18 October 2020 Blog Post: Why Testing Matters

In mid-July, Orange County’s COVID-19 outlook was bleak. Case rates were peaking and more than 700 people were hospitalized at a time because of coronavirus. The Sheriff declared “non-enforcement” of mask ordinances, the School Board voted 4-1 to return to school without restrictions and declared masks “harmful” for good measure. The County’s Health Officer had quit after receiving death threats.
But now, their situation is completely different. Newly appointed County health officer Dr. Clayton Chau said the situation is getting better because “residents are overwhelmingly complying with public health orders — like mandatory masks and limiting the number of people indoors at certain businesses.” The County has teamed up to promote testing among disproportionately affected ethnic groups. One non-profit even provides housing for those affected by COVID-19 who are otherwise unable to care for themselves.
Orange County has been in the Red Tier on the state’s four-tiered virus monitoring system since Sept. 8, which limits indoor business activity. It is close to moving into the Orange Tier which means that bars can open for outside operations and bowling alleys could resume operations.
In Los Angeles County, a totally different picture has emerged. Los Angeles has seen rising daily COVID-19 case numbers and an uptick in the transmission rate, indicating a likely increase in future cases barring “major behavioral changes and stricter adherence to health guidelines such as wearing face coverings.”
According to the Los Angeles Daily News “in order to move out of the most restrictive tier of the state’s four-tier coronavirus economic-reopening roadmap, the county needs to get its daily average new case numbers down to about 700. In the past week, however, the number has regularly topped 1,200.”
From my perspective, the difference is simple – Orange County has continued to show a commitment to testing and Los Angeles has not. In Figure 1 below, the different in per capita testing rates is clear. Orange County rates (blue line) dipped some from their mid-July peaks but then have maintained a rate typically exceeding 200 daily tests per 100,000 population.
Testing functions not only to identify new case clusters but also serves as a proxy measure of public health efforts. Core public health functions include (adapted from CDC):
1. Assess and monitor population health status
2. Investigate, diagnose, and address health problems and hazards affecting the population
3. Communicate effectively to inform and educate people about health, factors that influence it, and how to improve it
4. Strengthen, support, and mobilize communities and partnerships to improve health
Without a return to these core functions, Los Angeles County will continue to find itself mired in the highest risk tier, with no end in sight. More worrisome, persistent moderate level community spread of COVID-19 will make the county more susceptible to a subsequent surge in cases.
We can learn from our neighbor. While Orange County has redoubled its surveillance efforts – it has gone one further by specifically including communities that have been disproportionately affected by COVID-19. Los Angeles has done nothing approaching these outreach efforts which are a key element of any public health response.

𝗦𝗶𝗴𝗻 𝗨𝗽 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗡𝗲𝘄𝘀𝗹𝗲𝘁𝘁𝗲𝗿

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