Kansas' COVID-19 testing capacity finally seeing a boost

While eyes may be focused now on the COVID-19 vaccine, testing still remains vital in Kansas' battle of containing the disease.

COVID-19 testing is still an eyesore for the state ― it ranked seventh on the week of Dec. 28 for the least amount of tests per 100,000 people per John Hopkins University's coronavirus database ― but since the state finally got out its testing money mid-November, things are trending in the right direction.

"You want to be able to stop chains of transmission. COVID is very often asymptomatic. So, testing is really important to be able to have people learn if they have COVID, so that they can go into isolation, and so they don't infect other people," said Gigi Gronvall, a senior scholar at John Hopkins, on why testing is paramount to stopping COVID-19.

A look at the numbers

In recent weeks, Gov. Laura Kelly has been touting the fact that Kansas was fifth best in the nation for increasing weekly COVID-19 testing rates. 

Data from John Hopkins roughly backs her up. Kansas did rank fifth on Christmas week in the percentage decrease of positive tests. As of New Year's week, the state ranked second. The bigger the decrease in the percentage of positives, the more likely that means a state is conducting more asymptomatic instead of only symptomatic testing, said Gronvall.

The number of tests Kansas is doing has also seen a noticeable uptick. According to the Kansas Department of Health and Environment, the state was stuck at a rate of testing around 4,000 per 100,000 people since July, but in November, it jumped to more than 6,000.

That increase can be attributed to coronavirus relief funding allocated for testing finally getting into the hands of groups and companies as part of the state's unified testing strategy, said Marci Nielsen, special advisor to the governor. 

Overall, as of the week of Dec. 30, Kansas had done 170,000 tests resulting from the unified testing strategy and 962,000 tests total since the pandemic began, said Kelly. But there's still work to be done.

"Kansas still ranks low because we have more ground to catch up with states that have had a rigorous testing program in place," Nielsen said in a written answer.

And the big improvement in testing rates could likely be due to the fact the state ranks pretty low in testing capacity in the first place, hinted Gronvall.

"I guess it's more noticeable. That's for sure," she said. "But I'm not going to undercut an effort ... if more states want to brag about how much testing they're doing, and increase the amount of testing ... then I think that's a net good."

To climb the ranks in the number of tests done, the governor's office has made a concerted effort in encouraging people to get tested. A huge focus in the state's PSA strategy promoting mask wearing is highlighting where one can get free COVID-19 tests.

When the "Stop the Spread Kansas" campaign first launched in early December, only around seven sites were listed. But in less than a month, that number has exploded to at least 42, with more still being added each week.

Challenges to expanding testing

Setting up all these testing sites in such a short timeframe is "a very complex endeavor," however, said Doug Rogers, who heads TourHealth. The company includes NIC, which Kansas has given testing money to.

The group was asked by the state to focus on northwest Kansas, where TourHealth has three mobile units (which go from location to location to test people) and two general testing sites. It recently expanded into the Kansas City area with three more testing sites. 

Setting a testing site up has many moving parts. They first engage with the county health department or other local resource to analyze the site and understand traffic flows and the environment. Infrastructure must be taken into account, ranging from large-scale industrial tenting to multi-segmented spaces with heating and cooling units. There's a technology component to guide and engage folks in how to get testing at a certain site. And then there's the typical, everyday matters, such as restrooms or food.

More importantly, having the appropriate amount of staffing at all times is key and can be challenging.

"I'm sure you can appreciate that in the environment we are in today, clinical staff can be quite scarce, because they are in high demand, and rightly so," said Rogers.

Wichita State University's Molecular Diagnostics Laboratory has found a way around that staff shortage. The lab, which serves 33 counties in south-central Kansas, has also received money from KDHE for testing, and very recently, transportation of specimens. 

The problem with the state's low testing volume wasn't with the ability to process results, but on the collection end, said Tonya Witherspoon, the lab's executive director. 

"We rely on collection sites to do the collections and bring the specimens to our lab. But there's just not enough collection happening now, like our hospitals and doctors' offices and county health departments are already doing all the collecting that they can do," she said.

To solve that, WSU has signed up more than 500 organizations to be collection sites and trained over 2,000 users to do collection. These sites are your typical, everyday organizations, such as businesses, schools and nonprofit groups. 

The training to do collection is for a specific type of method ― using saliva  ― which doesn't require a health care worker, unlike nasal and throat swabs. The collection process is actually self-administered, with the trainee only needing to observe the process and making sure enough was spit out.

Wichita State's lab, which has grown from scratch to processing 2,500 tests a day, still is wary of other obstacles that could crop up.

"The supply chain bottleneck is real. Everybody needs the same supplies across the globe," Witherspoon said. "Getting saliva tubes has been very, very hard. There have been a couple of times where we've had to call dozens of suppliers all over the place, and use our industry connections to get the right kinds of supplies."

The lab has had to increase its warehouse capabilities and has staff fully dedicated to easing any potential supply chain issues. 

Rogers added that expanding testing in different regions requires different approaches and obstacles to overcome. In rural parts, his company coordinates with health departments to reach out to people and cycle services throughout the population, but in urban areas, it's more about setting up a high-volume, easy-access testing site and making people aware it exists.     

Latino communities of northwestern Kansas require more nuance, too.

"Deliberately, we provide a wide range of threads and paper resources ... in languages that are appropriate for that respective population," he said. "We also take very deliberate steps to make our environment as welcoming as possible. We, in direct collaboration with the state, are very deliberate about what information we do or don't ask for, and then how we present that information back."

In the near future

Kansas' goal, said Nielsen, is to double the number of tests by the end of the year. That would be approximately 1.2 million tests, a goal the state is "optimistic we will reach."

But at what point can one say Kansas is doing enough tests? There's no consensus-based magic number, said Gronvall. According to one analysis model by Brown and Harvard university researchers, Kansas would need to do 56,708 tests a day ― a far cry from where the state is now.

"I mean, this may not be possible, because there are not enough tests to be able to do this. But, that's part of the problem," said Gronvall, adding that the bottom line is more testing still needs to be done. 

Much of the unified testing strategy is being funded through federal coronavirus relief funds, which were originally set to expire at the end of 2020. But a recently passed extension by Congress of one more year will be a huge help.

"It will probably be most useful to us in terms of our testing. We put a whole lot of money into the testing program, and we were going to have a really hard time — in fact, it was going to be impossible — to spend it on testing in that length of time," said the governor.

 Wichita State's lab was also relieved by the extension, as it would mean funding could comfortably continue, said Witherspoon. 

Additional testing dollars were also included in the stimulus bill passed by Congress, which will further help the unified testing strategy.

For now, the expansion in testing has meant individuals and organizations can have more control on how they can run their lives with knowledge of who has COVID-19 and who doesn't, said testing organizations.

"If you're urban or rural, you're trying to keep a business open, you're trying to keep the school open, you're trying to keep your church open. Before, they felt like they were powerless to COVID," said Witherspoon. "Just having the testing kits in their possession, and being trained, and having the ability to do testing makes them feel empowered, makes their employees feel like they've got a tool."