Flagler County’s emergency management division got delivery of 500 coronavirus test kits Monday evening, and hopes to have a testing site running on the campus of Daytona State College by early next week. There’s a utopian chance that testing would be available later this week, says Emergency Management Chief Jonathan Lord. The tests will double the current capacity of testing.
The tests will help provide a much clearer picture about the extent of the coronavirus pandemic in Flagler, where, to date, the Department of Health has conducted or documented only 469 completed tests, including 68 at AdventHealth Palm Coast hospital, with 35 of the total confirmed as positive as of 5 p.m. Tuesday. Sixteen of Flagler’s cases have been confirmed in the first seven days of April, including the latest confirmation, affecting a 76-year-old man who had traveled to Germany and Spain. Spain is one of Europe’s hot spots for the virus.
As of 5 Tuesday evening, Florida had 14,747 cases, almost 1,900 hospitalizations related to Covid-19 (though not concurrent hospitalizations: the number is cumulative) and 296 deaths, one of them of a Flagler County resident. The University of Washington’s Institute for Health Metrics and Evaluation, whose model state and local officials are following as a standard (on par with the Global Forecast System and the European Centre for Medium-Range Weather Forecasts during hurricane emergencies), today had Florida’s peak for Covid-29 deaths still on April 21, with a steep rise yet expected despite an apparent flattening of the curve in the last few days. Lord said that as with hurricane forecasts, a single day or even a weekend’s worth of data is not a trend, and that the data must be analyzed in tandem with modeling.
The Washington State University model does not project a bed shortage in Florida hospitals overall, but it does forecast an ICU shortage of 769 beds at the peak of the epidemic. An AdventHealth Palm Coast official said that though the local hospital is licensed for just over a dozen ICU beds, several wings of the hospital have been transformed into potential ICU-ready beds, quadrupling capacity either for local needs or for needs from other communities, should that become necessary. The Florida Agency for Health Care Administration today had AdventHealth Palm Coast’s total bed capacity at 37 percent.
The low number of tests in Flagler and in Florida generally has caused what is believed to be a significant undercount of the population infected by the virus.
The tests are in hand at EOC, but the state, which provided the tests, has not yet given Flagler permission to use them. The county is also developing protocols regarding what criteria will be used regarding testing eligibility. This is not a free for all: priority will still be given to health care workers, paramedics, cops, other first responders and people over 65, all of whom are at higher risk of exposure to Covid-19. And within those groups, Lord said, priority will be given to people exhibiting coronavirus symptoms.
It is now acknowledged that a quarter or more people infected do not show symptoms. But the county must still use its tests judiciously, since the shortage continues, and previous promises by federal and state officials that rapid tests would be made available by the tens of thousands are not materializing.
Smaller counties like Flagler have not generally managed to get extra tests. “It was persistence, honestly, persistence,” Lord said Tuesday evening, mostly through phone calls and efforts to “prove to the state that we can manage it and that we can do it ourselves.”
Other counties such as Volusia, St. Johns and Brevard have set up testing locations with private providers, but residents must pay for the tests. That won’t be the case in Flagler, where the county will pick up the cost, which runs between $25 and $75 a test: the exact figure will not be nailed down until an actual laboratory is contracted with on Wednesday. Lord is estimating the cost at $50 per test, so the cost to the county will be around $25,000–an expense county officials are not likely to get any blow-back about. Emergency management and the county administration have authority, under the county’s disaster declaration, to approve the contract without county commission approval.
The tests themselves are nothing remarkable. They amount to a small tube and a swab. “It’s a powerful little tube though,” Lord said. The swabs are for throat cultures, not nose cultures. The swabs will be conducted under the authority of Dr. Stephen Bickel, the medical director at the Flagler County Health Department, though he will not necessarily be present during each test, which will be conducted by paramedics, AdventHealth Palm Coast personnel, and Department of Health personnel. Test-takers will be dressed in full protective gear.
It will not be a drive-up testing site for anyone who wishes to be tested. Rather, those qualifying for a test will have been pre-screened by phone–by appointment–and will be more extensively screened at the testing location on the college campus. But they will be tested in their car. In effect, it’s a drive-in testing site for the pre-qualified. The cultures will be sealed in the so-called “transport container” (which looks like a test tube), and stored in a cooler, for the testing-lab company to pick up at the end of the shift. Lord said that the contract with the lab company calls for test results to be provided within 48 hours. The individuals being tested will be contacted by phone to learn of their results. County officials involved in the testing will not know the results–not individually, though the cumulative number, of course will be released through the health department’s dashboard.
If the same proportional trends hold as those recorded so far, it is likely that the number of positive cases for Flagler will double once the 500 tests have been administered.
The EOC’s tests are in addition to the tests being administered at the department of health and at private doctors’ offices. Lord said that once the EOC is through with its batch of 500, it hopes to get another batch. The ultimate goal for local public health and emergency management officials is to have as much testing capacity as possible, potentially making testing on demand possible, thus changing the county’s approach from diagnostic testing (of only those showing symptoms) to surveillance testing (facilitating the more detailed analysis of where clusters and hot spots are). But officials cannot yet forecast that day, since test-kit shortages continue.
Lord said he intends to “pace-out” the tests over a few days.
Looking at the broader numbers of ongoing infections, he said “this is not a short-term event, it’s got weeks upon weeks to go,” with caution required even when the curve of infections begins to decline. In the absence of a vaccine, residents will still have to stay vigilent with precautions after the peak. “We’re going to come back to a new normal,” Lord said.
Liberty and Lafayette are now the only two out of 67 Florida counties without confirmed cases, though it is almost certain that both counties have numerous unconfirmed cases.