Florida has recorded nearly 1.5 million COVID-19 infections since the first case of the omicron variant was identified in the state six weeks ago. Last week the state hit a record 61,500 infections a day.
But the true number of infections is likely much higher.
“Throughout the pandemic we’ve never really known the true rate of spread of the infection,” said Jason Salemi, an epidemiologist at the University of South Florida. “It was horrible at the beginning of the pandemic, because we had no tests, then it got better during the course of the pandemic, but omicron is just a different beast.”
Experts said testing resources can’t keep up with the scale of the contagious variant, aren’t being deployed properly and can’t be tracked. They fear the state’s new testing recommendations could make the problem worse by discouraging asymptomatic Floridians from getting tested.
Here are five things to know about COVID-19 testing in Florida.
1. Not all tests are counted
Florida has conducted nearly 5.3 million COVID-19 tests since the first omicron case in the state was confirmed Dec. 7, according to the Centers for Disease Control and Prevention. But that is likely an undercount, because federal test data doesn’t include all COVID-19 tests.
Federal health officials have approved two types of tests to track COVID-19: Rapid antigen tests are less precise but produce results within minutes. PCR tests are highly accurate tests that look for traces of the coronavirus’s genetic material, but it can take days for the results to come in.
Under current CDC guidelines, antigen tests don’t get counted in testing and positivity rates. But as demand for testing increases, facilities rely more and more on them, according to data collected by Johns Hopkins University.
Antigen tests accounted for 10 to 15 percent of all reported tests in Iowa and Missouri over the past three months, according to data collected by Johns Hopkins University. In Utah, antigen tests accounted for over 30 percent of tests and in Arizona it’s nearly 40 percent.
Antigen tests are not included in federal positivity estimates, according to CDC guidelines. Those estimates measure the rate of tests coming back positive, which indicates viral spread across the state or community.
Relying on PCR tests makes sense if officials only want to count the most sensitive tests, Salemi said, but it also means missing out on crucial data.
That’s because the characteristics of people using antigen tests may not be the same as those using PCR tests, Salemi said. Missing out on antigen test users could hinder efforts to identify COVID-19 hot-spots.
State health officials report both antigen and PCR tests to the CDC, according to Florida Department of Health spokesperson Jeremy Redfern. Both tests are used to determine cases and infection rates in the state’s weekly COVID-19 report, he said.
But the state won’t share antigen and PCR test data with the public. Officials stopped releasing COVID-19 data on June 4. They now release a print report once a week, but it doesn’t differentiate between types of tests.
The CDC does include antigen tests when it reports some case numbers, but the states’ data isn’t consistent. CDC spokesperson Jasmine Reed said Florida is among 22 states that only report “confirmed” cases — PCR test results — and do not send antigen test results to the federal government.
Florida health officials, however, said the state reports both types of test results.
2. No one tracks home tests
The state can track tests taken at hospitals, pharmacies and government-run testing sites.But during the omicron wave, an increasing number of Floridians have sought at-home COVID-19 tests. Those results are unavailable to public health officials.
There is no way to determine how many home test kits are sold in Florida. The state does not track sales, and CVS and Walgreens do not release numbers.
Floridians have turned to Google for answers, a sign of how popular home tests have become. Searches for home tests the week after Christmas were three times higher than at the peak of the delta wave in August, suggesting more households are turning to at-home antigen tests while crowds line up outside public testing sites.
Florida health officials have no idea how many home tests come back positive, Redfern said. Some test kits made by Abbott Laboratories allow users to upload results, which the company shares with Florida. But the company doesn’t tell the state which results come from home kits, Redfern said.
“So many more people are using at-home antigen tests,” Salemi said, “and unless the person develops symptoms and goes and seeks health care, (the positive tests) are probably not getting reported.”
3. Testing isn’t keeping up with infections
Based on PCR results, Florida has fallen behind many large states.
Nearly 1.5 percent of the state’s population tested positive for COVID-19 in the past week, according to CDC data. That’s the fifth-highest number of new cases per capita in the U.S. — higher than any other large state, including New York.
