This post was updated at 11:15 a.m. on May 7, 2020.
With Kentucky just five days from its first phase of reopening, it’s important to look at what the data we have to better understand the risks posed by the virus.
Kentucky has not met a White House recommendation calling for 14 days of declining positive results ahead of reopening, but Governor Andy Beshear says that increased testing capacity will help protect Kentuckians as they head back to work.
On Thursday, Kentucky saw its largest bump in testing to date: 17,589 tests came back. The previous daily high was 6,769 tests in late April.
Beshear has said he expects to be able to conduct 30,000 tests per week in May in cooperation with Quest Diagnostics.
Public health experts recommend looking at the number of positive cases relative to the total number of tests to understand if we are doing enough testing. This is called the positive test ratio.
Looking at the positive test ratio for one week of results can give a snapshot of where we are now and how much more testing we may need to do.
When you look at the one-week average from April 29 to May 5, the positive rate jumps to 16.8%, suggesting the state is under testing.
However, if you include Wednesday’s record test numbers—an outlier in the data—the positive rate drops to 5.7%.
Clear as mud right? If the testing ramps up to what Beshear estimates and the rate of positive cases remains relatively stable, then it appears Kentucky will be testing enough people, at least based on that one metric.
An NPR report made in conjunction with the Harvard Global Health Institute estimated that Kentucky needs to more than triple its testing volume from 28 tests per 100,000 residents to 104 tests per 100,000 residents, if we want to accurately track the spread of the virus.
Kentucky Gov. Andy Beshear says increasing testing capacity will allow the state to safely return to work even as it’s yet to meet a key White House guideline put in place to avoid a resurgence of the coronavirus.
On Tuesday, Beshear announced the state’s highest number of confirmed coronavirus cases in a single day – 625 cases (about half of which came from a state prison). Overall, cases have plateaued.
Ahead of reopening the economy, the administration has decided not to follow a White House recommendation calling for 14 days of declining positive results. Beshear says he believes the state will have adequate testing to protect workers by the time they begin returning to their jobs.
“I believe that we can safely engage in phase one of healthy at work,” he said. “Here’s the reason: We have increased our testing capacity just with [Gravity Diagnostics} to about 30,000 tests per week.”
Beshear has released guidelines for reopening the health care sector and has staggered further openings beginning with manufacturing and construction on May 11, retail and houses of worship on May 20 and barbershops and salons by May 25.
If all goes according to plan, Beshear says groups of up to 10 people can congregate together by the end of May as long as they take the necessary precautions including face masks.
In the absence of an effective treatment and vaccine, public health experts say widespread testing, contact tracing, and social distancing are the best tools we have to fight the spread of the coronavirus. With that in mind, let’s unpack one piece of the puzzle: Where Kentucky stands with testing.
How Much More Testing We Need
The White House has recommended states test at least 2% of their populations per month to reopen the economy, or at least that’s what a White House official told the New York Times. Some experts say that’s not enough.
Nobel Prize-winning economist Paul Romer told the NYT that as much as 50% percent of the population might need to be tested each week to understand where and how far the virus has spread.
In April, 49,056 Kentuckians were tested for the coronavirus, or, about 1.36% of the state’s total population, according to a WFPL News analysis.
That means that Kentucky needs to almost double its testing over the next month in order to reach the White House goal. Beshear says the state can do that.
“If you look at that, that’s 120,000 tests per month, which exceeds the 88,000, which would be the two percent that the White House in now recommending,” he said.
On Wednesday, a record 17,589 test results came back. With that, Beshear said the state is on track to test 3% of the population by the end of the month.
To increase access, Kentucky has expanded drive-thru testing sites across the state, Beshear said.
Kentucky was also dealing with a shortage of swabs necessary to conduct the test, but Beshear said the federal government has supplied the state with a “significant” number of swabs at the same time the state has had its own manufacturing breakthrough.
“The challenge that’s left in testing is to have it regularly done,” Beshear said.
What Does Our Current Testing Tell Us?
Testing as a percentage of the population is one way to understand whether the state is prepared to reopen, but there’s also a second way to slice it, according to Tom Tsai, assistant professor in Health Policy and Management at the Harvard Chan School of Public Health and the Harvard Global Health Institute.
Tsai said that ahead of reopening, states should look at how many people are testing positive for the virus relative to the total number of tests. If more than 10% of total cases are positive, that suggests not enough people are being tested, he said.
If you look at Kentucky’s total number of tests completed, the test positive rate is 7.6%. However, when you dive a little deeper into the numbers, it can look very different, as noted in the update above.
What’s important to understand is that these metrics are not an on and off switch for the economy, but indicate what success and failure looks like, Tsai said.
“And understanding that in the next weeks to months, based on the testing data, if the number of positive cases is actually increasing, then we may have to dial up social distancing, again, in order to make sure that well, we’re not going to be creating a resurgence of cases by lifting social distancing too early,” he said.
Beshear expects to see more positive cases as people go back to work, he said. It would make sense to assume that increasing the number of contacts people have will increase the number of positive cases.
However that’s not why Beshear said he expects more cases. He anticipates that more testing will result in more positives, but the overall positive rate will remain the same.
“We believe as an overall rate in testing that we can hold it steady,” he said.
But if we do see a spike in new cases of COVID-19, Beshear said he’s willing to put the reopening of the economy on hold.
“And if we believe that we see deaths that are related to work, we’ll be willing to pause and reevaluate as we go,” Beshear said.
Becca Schimmel of the Ohio Valley Resource contributed to this report.