In just a few minutes, David Gaston swabbed his nose, then placed his sample in a big white box outside Dorothy I. Height Library in the District.
“That wasn’t hard at all,” Gaston, an ambassador with the D.C. Covid-19 Community Corps, said last week under the blazing sun. “Easy.”
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The Test Yourself D.C. program, which provides free at-home coronavirus tests for anyone who needs them at 16 libraries around the city, is one of the approaches public health experts are using to try to encourage people to know their coronavirus status.
As people return to work and school amid a surge in the pandemic, tests are more available than ever at clinics, pop-up sites, doctor’s offices, urgent care and pharmacies, resulting in an overall increase in testing from last year, when tests were harder to access.
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But public health experts say governments must do more to make tests available and accessible. If people don’t know whether they are infected, they won’t isolate — and they will continue to spread the virus. With a positive diagnosis, they can say home and avoid infecting others.
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“Testing is important because it allows us to identify people who are likely to infect other people and to break those chains of infection,” said Neil J. Sehgal, an assistant professor of health policy and management at the University of Maryland School of Public Health. “We can’t expect to have our daily case count change if we don’t change our behavior.”
Overall, community transmission in the United States is high, and on Thursday the seven-day case rate per 100,000 people was about 281 with a positivity rate at nearly 10 percent, according to the Centers for Disease Control and Prevention.
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Compared with the hardest-hit states — such as Florida, Louisiana and Mississippi, where the seven-day average number of cases per 100,000 exceeds 600 — locally there are much fewer infections.
But cases have been steadily increasing for weeks, and in Virginia, Maryland and D.C., like much of the rest of the country, the level of community transmission is high. Only Maine and Vermont have substantial transmission.
The seven-day average of new cases per 100,000 was 184 in Virginia, 166 in D.C. and 108 in Maryland, CDC data show.
Virginia had the highest positivity rate locally with 9 percent, followed by Maryland at 5 percent and D.C. at 5 percent, data show.
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Leaders have long ago abandoned the 5 percent test positivity rate that the World Health Organization set early on in the pandemic as a reopening benchmark — meaning of all the testing that is being done, 5 percent is positive. But Sehgal said the figure is still useful in gauging whether enough testing is happening.
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In states with very high positivity rates — such as Alabama, Mississippi, Florida and Oklahoma, where at least 20 percent of all tests taken are positive — it’s clear people are only taking tests when they have symptoms, thus missing asymptomatic or pre-symptomatic people who can still transmit the virus, he said.
Vaccinated people infected with the delta variant can still transmit the virus even if they have no symptoms, a finding that helped drive the CDC to recommend indoor masking in communities with substantial and high transmission — which includes all of the greater Washington region.
Testing is up dramatically in the weeks since D.C. Mayor Muriel E. Bowser (D) reinstated the indoor mask mandate, said Patrick Ashley, senior deputy director of the Health Emergency Preparedness and Response Administration at D.C. Health.
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At the start of July, when cases were ebbing, the city was processing about 2,000 tests per week. At the start of August, when cases were on the rise, that number was up to 6,000 or 7,000 a week, he said.
Private testing — at doctor’s offices and hospitals — is also up, for a combined public and private total of about 4,000 tests per day, which is still lower than the peak in December when there were 6,600 tests in the District a day, Ashley said.
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In Virginia, about 22,000 tests were reported on Aug. 11, compared with about 9,000 tests one month earlier, according to state data. The high daily testing mark was more than 43,000 tests in mid-January, according to state data.
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Laurie Forlano, deputy director of the Office of Epidemiology at the Virginia Department of Health, said the numbers of tests are expected to grow as people return to in-person work and school.
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At least 45 school divisions and 20 private schools in Virginia have asked to be part of a pool testing system in which students and staff would be tested regularly, regardless of whether they have symptoms, as a way to identify potential outbreaks early.
The contrast was even more stark in Maryland, where testing went up from about 9,200 in mid-July to nearly 30,000 on Aug. 11. The high point was 66,300 in mid-December, state data show.
Despite the increase in testing, Gigi Gronvall, a senior scholar at the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health, said not all cases are being detected.
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“We are probably undercounting by a greater amount than at other parts of the pandemic, especially when people were more frequently using the mass testing sites,” she said.
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Gronvall said the undercount is driven by the absence of mass testing sites, the number of people who are vaccinated and the hiatus in testing at K-12 schools and universities because they were out for the summer.
“Public health resources are not infinite and have been allocated toward vaccination, which is appropriate,” she said of the reduced hours and closure of some vaccination sites.
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In Cecil County, Md., the health department closed its testing facility and encourages residents to make appointments to pick up free at-home tests — unlike in D.C., where residents can pick up tests at 16 neighborhood libraries any time they are open.
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Samples must be dropped off before 8 p.m. the same day the test was taken and results are sent by email in three to five days.
In addition to the Test Yourself D.C. program, which started in April, four fire station testing locations are open six days a week and there are rotating pop-ups throughout the city, including a Farragut Square location that will be in place for at least 30 days to accommodate workers downtown.
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Ashley said the city maintained a robust testing program, even when new infections had subsided.
“The public is more interested recently in getting tested,” Ashley said in an interview last week. “Our infrastructure has always been there and has always been ready. What you’re seeing is the numbers jump.”
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Jon Weinstein, director of the Maryland Covid-19 Recovery Program, said the state is continuing to remind residents that testing is a critical part of the state’s fight against the virus.
Public health experts advise people to get tested if they have symptoms and also if they have no symptoms but have traveled recently, regardless of vaccination status.
“It gives people pause when they think, ‘I’ve got this cough that I didn’t have a week ago,’？” he said, ‘“I need to get tested.’？”
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