COLUMBUS — While the world watched Jennifer Lopez and Shakira shake their bedazzled bodies at the Super Bowl halftime show, news was breaking that two college students in Ohio had tested negative for the novel coronavirus.
At the time, the respiratory disease, COVID-19, and the virus that causes it were barely a blip on most Ohioans' radars. We still had sports, million-dollar commercials and Latina superstars to distract us from what was to come just weeks later.
It didn't seem like a problem the tests had to be sent to the U.S. Centers for Disease Control and Prevention's headquarters in Atlanta or that they took five days to complete.
Guidance from the CDC, issued Jan. 17, restricted testing to those with a history of travel to Wuhan City, China, or those with close contact with someone who had the virus. So Ohio Department of Health Director Dr. Amy Acton – who was far from a household name – sought to calm fears on Miami University's Oxford campus.
"We know it’s likely a respiratory illness, and that normal precautions are all we need to be taking," Acton said on Jan. 28. "Only with that travel history (to China) or with a direct contact with someone under investigation are you truly at risk."
In the weeks that followed, efforts to ramp up COVID-19 testing in Ohio hit roadblock after roadblock. Test kits sent from the CDC didn't work. Ohio's labs faced a shortage of test swabs and chemicals. Private labs were overwhelmed and backlogged.
Those setbacks put Ohio, like the nation, at a disadvantage compared to countries such as South Korea and Singapore, which implemented early testing to isolate sick patients from the remaining population.
"You cannot fight a fire blindfolded, and we cannot stop this pandemic if we don’t know who is infected," said Dr. Tedros Adhanom Ghebreyesus, the director-general of the World Health Organization, in mid-March. "We have a simple message for all countries: Test, test, test. Test every suspected case."
A virus spreading with no tool to detect it
Ohio received its first test kits from the CDC on Feb. 7 – five days after the Miami University students tested negative. But two of the three chemicals, called reagents, didn't work.
Ohio wasn't alone.
Other states, including California, had problems with their CDC test kits. The CDC promised to fix the test, but it would take until March 5 for Ohio to receive a functioning one.
Meanwhile, scientists at universities and private labs begged the federal government to let them create their own tests. It wasn't until late February that restrictions were relaxed, allowing labs to develop their own tests.
Back in Ohio, Gov. Mike DeWine and Acton made the decision to ban spectators at the Arnold Sports Festival, a bodybuilding and athletic competition in Columbus, on March 3.
At the time, no one in Ohio had tested positive for COVID-19, but the state's leaders had a sense of what was to come.
By March 9, Ohio had three confirmed cases of COVID-19. Two days later, Ohio had an example of "community spread," a man who tested positive for the disease despite not traveling abroad or being in contact with a known COVID-19 patient.
The virus, it was now clear, had been here all along. We just didn't have the tools to see it.
The problem with private labs
As news spread about the coronavirus, the demand for tests skyrocketed. The need was part clinical and part emotional – people were afraid they might have the disease, said Dr. Steve Feagins, medical director at Hamilton County Public Health.
Even after Ohio obtain a functioning kit, options for testing were still limited.
Between March 5 and March 12, three private labs – Laboratory Corporation of America or LabCorp, Quest Diagnostics and ARUP Laboratories – rolled out testing.
Because the private labs launched tests before most public hospitals, they were quickly overwhelmed. Tests took as long as a week to return to patients and state health departments trying to track the spread of the virus.
Growing frustrated with that lag time, DeWine announced Wednesday that a new public health order would request tests be sent to hospital labs rather than private ones.
Cleveland's University Hospitals and the Cleveland Clinic became the first to offer in-house testing in mid-March.
Last week, UC Health opened its own testing line. Battelle and the Ohio State University Wexner Medical Center said they have developed a COVID-19 test that produces results in five hours.
Limits to preserve tests for most needy
Because tests were scarce, state and local officials put limits on who could get one.
"The massive need was going to overwhelm testing without criteria," Feagins said.
Initially, the CDC limited testing to those who traveled to Wuhan or had contact with someone who had. Later, the criteria expanded to Hubei province, then anyone with severe symptoms and no other explanation.
The Ohio Department of Health has prioritized those who are hospitalized and front-line health care workers with symptoms. Most otherwise healthy Ohioans won't be tested – at least not initially, Acton said.
Limited COVID-19 tests weren't the only problem. To screen out people who might have the seasonal flu or pneumonia, Ohio doctors were ordering other tests, including a little-used viral respiratory panel.
Feagins said that created a backlog of a test they rarely did.
Until recently, labs were required to use specific swabs, tubes and solution in the kits. The CDC eased that restriction in late March.
There are options on the horizon that could increase testing dramatically.
One is the point-of-care test, which can provide results in as little as five minutes.
Abbott Laboratories is boosting production of the ID NOW COVID-19, a machine that is about the size of a toaster. DeWine and Acton spoke with Abbott leaders Wednesday and hope to have the speedy tests soon.
Acton announced Saturday that a team of epidemiologists would start randomly sampling the state's population for COVID-19, starting with about 100 people.
At some point, Ohio will be able to conduct serological tests – blood tests that identify people who were infected with COVID-19 and have recovered. In one Colorado county, United Biomedical, Inc. is testing every resident using blood samples to detect antibodies.
"That is my dream that we will get that level of testing," Acton said.
Ohio's health officials are preparing for a day when widespread testing is available. More tests would mean more information that Ohio's leaders desperately need to deploy their limited resources from staff to ventilators.
Put simply, DeWine said: "We can use all the testing we can get."