Meanwhile, testing in the Sunshine State hasn’t kept up. Florida administered approximately 5,735 tests per 100,000 residents between Jan. 6-12, according to the CDC. That means the third-largest state ranks 15th in testing out of 50 states and Washington, D.C. It’s slightly higher than the U.S. average, but behind many states with lower infection rates.
In the past week, Florida administered fewer tests per resident than New York or California, despite having a higher positivity rate.
Florida testing has picked up during the omicron wave. Daily PCR tests rose 150 percent since the first week of December.
But as COVID-19 cases boomed, Florida’s testing infrastructure was swamped. In the weeks after Christmas, wait times at Tampa Bay public testing facilities stretched for an hour or more so new sites were opened. Sites across the state saw similar lines and pharmacy testing appointments quickly filled up.
There’s no way of knowing how many were dissuaded from getting tested.
While omicron spread in December, nearly a million rapid tests expired in a state warehouse instead of being sent to local test sites. Agriculture Commissioner Nikki Fried, a Democrat running for governor, raised the issue in a Dec. 30 tweet criticizing the office of the Republican incumbent, Gov. Ron DeSantis.
Days after the tests reached their expiration date, the Food and Drug Administration in early January reauthorized the tests for use as late as March.
DeSantis defended his administration, saying that before December there was “almost zero demand in Florida for testing,” the Orlando Sentinel reported. Those tests are now available to local governments that request them, said Redfern.
4. Not enough tests go to those who need them
In the scramble for testing, Florida’s most vulnerable counties are often left with the least resources. In an ideal situation, Salemi said, tests should go to populations with the highest risk of infection, serious illness and death.
That means testing should be highest in the counties with the lowest vaccination rates and highest case counts. But the 17 counties with the highest vaccination rates had over 2.5 times the number of tests as the 17 counties with the lowest vaccination rates in the past week.
Some counties with the highest infection rates — concentrated in Florida’s Panhandle — are getting the fewest tests per capita.
Florida testing is also leaving behind Black residents. The state’s weekly report shows 41 percent of Black Floridians had been vaccinated — the lowest rate of any demographic group. (Race is missing for about 12 percent of vaccinations, so the real number could be higher.) Black residents also had the highest infection rate among those whose race is known.
Access to testing in the Black community has slipped, said Pastor Marcus R. McCoy Jr. of Greater Refuge Memorial Church in Orlando. Recently, he and a group of pastors representing 15 counties sent a letter to the governor asking him to address what they say is the state’s unequal COVID-19 response.
“Another surge is here and COVID hospitalizations are climbing to record levels,” the letter said. “We don’t see state-testing sites in our neighborhoods, yet we see one million tests being wasted.”
5. Florida’s testing strategy could make things worse
Florida health officials on Jan. 6 released their own testing recommendations that contradict CDC guidelines.
The CDC tells people they should get tested in all kinds of cases: If they’re symptomatic, if they’ve been exposed to a confirmed infection, if they’re traveling or going to school.
Florida, though, recommends that individuals with COVID-19 symptoms who are at increased risk of severe illness “should” get tested. Those who are symptomatic but not at increased risk should “consider” it.
The state says “testing is unlikely to have any clinical benefits” for those who have been exposed but are not symptomatic.”People who are unlikely to benefit ... to sort of be in line waiting to get tested, that doesn’t make a lot of sense to me,” Florida Surgeon General Joseph Ladapo said at a Jan. 4 news conference, the Orlando Sentinel reported. “It doesn’t make a lot of sense to me as a physician. It doesn’t make a lot of sense to me as a clinical researcher.”
“Because we are in a resource-constrained environment,” Salemi said, “our current testing strategy flies in the face of a public health response and the ways in which we should be able to utilize these tests.”
Testing to confirm COVID-19 doesn’t inform treatment decisions, he said, especially for those at high risk of severe illness. Someone who is exposed but doesn’t develop symptoms and doesn’t get tested still risks spreading the virus. And those who heed the state’s advice and choose not to get tested make it harder to track the virus.
For Salemi, the solution is more testing and better data: “If we had enough tests, if we had enough planning ahead of time, we could be proactive with testing.”
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