Fewer than 1% of the people living in the Roanoke Valley have been tested for COVID-19, making it difficult to know how much disease exists in the community as businesses begin to reopen.

What Dr. Molly O’Dell does know is that cases reported to the Roanoke and Alleghany Health Districts continue to rise.

“We have gone from an average of 20 cases a week to 30 some cases a week,” O’Dell, who is leading the districts’ pandemic response, said during a media briefing Tuesday.

Gov. Ralph Northam on Friday allowed Virginia to enter Phase 1 of reopening in which some nonessential businesses could welcome back customers. To enter the first phase, Northam had called for a downward trend in cases for 14 days.

That has not happened locally. Northern Virginia, Richmond and Accomack County have delayed reopening for that reason.

O’Dell said no local government leaders asked her about trends. She said it’s difficult to know how much of the disease is here as there have been too few tests, and local residents with mild cases aren’t being tested and could be spreading the virus.

The Roanoke Health District has had the fewest tests of any district in the state, according to numbers posted on the Virginia Department of Health’s dashboard.

In April, the state agency said more than 2,000 people had been tested in the city. Testing numbers by health districts were removed during one of the website updates. The information reappeared on Friday, along with other details about localities, in order to help local government leaders determine if their areas were ready to enter the first phase.

The website on Tuesday reported Roanoke had 665 testing swabs for live virus and 785 for all types of tests, which include blood draws to check for antibodies.

Em Stephens, who works with the state’s surveillance data, explained the discrepancy in a phone interview Tuesday.

“Our procedure has changed,” she said.

The department assigns tests by patients’ ZIP codes. Initially, if a lab report lacked that information, the result was logged for the ZIP code of the physician who ordered the test.

“Unfortunately, in areas like Roanoke where we know people from surrounding counties go to get tested, we know the ordering providers weren’t necessarily in the same ZIP codes as the patients themselves,” she said. “So we made a change to make our testing data more accurate to use patient ZIP codes alone.”

This has left 25,864 of the 224,991 tests with no home address. Stephens did not know how many were ordered by Roanoke providers.

She said the department is considering again assigning lab results without patients’ addresses to the providers’ locations.

“We know that somebody from Alleghany (Health District) might get tested in Roanoke, but they won’t get tested in Richmond. There’s a potential for that to happen, but it’s not a likely scenario,” she said.

The Roanoke Health District includes about 100,000 people. About three-quarters of 1% have been tested either for the virus or to see if they have had it and developed antibodies.

O’Dell said 162 city residents have tested positive for the virus.

“We don’t know the prevalence of it in a community until we do much more than 1% of the population, and we haven’t even met 1%,” she said. “The issue is a large percent of people with COVID will not have symptoms. A hidden disease is being transmitted, and we have no idea of the prevalence.”

The virus has killed 12 Roanoke residents, and nine in the Alleghany Health District, with three in Botetourt County and two each in Salem, Roanoke County and Alleghany County. The rate of death, at 6.3%, mirrors the state’s and nation’s, she said.

O’Dell said the health districts have used hundreds of hours from volunteers with the Medical Reserve Corps, but that there just aren’t enough resources to run large testing events.

“Our first priority has been disease investigation and contact tracing because we know that is containment No. 1,” she said.

She said they are attempting to put together a team to be proactive in testing rather than just react to outbreaks.

“If I had two teams of testers — one that could go just to congregant living and one that could go just into neighborhoods, of five people each — that would be pretty awesome,” she said.

To date, there have been 328 confirmed cases of COVID-19 in the Roanoke and Alleghany districts. O’Dell said the ages range from 8 months to 99 years.

She said more children are showing symptoms, but none so far have required hospitalization. The Fairfax Health District on Tuesday confirmed it had the state’s first case of multisystem inflammatory syndrome in children, and that the child was hospitalized May 5 but has since been discharged and is recovering at home.

More women than men, 192 to 136, have had the virus locally. O’Dell said many of the women were health care workers tied to outbreaks in health care and long-term care.

Also, cases among Hispanics are disproportionate to their percent of population, she said. However, she cautioned the number is small and the census information on which the ratio is based is nearly a decade old.

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