COVID-19 testing: NY’s coronavirus infection rate is the lowest yet. How it got here and what's next

David Robinson
New York State Team

In early April, as COVID-19 ravaged New York, close to 50% of those tested in the state for the respiratory disease turned out positive on many days.

Now, the percentage positive is down to a mere 1% to 2% of New Yorkers tested, and deaths have fallen to the lowest level since the pandemic took hold in March.

Gov. Andrew Cuomo has touted the striking drops in positive tests as proof New York’s move to shut down businesses, as well as require social distancing and mask wearing, helped slow the spread of coronavirus, which causes COVID-19.

“It means the plan is working. It means that we bent the curve, and on those numbers we can advance the reopening,” he said Sunday during a press briefing.

Going forward, Cuomo also encouraged New Yorkers to check daily COVID-19 testing totals and percentage positive by county and region with a new online dashboard launched this week.

Catherine Hopkins, Director of Community Outreach and School Health at St. Joseph's Hospital, right, performs a test on a patient in a COVID-19 triage tent, Monday, April 20, 2020, at St. Joseph's Hospital in Yonkers, N.Y. (AP Photo/John Minchillo)

But the statistics, in some ways, offer an incomplete picture of the evolving COVID-19 threat as New York proceeds with its phased reopening of businesses, restaurants and gathering places, according to USA TODAY Network analysis of state data and interviews of health experts.

The reasons include drastic changes in the number of tests being conducted today compared to two months ago, as well as who is getting tested.

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How COVID-19 testing evolved in New York

Workers in protective clothing wait for cars to arrive at Glen Island Park in New Rochelle, as New York State's first drive through COVID-19 mobile testing center opens, March 13, 2020.

In the pandemic’s early days, New York and other states restricted testing to suspected positives due in part to limited testing kit access. It stemmed from flaws in initial Centers for Disease Control and Prevention, or CDC, testing kits supplied to states.

At the time, New York was shipping out a couple dozen coronavirus testing samples each day to the CDC and waiting up to a week for results.

Then, New York gained federal approval on Feb. 29 for its own state-designed coronavirus tests. A few weeks later, it was conducting about 7,000 tests per day, shortly after the first drive-thru testing site opened on March 13 in the city of New Rochelle, one of the first COVID-19 clusters in the nation.

By contrast, New York is now testing about 50,000 people per day at 800 sites statewide, the highest in the U.S.

Testing locations span from drive-throughs and medical offices to Walmart, CVS and Walgreens, gathering a diverse sampling of symptomatic and asymptomatic New Yorkers that contributes to the lower percentage of positives.

The push to ramp up the blanket population testing, however, is only one aspect of the high-stakes push to prevent another deadly wave of COVID-19, which has already killed more than 24,000 New Yorkers, by far the most in the nation.

“I would be a little bit skeptical on absolute numbers and what those testing numbers mean,” said Dr. Luis Ostrosky, professor of medicine and epidemiology at UT Health in Houston.

“There is not much science to say, ‘You need so many tests per day to be safer,’” he added.

Instead, Ostrosky and other health experts suggested targeted testing based on communities hit hardest by COVID-19 is going to be key in coming weeks and months.

Dr. Robert Redfield, director of the Centers for Disease Control and Prevention, said last week that better testing involves more than increasing the number of tests.

"I don’t want to get into the number of tests because I don’t think that’s the real issue," Redfield told a Congressional committee Thursday. "It’s how testing is used and what’s the consequence."

Experts are concerned many states across the country are lacking a focused COVID-19 testing strategy as infections are rising again amid the reopening.

In New York, however, authorities have recently recognized the importance in identifying communities vulnerable to COVID-19, mainly in poor communities of color in New York City with densely packed housing.

Some efforts include deploying testing resources based on infection rates by ZIP codes, which would help drive contact-tracing to isolate infected people and quarantine anyone exposed to them.

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Cuomo addressed the issue on Tuesday, citing the state’s ongoing push for more testing in communities with disproportionately higher COVID-19 infection and death tolls.

“The virus does not attack equally. It hit lower-income areas, more minority areas harder and in New York City that is most demonstrative,” Cuomo said Tuesday.

“We are attacking these hot spots and we start with testing, with increasing testing,” he added, announcing a state partnership with actor Sean Penn and the nonprofit Community Organized Relief Effort, or CORE, to establish 11 testing sites in hard-hit communities in New York.

A COVID-19 outdoor testing area is set up at Rite Aid in Valley Cottage April 17, 2020.

Despite challenges across the country, the testing effort is far improved from the initial botched rollout, a governmental failure that contributed to widespread confusion and missteps that made the pandemic worse, experts said.

“It really was dysfunctional at the beginning,” said Ostrosky, who is also a spokesman for the Infectious Diseases Society of America.

“Sometimes it took up to seven days to get a test back. And meanwhile you’re having to take real-time decisions about treating and isolating a patient, and while they’re isolated you’re burning through personal protective equipment,” he added.

