolina who is a resident of another state, she said.
Testing continues to expand
The capacity to test for COVID-19 continues to expand across the state as private labs expand their ability to test for the virus.
North Carolina-based LabCorp, whose main lab is in Burlington, N.C., is one of the handful of lab companies in the country that has received certification from the FDA to test for the virus.
Many counties that responded to questions for this project indicated they had begun using LabCorp tests.
UNC Health, which has hospitals across the state, has started testing patients at its hospitals and is accelerating a plan for more widespread testing of its patients in the coming days and weeks.
“We think our capacity is in the hundreds to collect samples and we can get more efficient throughout depending on how many people come through,” said Dr. Amir Barzin, with the Respiratory Diagnostic Center at UNC Health in Chapel Hill.
The lab which will test those samples is also “ramping up as fast as possible,” he said. Altogether the collection sites and lab could collect and test between 300 and 500 samples per day.
The UNC Clinical Microbiology lab has authority for testing from the Food and Drug Administration, but only for UNC Health patients, said UNC Health spokesman Thomas Hughes. Testing for UNC Health patients began on Monday, March 16.
UNC Health then reports all positive tests to the local health department, which then sends that information to the N.C. Department of Health and Human Services, Barzin said. Negative tests are not reported to the state.
“Testing is important to understand where those positive tests lie in the community,” Barzin said. “But at the end of the day if we are all practicing what we have been asked to practice -- trying to quarantine and self-isolate -- we hope to curb the effect of coronavirus at a fast rate.”
This story was jointly reported and edited by Kate Martin and Frank Taylor, of Carolina Public Press; Gavin Off, Ames Alexander and Doug Miller, of The Charlotte Observer; Dan Kane and Jordan Schrader, of The News & Observer; Nick Ochsner, of WBTV; Emily Featherston, Brandon Wissbaum and Brad Myers, of WECT; and Tyler Dukes, of WRAL.