KEARNEY — Aravind Menon smiles easily, even when asked if this area is seeing its second spike of COVID-19 cases. Case numbers dipped in late June but are spiraling upward again.
Gently, as if to cushion his response, he shakes his head. “The first spike never ended,” he said.
Menon is an epidemiologist at the Two Rivers Public Health Department. A physician from India who holds a doctorate in public health and his focus now is research. He figures out daily trends and details of the COVID-19 pandemic. He charts seven-day averages.
“It’s a novel virus, and testing can still be flawed,” he said.
Menon, who lives in Lexington, is not surprised that Nebraska’s meatpacking plants have been the centers of COVID-19 infection. He said Nebraska has more meatpacking plants than any other state. Its 26 such facilities employ more than 26,000 people.
He wasn’t surprised that the Tyson Plant in Lexington was a center of infection.
Nor was he surprised that Hall County, where the JBS Beef Plant is located in Grand Island, has had among the highest number of cases in the state. It’s currently ranked fifth, with 1,688 cases as of Wednesday. The sixth-highest county, Dawson County, had 917 cases as of Wednesday, according to the Nebraska Department of Health and Human Services.
“I could have predicted this. There are multiple factors involved in outbreaks,” he said.
First, there’s a remarkable amount of mobility between these places, he said. He said a bus leaves Lexington in the early morning and transports people to and from tiny meatpacking towns all the way to Minneapolis 12 hours later.
“People ride that bus from plant to plant, from here to the JBS plant in Grand Island. This is a remarkably mobile community,” he said. He said some people work an early shift in Lexington, then ride the bus to Grand Island to work the late shift at a plant there.
Many Hispanic and Latino families live in multigenerational homes, so they can’t self-quarantine if they get the virus. A graph on the Two Rivers website shows that 75 percent of those (607 individuals) who tested positive in Dawson County were from a Latin or Hispanic background, compared with 200 whites.
By contrast, Lexington’s Somali residents live in nuclear families, he said. But there are many people in Lexington from foreign backgrounds. He said Lexington High School has students from 19 nations.
As COVID-19 cases soared in April, more than 1,000 people were tested. At one point, Dawson County showed a “staggering” rate of 50 percent positive cases, Menon said.
“That outbreak was overwhelmingly Hispanic people between the ages of 18 and 49. We know the outbreak was mostly related to the meatpacking plants,” he said.
“It was a double-whammy. Workers there work close together. They had less protection, fewer gowns and effective masks,” he said. Some were undocumented immigrants who were afraid to be tested for fear of deportation, he added.
Initially, private clinics did COVID-19 testing, but “each clinic was different,” he said.
“Tests are incredibly expensive. Each test takes one hour. Personnel have to change into personal protective equipment, do one test, sanitize the room, and then change into new personal protective equipment for the next test. They have to follow other guidelines They do the next test and change again. This can be quite a financial loss for a private organization,” he said.
Menon believes the TestNebraska program, which was launched as a private-public partnership by Gov. Pete Ricketts in late April, is a step in the right direction. It has done 100,000 tests statewide so far, or about 30 percent of statewide testing, but he cautioned that it is not perfect.
TestNebraska did testing in a city building parking lot in Lexington with the assistance of the Nebraska Army National Guard. “The effort was a success. People wanted to be tested,” he said.
Testing: the fine points
TestNebraska also did a lot of bulk testing in long-term care facilities. Many people tested negative, according to DHHS, but Menon says those numbers can be misleading. Bulk testing was done as a precaution in many nursing homes where, so far, COVID-19 has not intruded.
“Over the last few weeks, we’ve been testing people who are less likely to be positive,” he said, “If your long-term care facility locked the doors in March and someone tests you in July, that facility probably doesn’t have a single case. That means public health is working the way it should,” he said.
According to the DHHS website, 238,876 tests out of 264,313 people tested as of Wednesday have been negative. On average, 6% of people tested are positive. Just 5% of those are hospitalized.
Statewide, however, positivity rates are increasing “because younger people are getting sick — people in their 20s and people between 18 and 49,” he said.
“I worry about the absence of universal testing. More kids are back in day care, people are becoming more mobile. Many people over 65 are staying at home, but younger people are not, and they’re more susceptible,” he said.
‘Priority’ testing only
The TestNebraska system requires people to sign up online to get tested, but it authorizes testing only for certain people.
The TestNebraska website indicates, “We can’t test everyone, but we will prioritize testing for those who have visited places with a wide outbreak, those who have interacted with people who tested positive, and those who have symptoms.”
Menon said: “TestNebraska is a good website, but test accessibility is not as high as it was in May. As an epidemiologist, it frustrates me. We need to test more. Other countries are testing much more than we are.”
Testing is now being done in smaller communities like Cozad and Gothenburg, and in what he called the “lower five” counties in the Two Rivers district (Franklin, Gosper, Harlan, Kearney and Phelps.) While Dawson County at one time had nearly a 60 percent weekly positive rate, Buffalo’s weekly positivite rate never exceeded nine percent, he said.
“But when you look at Two Rivers, one in 10 people tested are positive. That’s still pretty high. We see it as ‘lower’ because our base standard is 25 percent, based on initial numbers during the outbreak in Dawson County, but it means the outbreak is coming back to more manageable situation,” he said.
“Dawson County has cumulative positive rate of 20 percent, while Buffalo County has an accumulated positive rate of 4.5 percent. It was up to 15 percent in March, but it’s coming back down after an initial spike,” he said.
However, he said different test sites have different outcomes. More tests conducted by CHI Health Good Samaritan came back positive than tests done by TestNebraska. “I don’t know why, unless Good Sam were testing people more likely to be sick,” he said.
“TestNebraska tested a large number of people in long-term care facilities in June to see if the virus is being passed among the must vulnerable part of the population, but many of these people returned lower positivity rates, lowering the overall rate of positive cases,” he said.
“All tests are not the same. We see different rates of positive depending on who’s doing the test. Clearly, there is a reason, but we don’t know why,” he said.