By contrast, testing results today are returned almost immediately in some cases due to rapid-testing kits, or at most 48 hours later, Ostrosky said, adding the fast turnaround time is crucial to public health strategies.

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The cost of COVID-19 testing in NY

A New York State Trooper answers questions about COVID-19 testing outside the coronavirus site entrance in New Rochelle, NY March 13, 2020.

As COVID-19 testing is poised to remain necessary over the coming months, concerns about the financial burden on government and business is mounting.

“Eventually people are going to realize all the millions of dollars we’re spending on testing,” Ostrosky said, adding targeted testing could soon become even more crucial to stretch testing dollars.

New York state officials, however, have released limited details about government spending associated with testing.

So far, the state Department of Health appears to have contracts worth about $169 million for COVID-19-related lab work and testing, state records show. That includes $165 million for two contracts with BioReference Laboratories, a New Jersey-based company.  

But it is difficult to determine many details about pandemic spending, in general, because Cuomo issued executive orders declaring it an emergency, which waived many legal requirements related to state Comptroller’s Office oversight and pre-approval of state contracts.

New York Gov. Andrew Cuomo submits to a nasal swab for a COVID-19 test during his daily coronavirus briefing on May 17, 2020.

Cuomo has said New York state government has spent $1.9 billion directly related to the COVID-19 response.

State auditors are currently reviewing pandemic spending and contracts, including with some vendors that reportedly failed to deliver products, which would prompt actions to recover funding, according to the state Comptroller’s Office.

New York City government has also spent $1.2 billion on hospital, health care and laboratory supplies since March 11, according to the COVID-19 spending tracker on the city’s independent budget office website.

Cuomo and Mayor Bill de Blasio have both urged federal lawmakers to provide more pandemic-related funding to state and local governments in hard-hit states.

"If we don't get that, we're going to be in a horrible, horrible situation where we're going to be having to cut back city government across the board, and that's not going to help anyone," de Blasio said June 3.

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What’s next for COVID-19 testing in New York

A new COVID-19 and antibodies walk-in testing site at the Martin Luther King Multipurpose Center June 2, 2020 in Spring Valley. Testing runs from 9 a.m. to 5 p.m. until June 12 regardless of insurance or immigration status.

Amid the ever-changing pandemic response, testing demands in New York have significantly ratcheted up in recent weeks.

One reason is Cuomo on May 10 ordered nursing homes to test employees twice a week after thousands of elderly residents at the facilities died due to COVID-19 complications.

Nursing home operators have estimated it cost more than $40 million a week to test all 205,000 employees. Some described it as an unsustainable financial burden that endangers the industry, calling for more clarity on how much cost should be borne by government and health plans.

On Wednesday, Cuomo ordered nursing home employee testing to be reduced to once a week in regions that have entered Phase 2 of the reopening.

“No state has been more aggressive than New York when it comes to testing at nursing homes, and our efforts have saved lives,” Health Commissioner Dr. Howard Zucker said in a statement related to the order.

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The state Health Department also completed its weekslong push to test all of New York’s nearly 90,000 nursing home residents over the past weekend, he added.

“Infection rates are decreasing across New York State, but now is not the time to let our guard down,” he said. “The continued weekly testing mandate will continue to protect our nursing home residents and the frontline workers who support them.”

Meanwhile, growing COVID-19 testing demand also stems from many hospitals statewide re-starting elective procedures, which were shut down to free up bed capacity during the pandemic peak.

The effort requires widespread COVID-19 testing of patients and staff to limit exposure risks.

And as businesses reopen across the state, many employers are requiring varying degrees of COVID-19 testing in the workplace, suggesting demands will continue to rise as the reopening expands.

Thousands of the tests are being processed by BioReference Laboratories, and Dr. Jon Cohen, executive chairman of the New Jersey-based company, struggled to contrast the scope of testing to prior outbreaks.

“I was involved in the H1N1 swine flu and Zika, and they all pale by comparison. None of them was like this,” he said.

To meet the COVID-19 demand, BioReference has invested more than $40 million in its testing infrastructure and staffing to keep the operation churning around the clock. It added several hundred workers, bringing its workforce to about 4,000, Cohen said.

The company is performing about 35,000 COVID-19 tests per day in New York, New Jersey, Maryland and Florida, with a majority in New York.

But Cohen couldn’t say how many more tests will be needed in the future, citing the many unknowns that span from concerns about testing supply shortages to governmental budget crunches.

Yet Cohen and many health experts agree testing is expected to remain a crucial tool as scientists race for treatments and a vaccine in coming months.

“There is going to be a fair amount of testing going on until there is vaccine,” Cohen said.

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Ken Alltucker of USA TODAY contributed to this report

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David Robinson is the state health care reporter for the USA TODAY Network New York. He can be reached and followed on Twitter:@DrobinsonLoHud