'Grave concerns': COVID-19's surge in Sunbelt states shows the virus, not testing, to blame

Ken Alltucker and Karen Weintraub, USA TODAY

President Donald Trump blames the rising number of COVID-19 cases on increased testing and suggests case counts would drop with fewer tests. But infectious disease and public health experts dispute that claim, saying the surge in coronavirus cases in Sunbelt states reflects a potentially dangerous new phase of the pandemic.

Arizona, California, Texas, Florida, Oklahoma and South Carolina reported record-high new daily coronavirus cases during this week, as case counts continue to rise in more than half of U.S. states.

Texas Governor Greg Abbott said the state is facing a massive outbreak with another 5,000 cases reported Wednesday. California Gov. Gavin Newsom reported Wednesday 7,149 tested positive, a record number for the nation's largest state. Both states this week surpassed the entire European Union on the average number of daily cases. 

New York, New Jersey and Connecticut will make travelers from nine states with high infection rates to quarantine for 14 days. It's a reversal from the early pandemic weeks when Florida, Texas, South Carolina imposed a similar quarantine on travelers from New York and the two neighboring states.

This week, both Connecticut and Arizona conducted 1.7 tests per 1,000 people, according to Johns Hopkins University's testing tracker. Yet, while Connecticut had 1.3% positive, Arizona had 22.1% positive for COVID-19. 

Arizona hospitals on Tuesday reported the highest-ever number of beds and ventilators used for confirmed or suspected COVID-19 patients. 

The World Health Organization recommends sufficient testing so that 5% or fewer individuals who take tests have the virus, but these states exceed that. When the positive test rate is higher, it could mean states are testing only the sickest individuals and missing those who show no symptoms but can still spread the virus. 

With cases surging in states with such high positive test rates, "that is not because of an increase in testing," but an indicator cases are spreading, said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security.

States that effectively test and trace contacts of infected individuals have a much better chance of controlling COVID-19, even with an increase in cases, Adalja said.

Many people are no longer staying home and avoiding large group gatherings. Some are congregating at bars, churches and political rallies without masks or social distancing. In those communities, COVID-19 has thrived.

Handlebar in Houston temporarily lost its liquor license for failing to comply with capacity limits in June 2020.

Stephen Kissler, postdoctoral fellow at the Harvard T.H. Chan School of Public Health, said testing is critically important to slowing the virus that causes COVID-19.

"It's because of testing that we're able to see these increases in cases in various places and probably able to catch them sooner than we would otherwise," Kissler said.

He said testing allows public health workers to track the contacts of infected and detect where there are large outbreaks.

"That allows us to escape from some of the negative economic consequences," Kissler  said. "I think that's one of most frustrating things about some of the suggestions that testing should be reduced that it is precisely testing that will free us from the most economically crippling solution ... by testing more we have a better sense of where the virus is, so our response can be a lot more targeted. That allows us to avoid having to do these mass societal shutdowns that are so detrimental to the economy."

Dr. Sonia Angell, Director of the California Department of Public Health and State Public Health Officer, said cases revealed from increased testing "only serves as evidence that COVID-19 is in our communities."

She said the increases in cases and hospitalizations are evidence people should stay home or wear masks and keep physical distance from others when outside "because that’s what helps us protect one another. Our ability to move forward as a state depends upon it.”

Fears in Phoenix

In Arizona, cases counts have increased by 1,000 or more every day for the past two weeks and 88% of hospital ICU beds were filled with patients on Tuesday. 

"We might be the hottest hot spot in the world," said Will Humble, executive director of the Arizona Public Health Association and former director of the state's Department of Health Services. "A very large chunk of why we are where we are is precisely because of policy choices that were made in mid-May." 

Humble said the high positive test rate "means you are missing so many because tests kits are in such short supply," and access to testing is uneven.

Alberta Cook (right) receives a COVID-19 test at Native Health in Phoenix, Ariz. on May 16, 2020.

Hospitals that operate their own labs or those who have access to commercial testing labs are able to test. Some primary-care doctors and community health centers that provide care for lower-income or rural communities can't get enough test kits.

A testing blitz last Saturday in a predominately Hispanic neighborhood in Phoenix attracted such large numbers that people waited up to 13 hours to get tested

Rural communities at risk

Dr. William Schaffner, a Vanderbilt University School of Medicine professor of preventive medicine and an infectious disease doctor, said the recent surge in warm-weather states has rekindled fears the disease trajectory, flattened by aggressive social distancing in March and April, is beginning to rise again.

But unlike the initial deadly wave, concentrated in large cities such as New York and Chicago, recent cases are moving from metro regions to smaller cities and rural communities. 

"There were many of us who were cautiously hopeful that COVID-19 would not be transmitted as readily during the warm, humid summer months, akin to influenza," Schaffner said. "It doesn’t seem to be impeded at all. It’s steaming ahead and we have literally grave concerns about a second wave, which could be very impactful."

He said the virus has reached smaller communities where social distancing and mask-wearing is less socially acceptable,  "it could be substantially greater than anything we have seen so far."

More on COVID-19:

Contributing: Mike Stucka 

This article originally appeared on USA TODAY: COVID-19 testing can't be blamed for coronavirus surge in Sunbelt